How might we stop a pandemic in the future?

[Tvtyrant]

Smallpox is different in that we're the only reservoir and once someone has had it, they're largely immune. Coupled with a very intensive, expensive, global and aggressive vaccination campaign, it still took 30 years to eradicate it (dating from the first hemisphere wide vaccination campaign in 1950, to it being declared eradicated in the wild in 1980).

Compare this to a corona virus, which can undergo both antigenic drift and antigenic shift, plus jump species. While it's less lethal than smallpox and less infectious, this ability to shift its surface antigens and have multiple reservoirs makes corona viruses in general very hard to contain.

For comparison, COVID-19 has a mortality rate of ~4% (based the figure above) and using data from January and February, had an R0 of 2.35 initially, which has dropped to 1.05 after the lockdowns (link). Coupled with its ~2 week incubation period, people can get far and wide while still being infectious.

In comparison, smallpox had an overall mortality rate of ~30% (it varied between the different strains with the 'ordinary type-confluent' strain being 50-75% fatal, the 'ordinary-type semi-confluent' being 25-50% and the 'haemorrhagic' type being 90-100%) and an R0 of 3.5 - 6, making it on paper the more dangerous virus, however its 2-4 day incubation period with the lesions being visible after 12-14 days makes it far easier to spot and contain.

True. I suppose my point was that we have beaten pandemics in the past, including the two worst fairly recently (India had a plague outbreak in 1897 and Smallpox was a more or less permanent pandemic.) It's not the science that is lacking, its the time factor. How many people that die before we get it under control.

[Xyril]

I'm sorry. I know you're hearing the opposite from a bunch of people you have better reason to belive than me. Actually, I'm not saying I'm right and they are wrong. I'm saying there's more than one way to handle an epidemic, and I disagree that this is the right way. Based on ... personal opinion. I'm not a doctor, and I'd be the first to advise anyone to never take medical advise from anyone except doctors.

However.

Respectfully, you keep following the pattern of "you guys would be stupid to listen to medical advice from non-experts, and I'm no expert, and I'm not saying that I'm right and the experts are wrong, but here's why I'm right and the experts are wrong."

And the last time you were active here, you were insinuating that the World Health organization was exaggerating the threat from this virus in order to keep themselves relevant.

I have two non-rhetorical questions for you:

1) How many people have died since you the last time you graced us with your insights, and in light of that number, are you still so confident in your assertion that the WHO was needlessly overreacting like you think they apparently did with ebola, SARS version 1.0, swine flu, etc?

2) Given how the situation is developing in countries that took the overreacting experts advice (i.e., South Korea, Taiwan) versus the countries that took something much closer to your "it's just the flu, failing to continue with business as usual would be more harmful than the disease" approach (i.e., Iran), do you still feel that your advice is the best approach moving forward?

Also, follow up question: Do you think that a country that keeps its economy going at 100% (well, as close to 100% as possible given that a few percent of their population will die in a brief period, while a larger percentage will likely be unable to work for at least a few weeks) is going to have that much of an advantage economically versus a country that attempted mitigation?

[NotASpiderSwarm]

That said, the biggest hurdle for getting a new vaccine out isn't technological, it's regulatory. There's at least 2 vaccines that have been developed specifically for corona virus - both at in Phase I clinical trials. Even with the FDA and various other regulatory bodies fast tracking the process and every test and clinical trial going well, it's still 12-18 months before there's enough data to show that the vaccine is safe and effective before it can be officially launched (they also need time to scale up the manufacturing and production, but that typically runs concurrently during the Phase III clinical trial).

The issue there isn't really regulatory. They have to inject people with the vaccine and then wait long enough to be relatively sure the vaccine doesn't have any horrible side-effects. If the vaccine kicks off an auto-immune disease with a 50% mortality rate 12 months from now, they want to know that before injecting it into a couple billion people. Yes, that's enforced by regulations, but this isn't a case of a law passed in the 1890's still being enforced because lol bureaucrats, there's legit reasons to wait that long before deployment.

Xyril has touched on why the PRC government might release inaccurate information - I'm just going to lay out the evidence for it:

Dr Li Wenliang and other doctors first reported the virus back on 30 Dec 2019, but were reprimanded by local police and later by the PSB (China's federal police force) for 'severely disturbing the social order': link.

The PRC government then tried to suppress the news as it wasn't another 'SARS-like epidemic' (link), even initially passing on information to the WHO that it wasn't of concern (can't find a link for this one now) until they realize they couldn't contain it any more at the end of January.

I'm not saying China was accurate. I'm saying that there's plenty of other countries which would also ignore, downplay, or misrepresent info in similar ways. Indeed, China is far from the only country to have done so during this epidemic.

[Saintheart]

I don't know what to tell you.

No quarentine is ever 100% effective. But it doesn't need to be. It needs to be mostly ok. A decent level of protection.

The vast majority of everyone doesn't need quarentine. For almost everyone, covid-19 is a mild infection. And for a few, it's really, really bad. This isn't that different from any other flu, btw. The real difference is in how it spreads. And the real danger is in the bottleneck. In the fact that a lot of people get sick at the same time, and need intensive care.

What we really need to prevent a situation like in Italy is a slower spread, so capacity will suffice. That's all. Some will die - they always do. Every year, millions of people die from the flu. It's like the third most common cause of death in the western world.

And then - because the virus isn't going anywhere - we will need flock immunity. Which we only achieve by vaccine, or infection. Vaccine is infection anyways. Kinda.

This is the sort of quasi-Objectivist thinking that has had a large hand in killing over fourteen thousand people so far, as well as hospitalising a good ten times that number worldwide. It's thinking done largely out of ignorance. We have no strong data as yet as to how complete the "recovery" is from the virus, whether reinfection with the virus is possible, what permanent damage is done for those who have a severe case but luckily don't die, or the ongoing medical costs of all of those measures.

There is also no data about any unseen effects the virus might be having on children: it is said the virus is not affecting children, or not affecting them as badly. I say absence of evidence is not evidence of absence. I would start a longtitudinal study of kids diagnosed with COVID-19 right now. It wouldn't surprise me in the slightest if those same kids wind up with a statistically significant rate of respiratory disorders such as asthma in about 20 years' time, if not sooner. Because the human immune response, as folks treating COVID-19 are finding out when people drop dead in front of them, is a funny thing.

The right way to deal with a very communicable virus about which you know very little is to overreact, or at least be cautious, at the start. That's called the precautionary principle. That's what Singapore, South Korea, and Taiwan did, and the reason they did was because they'd been smashed by SARS and therefore knew from experience how to protect their populations. That's also what certain statisticians and immunologists in the West were saying way back in December last year, but they weren't listened to. As it is we know comparatively little about this virus beyond the fact it seems to be transmitted like the flu, but kills like pneumonia and has a higher complication rate than the flu. There is case after case available in the MSM or elsewhere in which young, healthy people are infected with the virus or their systems suddenly collapse without explanation. The hilarity of the "staged" or "measured" response is about to be demonstrated in the United States, Britain, and Australia, if not in the entire EU.

[factotum]

The hilarity of the "staged" or "measured" response is about to be demonstrated in the United States, Britain, and Australia, if not in the entire EU.

Just to note, there are several EU countries in a worse position than the UK is right now, Italy being the most obvious example but France, Spain and Germany also have far more confirmed cases than we do (although not many deaths in Germany so far, so they're doing something right).

[Liquor Box]

I tend to think that most countries have acted appropriately in response to the virus.

I don't agree that overreaction is best. There's a cost to everything, and there's a huge cost to isolation (mostly in terms of people not working).

Saintheart, you pull out a couple of isolated examples. But both Italy and China have had relatively strong responses to Coronavirus (eg Italy acted faster and imposed more restrictions than most Euro countries), and the two have been amongst the worst hit.

That's not to say that testing and social isolation don't help - I'm sure they do. But it is not simply a case of do little and virus gets worse, overreact and it gets eradicated - it's more complicated than that. And whatever action is taken against the virus must be weighed up against countervailing factors.

[georgie_leech]

I tend to think that most countries have acted appropriately in response to the virus.

I don't agree that overreaction is best. There's a cost to everything, and there's a huge cost to isolation (mostly in terms of people not working).

Saintheart, you pull out a couple of isolated examples. But both Italy and China have had relatively strong responses to Coronavirus (eg Italy acted faster and imposed more restrictions than most Euro countries), and the two have been amongst the worst hit.

That's not to say that testing and social isolation don't help - I'm sure they do. But it is not simply a case of do little and virus gets worse, overreact and it gets eradicated - it's more complicated than that. And whatever action is taken against the virus must be weighed up against countervailing factors.

Sure. Just keep in mind there are costs to the economy when people get sick, regardless if any particular case is one that threatens to be fatal. A pandemic like this is going to have a rather negative effect on the economy regardless. Given that, do you want the economic costs of being sick, or the economic costs of doing something about it?

[Liquor Box]

Sure. Just keep in mind there are costs to the economy when people get sick, regardless if any particular case is one that threatens to be fatal. A pandemic like this is going to have a rather negative effect on the economy regardless. Given that, do you want the economic costs of being sick, or the economic costs of doing something about it?

To answer your question - it depends which economic cost is greater.

To add some perspective to that though - only about 1/1000 of Italy's (the worst effected country) workforce has been found to be infected by covid-19. So this week the economic cost of the sick people being off work is only 1/1000th of the cost of everyone being off work for isolation purposes.

Of course it's not as simple as that, and the counter-argument is that if left unchecked the effects of the virus will grow. But it is not clear how bad it will get if left unchecked, or how effective containment will be. It's not clear how long containment will be required for (probably longer than the symptomatic period of the disease).

I think there is good reason to think the sickness would cause less economic damage than isolation (if everyone is isolated then 100% of people would have to get covid-19 to have the same impact of work - assuming similar downtime for each).

However, the lessor economic impact has to be balanced against non-economic factors. I tend to think more people will die from covid-19 being left unchecked than from the economic fallout from isolation.

Overall, I don't think it is a no-brainer what should be done, and I think most countries have acted appropriately.

[Brother Oni]

The issue there isn't really regulatory. They have to inject people with the vaccine and then wait long enough to be relatively sure the vaccine doesn't have any horrible side-effects. If the vaccine kicks off an auto-immune disease with a 50% mortality rate 12 months from now, they want to know that before injecting it into a couple billion people. Yes, that's enforced by regulations, but this isn't a case of a law passed in the 1890's still being enforced because lol bureaucrats, there's legit reasons to wait that long before deployment.

I disagree, it's mostly regulatory for this class of drug product. Unlike other drug products where you have to show an improvement compared to the current gold standard treatment, there is no current gold standard, so any measured improvement in antibody production is better.
While I concede that I don't know whether the current diagnostic tests measure for the virus or measure for the antibody, they only require a few days after infection for detection - the Phase I clinical trial for the vaccine targeting the spike protein is something like 11 doses over 2 months in a small number of healthy male volunteers (at work at the moment, so can't check the exact numbers), and they're not even assessing vaccine effectiveness yet (that's in Phase II), only toxicology.

With regard to toxicity, an auto-immune response can happen within hours (e.g. Theralizumab), but I concede that any other chronic toxicity effects will take months to identify and assess.

In any case, there's still another 2 phases to go before the product is remotely ready for general release (Phase II is limited number of patients, Phase III is larger number of patients); Phase III trials can take months to run (I think the last one we did was ~8 months over 200-odd patients, with 2-4 months recruiting beforehand).

I'm not saying that the delay is unnecessary; various disasters like the 1937 Elixir of Sulphanilamide, 1957 Thalidomide, 2008 Heparin adulteration, etc, have all shown that gathering vast amounts of information is necessary to prove that your product is safe, effective and fit for purpose, but it's worth remembering that this data is all mandated by the regulatory authorities and barring dispensations for compassionate use (I believe some Italian doctors have received permission to use some of these vaccines on their worst affected patients), they're the main reason why it takes so long to develop a new drug product.

I'm not saying China was accurate. I'm saying that there's plenty of other countries which would also ignore, downplay, or misrepresent info in similar ways. Indeed, China is far from the only country to have done so during this epidemic.

True, point taken.

[sihnfahl]

barring dispensations for compassionate use (I believe some Italian doctors have received permission to use some of these vaccines on their worst affected patients), they're the main reason why it takes so long to develop a new drug product.

Due to a lot of talk on various medications helping with COVID-19, I believe there has been a rush on requesting those meds for compassionate use.

Problem goes back to the fact that they're still -in trial- for use with COVID-19. So I anticipate compassionate use being denied because they're trying to ensure availability not only for the usual consumers of said drugs, but also for the directed trials and evaluations in controlled medical settings...

[NichG]

To add some perspective to that though - only about 1/1000 of Italy's (the worst effected country) workforce has been found to be infected by covid-19. So this week the economic cost of the sick people being off work is only 1/1000th of the cost of everyone being off work for isolation purposes.

...

I think there is good reason to think the sickness would cause less economic damage than isolation (if everyone is isolated then 100% of people would have to get covid-19 to have the same impact of work - assuming similar downtime for each).

I've basically been working full time from isolation for the last 3 weeks. Only jobs that absolutely require direct physical interaction with other humans would be shut down 100%.

If everyone who can work from home did, those that can work at a distanceffrom others did, etc that would improve the situation significantly at zero direct loss of any essential activity.

[Ibrinar]

About the future in 50 years, most jobs that require manual work will likely have been automated or can at least be done by remote control of robots. And tele-presence will be quite a bit more advanced too. So I think in 50 years we can do something like this without stopping any work except for work that is stopped because it is about many customers in one place.

Aside from that we might have much better ways to monitor health, decent chance it just gets stopped cold by finding the first few cases. Sure we will be better at treatment too but stopping the spread at the start is likely still the least resource intensive option.

[Xyril]

About the future in 50 years, most jobs that require manual work will likely have been automated or can at least be done by remote control of robots. And tele-presence will be quite a bit more advanced too. So I think in 50 years we can do something like this without stopping any work except for work that is stopped because it is about many customers in one place.

We're already at that point, in theory. Manufacturing is already highly automated and jobs directly related to tangible production--manufacturing, extraction, agriculture, transportation, research--comprise a very small fraction of the economy as it stands. Right now, pretty much every developed country and a lot of undeveloped ones could keep enough people at home to drastically slow the spread of the virus without sacrificing production of "stuff."

The problem is that in practice, the economy is all interconnected, and keeping those mines and factories and farms running requires faith that people will buy what they're producing, and ultimately their demand is driven by a consumer-base largely employed in fields that involve face-to-face interactions. Much of this is due to cultural influences, not technological limitations. Yes, there are jobs that can't be done remotely--i.e., most surgeries still, complex inspections--that could be in the future if the technology advances enough. However, much of the stuff we do face-to-face is because humans see value in that sort of interaction or don't want to adapt to remote work.

We are fortunate enough to live in a time and place where most of our necessities--at a societal, but not necessarily individual, level--aren't an issue. This means that a lot of our economy is based on selling experiences: Spending a day at a theme park, eating out with a group of friends, seeing a movie or a concert. Taking away these jobs suddenly will hurt the economy, as would suddenly losing any arbitrary chunk of the economy that big. It gets even worse once you factor in the many jobs that could be done remotely, but remains largely face-to-face due to cultural inertia and the inability to adapt.

The legal system has done better than a lot of industries in adopting remote and electronic systems to increase efficiencies, but there is still a strong bias towards in-person for many aspects. Customers who pay thousands of dollars for representation want to meet their attorney in person, or at least talk to him live on the phone. Plaintiffs and defendants want the judge and the jury to see them and their witnesses directly, not through a video screen--if you look at the criticism of certain court systems, one point often raised is "the judge isn't even there, he's off site watching through a camera," as if everyone would naturally agree that using telepresence means (literally) phoning it in and not giving the case serious consideration.

[Vinyadan]

And yes. There may be a price to pay for that. Traffic kills more people every day than covid-19 does. So does malaria. So does hunger.

Reminder that road accidents in Italy killed 3,300 during the whole of 2018, while COVID-19 has killed over 6,000 in a few weeks.

[Fyraltari]

I am not an epidemiologist but it is my understanding that pandemics are caused by pathogens jumping species in a place that has regular contact with the outside world/lots of people in it

So unless we eradicate every other animal species and/or go back to hunting-gathering in tribes of a hundred-odd people, we can’t actually avoid pandemics. Just limit the casualties.

[Brother Oni]

Due to a lot of talk on various medications helping with COVID-19, I believe there has been a rush on requesting those meds for compassionate use.

Problem goes back to the fact that they're still -in trial- for use with COVID-19. So I anticipate compassionate use being denied because they're trying to ensure availability not only for the usual consumers of said drugs, but also for the directed trials and evaluations in controlled medical settings...

Getting a bit technical here, there's a difference between compassionate use and off-label use.

A dispensation for compassionate use is where an otherwise unauthorised drug is granted permission to be used in a very limited number of patients. The best example is where a drug product has failed in its Phase II or Phase III trial but has shown an improvement in the condition for a limited sub section of the patient test group. Rather than destroy all remaining unused supplies, the drug company can instead can transferred all remaining supplies to those patients, who can use them until the stock runs out.

This can be a very long time - for one clinical trial re-supply I was involved in, we made ~20,000 devices, with a device lasting a month under recommended dosing. Assuming a 50% usage rate in the trial, that's enough devices to last 100 patients over 8 years each.


Off label use is when a drug product has been licensed and is sold for treating one disease, but has unexpectedly been found to have some effect in treating a completely different disease - this is the case with chloroquine and hydroxychloroquine, both intended to treat malaria, but has shown some promise in treating COVID-19. Off label use is much harder to stop, as a doctor could simply say they're prescribing it for malaria. To prescribe either drug for COVID-19 requires another phase III trial, as stated by the FDA director recently.


Incidentally the repurposed ebola vaccine, Remdesivir, falls under neither category. It's not intended to treat COVID-19, nor did it ever complete the approval process to be sold, so any use of it for COVID-19 comes with a stack of waivers as thick as my arm.

[Tyndmyr]

For something like Covid-19, a simple mudkicker approach would have been far, far superior: Isolate the vulnerable, infect the rest. In other words, put the elderly, the diabetics, the immuno-depressed, the astmathics and so on - all into quarentine. Let everyone else get sick. Get flock immunity. Save everyone.

For a disease that's actually dangerous - say malaria, or ebola - that wouldn't be wise.

This is a risky approach. Not every disease targets the traditional vulnerable. Some target the healthy. If you misidentify this way one time, welp, there goes humanity.

Plus, even if that isn't the case, it is logistically difficult or impossible to get most of society sick at one go. How do you do that, care for the sick, and still maintain services to those in quarantine? Plus, with that much infection around, it's that many more chances for an accidental quarantine breach.

And of course, there is probably still a non-zero mortality rate. Yeah, it may be quite low, but if you are going for a mass infection approach, the absolute number of bodies attributable to this method would be large.

The approach may be simple, but it is not at all superior.

Even if you're right - and you're not - there's no way we can wait in isolation until we have a vaccine. So those supposed millions are going to die (or, really, they're not) either way.

What we're doing now is that we're shutting down society - all of society - to protect a very, very few vulnerable people. That may seem ... benign. But we're spending trillions to save a very, very small number of people, and that money is coming from everyone else who's in need for any other conceivable reason.

Well, it's...more than a few vulnerable people. The proportion of society that is elderly alone is not small. Once you add in the wide swathe of other conditions that puts one at risk, you may be well at a majority of the population. If not, at least very close.

At a certain point, it's easier to put in safety measures for everyone than for almost everyone. Consistency helps.

Yeah, I have a lot of concerns about the cost, and specific actions may or may not make sense, but generalized anti-infection measures are pretty logical in general. Even if everyone is going to get it, having them get it more slowly so the medical system can cope helps.

It would have been far, far cheaper to address it correctly from the start, but that opportunity is past, and there's not much to be done about that now. Yeah, panic buying a mountain of toilet paper won't help, but taking measures like staying at home whenever possible, sure. That makes sense. I'd be willing to discuss specific measures, and talk about what might be most effective, but "it's just the flu" is probably not the way to go.

[Asmotherion]

I suppose that when we'll have a fully decoded dna, we'll be able to develop softwere that can analise a viruse and suggest counter measures in a matter of a few seconds. Then we'll be able to bio-engenire a measure that immunises humans in 8 hours, and spread it faster than the pandemic itself. I'd say it's realistic to expect this by around 2050.

[Tyndmyr]

I suppose that when we'll have a fully decoded dna, we'll be able to develop softwere that can analise a viruse and suggest counter measures in a matter of a few seconds. Then we'll be able to bio-engenire a measure that immunises humans in 8 hours, and spread it faster than the pandemic itself. I'd say it's realistic to expect this by around 2050.

DNA sequencing is already a thing. Countermeasures and bioengineering are not at all simple, even if you have the entire genome. I don't think that's the roadblock.

[Strigon]

I am not an epidemiologist but it is my understanding that pandemics are caused by pathogens jumping species in a place that has regular contact with the outside world/lots of people in it

So unless we eradicate every other animal species and/or go back to hunting-gathering in tribes of a hundred-odd people, we can’t actually avoid pandemics. Just limit the casualties.

You're confusing pandemics with disease outbreaks - a pandemic only happen once the disease spreads around the world. There are plenty of ways to stop a disease, once identified, from spreading. It's just a matter of timing.

This is a risky approach. Not every disease targets the traditional vulnerable. Some target the healthy. If you misidentify this way one time, welp, there goes humanity.

That's a bit extreme. Diseases, by and large, aren't all that deadly. A really nasty illness might have a 30-40% mortality rate. Very few diseases go higher than that, and as far as I know, none of them are pandemic material - nor are any pandemics likely to approach that threshold. Humanity could survive a 40% reduction in numbers, as a species. Not only would you need to have the disease be unbelievably deadly and ridiculously infectious, but you'd also have to somehow confuse it with an almost harmless disease in order for humanity as a whole to be threatened.

I mean, it's still risky because of the threats to daily life and civilization, but the line between a civilization-changing event and "welp, there goes humanity" is very thick, indeed.

[NotASpiderSwarm]

We're already at that point, in theory. Manufacturing is already highly automated and jobs directly related to tangible production--manufacturing, extraction, agriculture, transportation, research--comprise a very small fraction of the economy as it stands. Right now, pretty much every developed country and a lot of undeveloped ones could keep enough people at home to drastically slow the spread of the virus without sacrificing production of "stuff."

The problem is that in practice, the economy is all interconnected, and keeping those mines and factories and farms running requires faith that people will buy what they're producing, and ultimately their demand is driven by a consumer-base largely employed in fields that involve face-to-face interactions. Much of this is due to cultural influences, not technological limitations. Yes, there are jobs that can't be done remotely--i.e., most surgeries still, complex inspections--that could be in the future if the technology advances enough. However, much of the stuff we do face-to-face is because humans see value in that sort of interaction or don't want to adapt to remote work.

We are fortunate enough to live in a time and place where most of our necessities--at a societal, but not necessarily individual, level--aren't an issue. This means that a lot of our economy is based on selling experiences: Spending a day at a theme park, eating out with a group of friends, seeing a movie or a concert. Taking away these jobs suddenly will hurt the economy, as would suddenly losing any arbitrary chunk of the economy that big. It gets even worse once you factor in the many jobs that could be done remotely, but remains largely face-to-face due to cultural inertia and the inability to adapt.

The legal system has done better than a lot of industries in adopting remote and electronic systems to increase efficiencies, but there is still a strong bias towards in-person for many aspects. Customers who pay thousands of dollars for representation want to meet their attorney in person, or at least talk to him live on the phone. Plaintiffs and defendants want the judge and the jury to see them and their witnesses directly, not through a video screen--if you look at the criticism of certain court systems, one point often raised is "the judge isn't even there, he's off site watching through a camera," as if everyone would naturally agree that using telepresence means (literally) phoning it in and not giving the case serious consideration.

There's also the fact that "theoretically possible" and "actually feasible" are two different things. Dispatchers from my company can and have made the schedule with their cell phones, a netbook running off a hotspot from a different cell phone, and paper records. But they were all in the same room at the time. Doing it from 4 different homes via a shared Google Docs spreadsheet is a lot more likely to see something go wrong. There's a lot of things that technically SHOULD work, and probably would with 6 months to get used to the transition and figure out new procedures, but that's 6 months from now, which doesn't help.

[Liquor Box]

I've basically been working full time from isolation for the last 3 weeks. Only jobs that absolutely require direct physical interaction with other humans would be shut down 100%.

If everyone who can work from home did, those that can work at a distanceffrom others did, etc that would improve the situation significantly at zero direct loss of any essential activity.

You are right that some people would be able to work from home. I think you significantly overestimate how many would be able to though. Even in the most developed country only some jobs are mostly at a computer - and in several of those cases the business is not setup to allow remote working.

Also, we are not talking about "essential activities" here. We are talking about economic damage from isolating the population.

[NichG]

You are right that some people would be able to work from home. I think you significantly overestimate how many would be able to though. Even in the most developed country only some jobs are mostly at a computer - and in several of those cases the business is not setup to allow remote working.

Also, we are not talking about "essential activities" here. We are talking about economic damage from isolating the population.

The difference between essential damage and inessential damage is whether that damage can be ameliorated by the way in which the lockdown is performed and associated measures and policies taken.

If restaurant waiters can't work, for example, then paying them not to work solves that issue - those losses can be spread out to avoid long-term damage from short term closures. If farmers can't work, then we starve regardless of monetary measures taken.

[Xyril]

There's also the fact that "theoretically possible" and "actually feasible" are two different things. Dispatchers from my company can and have made the schedule with their cell phones, a netbook running off a hotspot from a different cell phone, and paper records. But they were all in the same room at the time. Doing it from 4 different homes via a shared Google Docs spreadsheet is a lot more likely to see something go wrong. There's a lot of things that technically SHOULD work, and probably would with 6 months to get used to the transition and figure out new procedures, but that's 6 months from now, which doesn't help.

Well that's my whole point, isn't it? It is actually feasible given a few weeks to adapt, and not something that we need decades of technological development to pull off. Just to use your example, the only thing stopping your team of four from working from home isn't some technology of the future, it's just the fact that they haven't had a reason to adjust to working remotely (and apparently haven't heard of Skype or Zoom.)

Right now, a few specific industries and business models rely heavily on remote work because they see particularly clear benefits from doing so. For everyone else, it's a bunch of minor pros and cons that are largely situational. And not everyone will agree on what the priorities are. I personally like working around people--I see that as a drawback of remote work. Others feel the opposite way, I'm sure. Given all that, I'm not surprised that inertia wins out.

Maybe the risk of contagion changes that calculus now--maybe "everyone isn't all together in case of a new disease outbreak or terrorist attack" becomes the consideration that makes remote work the default for jobs that don't absolutely need to be done in person. Personally, I hope not. What I think is more likely is that businesses just become more prepared to transition: The default is working together in person, but they implement just enough training and tools so that if something happens, the sky isn't falling down and people aren't taking six months to adapt. Instead, it would be closer to our reaction to an earthquake or a hurricane: There's brief disruption as everyone adapts to the quarantine, and then enough people return to some semblance of normal that the economy as a whole bounces back.

[Liquor Box]

The difference between essential damage and inessential damage is whether that damage can be ameliorated by the way in which the lockdown is performed and associated measures and policies taken.

If restaurant waiters can't work, for example, then paying them not to work solves that issue - those losses can be spread out to avoid long-term damage from short term closures. If farmers can't work, then we starve regardless of monetary measures taken.

"Essential damage" is not a thing. You were talking about 'essential activities', which in this context usually means activities necessary to support societies function at the desired level (maintenance of food supply, medical etc).

You were arguing against my contention that mass isolation would cause massive economic loss. Your suggestion that we could remedy this by "paying people not to work". Who is going to pay the majority of the workforce to not work? Whoever it is (the employer or the government), there would be massive economic consequences.

[NichG]

"Essential damage" is not a thing. You were talking about 'essential activities', which in this context usually means activities necessary to support societies function at the desired level (maintenance of food supply, medical etc).

You were arguing against my contention that mass isolation would cause massive economic loss. Your suggestion that we could remedy this by "paying people not to work". Who is going to pay the majority of the workforce to not work? Whoever it is (the employer or the government), there would be massive economic consequences.

There are various ways to make this argument, but lets do the simple math one.

A hospital stay for a (non-fatal) Covid-19 case is about two weeks long, costs about $10k, and is needed in about 20% of cases. So if someone generates less than $2200 a month of economic surplus compared to them not working, the overall cost to the economy is the same at the level of that single person for a 1-month lockdown in which they absolutely cannot work at all versus just the 'just let everyone get sick' plan: 0.2 * ($10k hospital bill + $1100 for the 2 weeks lost) ~= $2200.

So basically, you pay as much to have them keep working as you would to have them stay home - it's just perhaps different people footing the bill in either case. If you take into account the people that person would likely infect (about 2.5 people on average per case) one step down the line, then the break-even point is $5500/month economic production. If the person could work at some percentage of full efficiency during lockdown, divide by that fraction.

This is not taking into account the added costs of death, costs of having synchronized impacts to the workforce due to failure of infrastructure versus desynchronized ones, how easy it is to bounce back from or legislate around different kinds of economic slow-down (which was the reason for my point about essential/non-essential), etc. And it's not yet taking into account that the one route involves deaths and the other route doesn't. In safety cost calculations, the value of a life in the sense of 'how much is too much to ask someone to pay to reduce deaths by 1 in aggregate' is about $10M. If 1% of cases lead to a death, then just on the deaths alone over a year of lockdown would still be break-even. The place where that breaks down is deaths from associated economic damage, but again in that case it matters whether those deaths could be prevented or not through attendant strategies, and that comes back to essential versus non-essential labor.

So yeah, I think that if for example you just paid food service people to stay home, you can actually save quite a lot of money in the long run. There are practical difficulties in implementing that (which verges into politics, so lets not), but at least from the point of view of what a hypothetical society with 50 years of prep time to the next pandemic could implement, it's a good option to consider.

[Chen]

$2200/month is only around $13.75/hour full time. I can’t fathom what industry actually produces less than that per employee.

[NichG]

$2200/month is only around $13.75/hour full time. I can’t fathom what industry actually produces less than that per employee.

That's about double US minimum wage, and restaurant margins for example are only ~3-5%, so there are plenty of jobs around the world that would fall into that range (which, note, doesn't take into account the people that person will infect), and in fact those are the jobs most likely to have high social contact and therefore anomalously large degrees of transmission of infection.

[Chen]

That's about double US minimum wage, and restaurant margins for example are only ~3-5%, so there are plenty of jobs around the world that would fall into that range (which, note, doesn't take into account the people that person will infect), and in fact those are the jobs most likely to have high social contact and therefore anomalously large degrees of transmission of infection.

Wages to revenue ratio shouldn’t be more than 30-35% for restaurants. We’re talking about how much money someone produces not how much they are paid.

[Liquor Box]

There are various ways to make this argument, but lets do the simple math one.

A hospital stay for a (non-fatal) Covid-19 case is about two weeks long, costs about $10k, and is needed in about 20% of cases. So if someone generates less than $2200 a month of economic surplus compared to them not working, the overall cost to the economy is the same at the level of that single person for a 1-month lockdown in which they absolutely cannot work at all versus just the 'just let everyone get sick' plan: 0.2 * ($10k hospital bill + $1100 for the 2 weeks lost) ~= $2200.

Even putting aside Chen's points and assuming your un-sourced figures are correct, this argument doesn't work for what we were discussing.

The flaw is that your math rests on an assumption that every single worker WILL get sick. Of course if you know a particular person will get (or is) sick it's better to isolate them. I think everyone would agree that's a no-brainer. But we weren't talking about isolating only people who were sick, we were talking about isolating the entire population.

I take it from your later answers that your figures are from the US, so lets stick with that example. On current figures only 1 in every 10,000 Americans has had the virus. Lets assume that the proportion of workers who are sick is consistent (in reality its likely to be lower because the elderly are worse effected).

So that means cost of the risk of sickness for a given person is the $12,200 (hospital plus time off work) divided by 10,000 (the chance of actually getting sick) = $1.22, and then divided by 5 (the chance the sickness requires a hospital visit.

So while I accept that it's possible that the average cost for a person who does get sick might be $2,200, the cost of 40,000 or so people getting sick averaged over the population is less than a dollar.

Now the flaw in my argument is similar to the flaw in yours. You assume that everyone will be sick. I assume sickness rates at their current levels. The truth (if isolation didn't happen) would almost certainly be somewhere in between. But the math holds even if tens of millions of people were sick. Even if 50 million people were sick your $2,200 figure would be divided by 6 (50m being a 6th of the population). So, my opinion remains that mass isolation is likely to cause much more economic damage than the cost of letting covid-19 run its course. As I said previously, that has to be balanced against the non-economic cost.

So yeah, I think that if for example you just paid food service people to stay home, you can actually save quite a lot of money in the long run. There are practical difficulties in implementing that (which verges into politics, so lets not), but at least from the point of view of what a hypothetical society with 50 years of prep time to the next pandemic could implement, it's a good option to consider.

So yeah, I think that even using a relatively low paid person (waiter) as an example the cost of sending him/her home greatly outweighs the cost of keeping him/her at work from the risk of exposure to the virus (unless infection rate approaches 100%).