The British approach to coronavirus

Not sure how aware you are of what’s happening here but the British government is taking a decidedly different approach to most other nations. They are not shutting schools or cancelling large gatherings or recommending self-isolation. They’re taking a longer view and saying if that happens it will be a way off yet. The policy is led by the scientists.

It’s a very bold approach, the govt is coming under a lot of pressure to do what other nations are doing, there’s a lot of shouting to DO MORE, but so far they’re ignoring it. It’s kind of fascinating to see it play out. If you have time, today’s press conference is really worth a watch, the chief scientific and health advisers give a pretty detailed explanation of what they’re doing (Johnson introduces and then the scientists start talking at 31.50). They don’t say this explicitly but their bet is that what China and South Korea are doing is not economically or psychologically sustainable and will just lead to another peak. (My friend has drawn a cute visual explanation of the thinking here).

In this press conference they also make a pretty persuasive case that cancelling large gatherings is pointless and may be counter-productive.

…One more thing – good summary of the arguments the govt scientists made in that press conference, in this Guardian report. eg “closures would have to be at least 13 weeks long to reduce the peak of Covid-19 by 10-15%. Measures such as self-isolation for seven days for those with symptoms … have been modelled and are shown to be much more effective”

That is from an Ian Leslie email.  I am skeptical about this approach (is it politically sustainable?), but we will know more soon.  Here is another good explanation, by another guy named Ian:

3. A UK starting assumption is that a high number of the population will inevitably get infected whatever is done – up to 80%. As you can’t stop it, so it is best to manage it. There are limited health resources so the aim is to manage the flow of the seriously ill to these.

4. The Italian model the aims to stop infection. The UKs wants infection BUT of particular categories of people. The aim of the UK is to have as many lower risk people infected as possible. Immune people cannot infect others; the more there are the lower the risk of infection

And here is a polemic critique of the British strategy.  Continuing…

Comments

As for the criticism of the British strategy, the author apparently knows not the difference between vaccination and inoculation.

They should infect the Boomers first. Herd immunity starts at the top.

I'm gone! You're next. :-)

Dismalist, as an incel, you'll survive and produce a nice brood of MR comments for other people's children to see.

Nice to meet you, I am Thad. For years I've been staying in California. I am currently a procurement officer and the salary has been really fulfilling. As a man what I like is to model trains and We will be starting another thing along by it. I am running and maintaining a blog here:

What’s the difference? None, according to my dictionary.

Ah, the bigots come out pretty quickly. Strangely it seems this is often the case when there are experts who disagree with other experts and those of a more ... authoritarian ... political bent take one side. Same happens when the subjects of economics, climate, identity politics etc come up, and those authoritarians so often take the side informed more by emotion and short-order assumption than by considered reason or evidence.

The UK is back to banning mass gatherings like the other countries:

https://news.sky.com/story/coronavirus-mass-gatherings-to-be-banned-under-government-plans-to-combat-covid-19-spread-11957350

To be fair to BoJo, he said he was considering banning big events:

https://www.youtube.com/watch?v=xRadMzCKnCU&feature=youtu.be&t=1644

He said, echoing the Scottish government, that the purpose is to release the police and ambulance services from the burden of such events. (By law you need ambulance(s) in attendance at big events. In Scotland the cut-off is a crowd of 500. I don't know what the cut-off is in England.)

He re-emphasised that he doesn't expect the action to impede the epidemic to any useful extent. I don't know whether he's being straight or just yielding to the pressure to showboat.

Is the UK using his Google Sheets pandemic planner?

I like it a lot . I think It's the smartest response so far. Start building immunity in the population, protect the most vulnerable. Don't do showy dramatic things with questionable effectiveness ( travel bans, cancel all sports events etc...). People will catch on it's ineffective sooner or later and will get tired of it.
The amount of fear I see out there is very high considering the actual risks to most people. After all this virus is basically harmless to ~ 98% of the population ! Move the curve and deal with only one peak, not multiple peaks.
I believe the Chinese will have to keep constantly on watch to stop the return of infections and will incur a lot of economic disruption and a vaccine isn't going to show up very soon.
Impressive, that they have the balls to do it. Brexit made the Brits smarter and more courageous ! hats off to them !

China policy would have been fine if they had of been able to keep it in the country and/or have small pockets of infection outside of China. Once the USA let it get to community spread then it was all-over rover for containment. All anyone can do is keep the spread rate low so that health resourses aren't rationed. Africa and the Pacific are probably screwed.

You will have to explain how the USA let the virus out of China and into Europe and the rest of the world.

Yeah, I kinda want to know how the US let it go to community spread especially now that we know that it was already spreading in china by mid-November. It was already in the US before the initial travel ban was implemented. Just common sense when we know how many travelers were picking this up in early January and spreading it around the world. By censoring information early on, China screwed the rest of the world.

mpledger said: "Once the USA let it get to a community spread ...."
please reference this with supporting information. Started in Wuhan, China. Spread from China to elsewhere. Back up your claim.

Why do you suppose immunity gets built?

Where do you see that the virus is virtually harmless to 98% of people? I see stats saying 10 percent of people infected need ICU, including younger people. There is a big gap between fatal and harmless.

Craig

mpledger said: "Once the USA let it get to a community spread ...."
please reference this with supporting information. Started in Wuhan, China. Spread from China to elsewhere. Back up your claim.

How's that "herd immunity" to the seasonal flu working out?

[Peter Dinklage voice] But..... that's what seasonal means

Antibodies from earlier exposures affect response to new flu strains
https://www.sciencedaily.com/releases/2019/03/190320110619.htm

My guess is the r0 of seasonal flu is much lower precisely because of herd immunity (some people don't get it and spread it because their immune system has seen something similar before).

the brexiloons here in the UK have not made us "smarter" - we have been wise to their xenophobia, their lies and fear mongering for some time.. that they are in government only means that they are easier to take down when they screw both the virus response and brexit.
The majority of the UK wont be listening to BOJO the clown for advice or guidance much like the US wont be reassured by that unflushable turd of a president.

Unflushable turd.... Thank you.

Abyss - your ignorance is not a good argument. The fact that you don't understand the arguments for leaving the EU does not make leaving xenophobia, lies or fearmongering, and it is hilariously lacking in awareness to complain about lies and spreading fear when the whole Remain campaign was literally the lies of Project Fear.

However I do love the obvious butt hurt of vile authoritarians like you when mentioning Boris Johnson (who is a bit of a leftie, but the best we have been offered in 30 years) and Trump (who has turned out to be a pretty good POTUS, and has the corrupt, venal, arrogant, self-dealing, self-appointed ruling class running scared).

"Brexit made the Brits smarter and more courageous ! hats off to them !"

The strategy was published in 2011, long before Brexit.
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/213717/dh_131040.pdf

It's remarkable - but not surprising, perhaps - that the US has no equivalent.

It's interesting that for all the propaganda from the anti-Brexit forces about how Britain was going to be in danger of running short of various necessities of life, it's Italy that is suffering as its EU allies refuse to share their medical supplies and protective gear.

Yes, every time someone refers to Our EU Partners, remember to look for the spittoon.

I agree. The Chinese are inevitably going to encounter a second wave as they relax social-distancing mandates, maybe next fall. Given the fact that the vast majority of people are going to be fine, as some point we have to ask how much economic damage we're going to be willing to sustain to prevent the early deaths of 70 year olds with heart disease.

I don’t think that they will see a second flare up in the fall, so long as they keep monitoring people for fevers, testing everyone who has symptoms, and quarantining people who test positive and their close contacts and doing contact tracing and observation of people in contact with people who have tested positive.

The fact that Taiwan and Singapore have very few cases without shuttering their economy and schools makes me optimistic that if Chinese cities follow their lead, they shouldn’t see any large outbreaks going forward (though banning large gatherings may still be wise, given the role that has played in South Korean and presumably in Iran and its mosques).

I don't think you quite appreciate how unlikely it is for China to slack off or the likelihood of a vaccine and or drug therapy that increases survival rates being developed in the fairly short term.

A friend of mine who is a doctor said she will get it eventually. Her own good health was her only realistic protection from its worst effects.

"Basically harmless?" Many of those surviving are quite ill for 2 or 3 weeks, and have to be hospitalized to prevent death from pneumonia. So far, the fatality rate is about 3%. If 80% of the populace get it, and 3% die (let's say only 1% to be conservative, as some people are not affected, so the death rate may be a bit inflated), that's still 56 million people killed worldwide, and 2.6 million dead in the U.S. alone (where by comparison only 12,000 - 60,000 people normally die each year from the flu).

The British government published its pandemic plan in 2011 based on modeling of what would be the best response to a hypothetical disease.

My question is: have they updated their models using actual data from COVID-19 and they arrived at the same conclusions? If so, good for them.

On the other hand, perhaps they are they just locked into their old plan and haven't done a rethink based on the specific realities of 2020.

Yes here is a link to a data scientist walking people through how the models inform the response and linking to the individual models. https://mobile.twitter.com/AdamJKucharski/status/1238418007824764930

I am yet to see anything similar from other countries.

"perhaps they are they just locked into their old plan ": for Christ's sake, Steve, only someone inured to the incompetence of the US federal government would think that.

They should have thought about it ahead of time, with appropriate error bars. You wait for the specific data for your specific plan, but thinking about it over a few years without panic is how you intelligently respond.

I don’t think we can say with confidence whether this approach will be better or not, but I’m glad one country is trying it. It will be good to have a lot of data points from this pandemic to see what is effective and what is not before the next one. Right now the discourse seems to be along the lines of more restrictive measures are always good—if a country puts in more restrictive measures with no discernible impact on the pandemic, that just means the measures weren’t restrictive enough.

And it seems at least plausible that if 80% of people are going to get this disease anyway, might as well get it over with and isolate the highest-risk people while letting everyone else develop herd immunity. Stretching it out for however long it takes to get a vaccine is very risky. What if we don’t get a vaccine for ten years? Will we ban travel and practice social distancing for ten years, and give the government extraordinary powers to control people’s movements for that whole time? That’s a recipe for another Great Depression at best and the end of liberal democracy at worst. I’d rather have a more severe acute phase and forget about this in six months like we did the Spanish Flu rather than risk potentially ending the world as we know it.

No one thinks that "let 80% get it tomorrow to get it over with" is the right strategy, exactly. The UK chief scientific advisor, like everyone else, is talking about broadening the peak, both spatially and in time, for normal reasons of preserving capacity for care, which every medical authority is going for.

The difference (missrepresented online!) is in level of belief that virus spreads at large gatherings particularly, and in sustainability of quarantine measures. UK does not want to force people into gathering in small, tight spaces by banning big events, and thereby worsen the spread, and does not want to go too early with quarantines which excessively avoid population experiencing and so leading to a second flare up when they are exposed. (It's not about libertarian concerns about economy or excessive powers in the hands of govt.)

Yeah, the sustainability of quarantine measures is my main concern here. The UK seems to be the first country to acknowledge that quarantine measures are not sustainable. Many other countries may try to keep quarantine measures going until we have a cure (and the US government probably wanted to use this to restrict foreign travel all along). I would have no problem with quarantine measures that would definitely be temporary, but as we learned from 9/11, government restrictions on liberty once created often remain long after the threat had passed.

It seems at the moment everyone is 50:50 on the sustainability of quarantine measures, for a disease that will without doubt have reserve across the world unless we can somehow coordinate globally on an eradicating quarantine to the degree that is only possible, to the degree it has been possible, within relatively compact East Asian municipalities. (And even then, the disease probably will have reserve in animals and zoonotic infection).

Maybe the people who believe these are sustainable are right, but I'm far from convinced that it is obviously so.

It's mainly just annoying to me that the British strategy is effectively "Flatten the curve", which every self proclaimed "high information" type on twitter and in public life, has been advocating as the smart, science focused strategy for the last couple weeks, until a government actually stated it was following it, at which point very aggressive containment seems to be being advocated by them.

And by the WHO of all people, the exact same people who completely rejected aggressive containment within China at the early stage when it would have been most viable!

I don't think 9/11 expansions of powers are necessarily a good analogy here. The War on Terror was designed to be, and is, a permanent state of being. War on Covid19 would not be, unless broadened into a general huge, authoritarian mandate against infectious disease.

Isn't it clear at this point that aggressive containment is what's required to flatten the curve?

What specific measures then?

Again, why does everyone suppose herd immunity will develop?

Is the herd immune to the common cold?

The "common cold" is not a single virus. Many viruses each with multiple strains each create the symptoms common to the cold. The most common viruses that we call the common cold: rhinovirus, RSV and coronavirus. There are also viruses that we know account for 20% or more of cold that we haven't identified (Wuhan could have been one of them), call them known unknowns. To make matters more complicated almost any virus that causes cold like symptoms will get called the cold if the infection is merely annoying or only last a few days to 2 weeks.
Covid19/Wuhan is a new strain of corona, out of 30+ we know of, of which 3-4 (I suppose 4-5 now) that account for 20% of what we call the cold. Hopefully as it spreads the "herd" will build up a resistance.
Once you've been exposed to one strain of the many, you should have a resistance to it in the future.

So, does that mean that good British citizens should "defer to the scientists" and "do their part" by allowing themselves to become infected? The alternative would be to understand that self-isolation is a private decision rather than some sort of contribution to a greater public good. Individuals should learn science (different from deferring to scientists), which knows no nationality, to evaluate the risk of large gatherings and self-isolate when the private risks outweigh the private benefits of attending such gatherings. So, no, British citizens should not simply defer to British scientists. (Although they should certainly take advantage of the free science produced by scientists.) They should avoid large gatherings for the same reasons that Americans and others would: to minimize their own risk of becoming infected, even more so if British infection rates are or become higher.

On a related note, it has been striking this last week to see how rapidly so many distributed, non-federal-government entities in the US have moved to cancel/close/postpone events: colleges, NCAA, NBA, MLB, PGA, private firms, etc. Of course, many of them may be following CDC and other governmental guidelines, but the ultimate decision-makers are distributed. They have moved much more rapidly than, say, the CDC originally did in approving tests and how we expect the FDA to move in approving vaccines. If cancelling all those events had required Pelosi to negotiate an agreement with Trump, or required seeking approval from Federal bureaucracies, many of those events would probably still be in limbo. Paradoxically (to some), distributed decision makers seem to be able to move (even in one direction) more rapidly than one powerful centralized decision maker, given that such a centralized decision maker requires a cumbersome bureaucracy to support it. The space for which centralized decision making makes sense seems to get smaller the more we learn and observe.

Slightly paraphrasing tongue in cheek, people are idiots who overreact in a correlated fashion whether they work within the government or private organizations.

My theory is that private actors and state governments went into ban everything mode because we’re flying blind (I.e., don’t have the capacity to test enough people to have a sense of where the virus is most prevalent) and they don’t trust the federal government, and especially the White House. Trump’s national address with all its misstatements and blame avoidance sent strong signals that everyone is on their own on this one and the people at the top have no real plan based on good data or analysis. There have been huge failures by both the White House and the career bureaucrats (with their inability to get test kits together). And the best we know is that social distancing and quarantined in other places seemed to at lesser prevent hospitals from getting overwhelmed.

It will be an interesting experiment. Isn't the hope of the delay strategy that a vaccine will be developed in time to reduce the possibility of a second peak?

I would think that a delay strategy is hoping to accomplish several things. One would be that delaying the first peak allows time for manufacturers around the world to ramp up production of materials vital to protecting healthcare workers, and also in treating severe cases of Covid-19 patients. It might turn out that one of the anti-viral drugs is effective against Covid-19, possibly remedsivir. By delaying, you have a better chance of having the results of the clinical trials on that coming out of China, and of producing large quantities of it. You also have time for healthcare workers to practice good hygiene, and you also start to build up a reservoir of health care workers who have caught the virus and are inoculated against it for the second wave. Maybe you also have antibody tests to see who has, and has not had the virus and that helps in deciding who is doing what at hospitals and clinics, and in other workplaces. You also have more time for labs to beef up testing capacity, you have time to develop some kind of administration of social insurance if people are forced into quarantine if they test positive. You have time to develop protocols to check people for fevers before they can enter into a school, workplace, or store. You have time to hire and train people to do contact tracing. There are so many things that delaying cases can buy you at this moment.

I think you only need look at Taiwan and Singapore, who have been preparing for this since the first Sars outbreak, to see that delaying cases allows a country to develop the capacity to greatly contain the virus.

It's not supposed to be sustainable. They actually have no delusions they'll achieve herd immunity this year. They'll eventually prohibit public gatherings, close schools and declare a lockout like everyone else.

But they want to delay that moment as much as possible - up to the point that the NHS needs to start triaging - in order to be able to prolong it as much as possible and minimize economic damage.

Yeah. Boris video says what they'll do GIVEN the constraints on the NHS.

Could be a lot more unconstrained in the US of A, except that the government messes up on testing, so I can't buy my test, even with folding money, and God knows what else.

Does triaging start later in the US than in Britain, or sooner? :-)

<a href="https://www.theguardian.com/world/2020/mar/13/uk-to-ban-mass-gatherings-in-coronavirus-u-turnThey're already walking back part of it.

I spoke too soon in my own comment.

The argument that having a lockdown too early because it is unsustainable in the long run seems plausible. If it takes a minimum 13-16 week school closure to have a significant effect, it does not seem realistic that schools could be closed for the remainder of the term and quite possibly the fall term too, all the while preventing kids from socializing with each other.

This doesn't seem like it's going to work. Getting the least vulnerable exposed enough so that the whole population develops herd immunity (assuming Covid-19 leaves immunity long enough for that to happen) could work, if you can prevent the especially vulnerable sub-population from getting it. But from the Guardian piece, it sounds like they don't believe they can do that:

The government accepts that both care homes and nursing homes will be difficult to defend from the virus as people circulate in and out of hospital so frequently. The overall mortality rate is 1% but could be higher among elderly people.

So . . . what is the point? Maybe buy another week or three before having to go into Lockdown like everyone else?

But can one prevent the vulnerable sub-populations from getting infected? I doubt it.

Jesus, trade-offs every where you look.

That's the idea of the Lock-down, at least. Slow it down enough so you can roll out mass testing and reduce the need for lengthy self-quarantine just from exposure, hopefully spreading out the number of people who have to be hospitalized so the system can handle it without crumbling. Eventually you can just start putting anyone who comes into the country into mandatory testing for Covid-19 and hope a vaccine gets here.

Yeah, I thought the testing thing was and perhaps still is important. But gummint screwed up. All this matters only if testing is really really cheap, though.

Isn't it easier to keep the hospitals from overflowing if you start trying to drive R0 down under 1 _early_ rather than late?

I’d think so and what we’ve seen in terms of the effectiveness of response between countries absolutely mandates that everything that can be done must be done at all levels as soon as possible.

But understand that R0 is an average, bigger R0 doesn’t mean a worse disease. If the virus has an R0 of 2, it means that an infected person infects two other people. But let’s say that one infected person is a “super-infecter” who infects 100 people. These are two situations that have different consequences for what will happen during a pandemic. But I’m the end, yes, better safe than sorry.

*in the end*. (I’m NOT the end)

The UK has experience of disease modelling in real life from the foot and mouth epidemic in 2001 (e.g. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1564112/). I suspect that this is at least making them more practiced in requesting and interpreting a model. The largest dissent I have heard as gossip is not coming from people either pro or anti the details of more proposed restrictions but from people who bought into the "it's just the flu" line and are now still pushing it.

TDS alert! TDS alert!

Report to isolation immediately!

TDS alert! TDS alert!

Well, the linked summary in the Guardian article actually explains this better. Minimize the spread through mostly likely to be effective strategies which incur the least social cost. And certainly there is a logic to considering the costs of all the closures and disruption for potentially minimal benefits.
And the focus on protecting the most vulnerable seems a logical targetting of effort...
School closures does seem an worrying strategy... with community spread as kids continue to play with each other (and stay with their grandparents while their parents try to continue working?).
If I go to a sports event or concert with 10,000 others, I am really only at risk from those I have immediate contact with. Not much different from an event with a smaller group and the lines in the supermarkets around here. Is one big gathering worse than many small gatherings for practical likeihood of spread?
What I wonder is whether the UK strategy will elongate the curve or lead to an immediate peak? (The general strategy of countries to try to "flatten the curve" seems the logical priority from a health care capacity perspective.)

PS - The final link to the Medium article was not worthwhile. Repetitive drivel which completely misrepresented the UK strategy either through ignorance or intentionally.)

"And the focus on protecting the most vulnerable seems a logical targeting of effort..."

It is not and they don't. The old have fewer life years to save than the young. Let them go.

Brutal utilitarianism, except for the alternatives.

Actually, it is the UK. So "QALY" (Quality Adjusted Life Years) is the metric to maximize. Now that's what I call utilitarianism.

The medium article is an illustration of Tyler's question regarding whether the approach is politically sustainable - i.e. if this is the type of response it generates

So the British plan is the pre-quarantine Hubei plan. They are an island with a younger population so they have that going for them.

The UK's average age is about 40. It would be higher if it weren't for recent immigrants.

I don't think they will have much control over the location or the size of the peak, however, I like the philosophy behind it. You can wait for a vaccine, but you might be waiting anywhere from 1 to 5 years to never.

What this plan is actually missing is the one thing that would give actual control over the location of the peak and control of the size and duration- deliberate inoculation of the non-vulnerable in a controlled fashion during the period where you put the most effort to isolate the vulnerable for a practical period of time.

To be honest, if I knew someone had COVID-19, I would go and inoculate myself just to get it over with.

We had just a person for you in our ER just a few days ago- she was 60 years old and presented in acute distress. Sadly she expired despite intensive efforts to revive her. She never made it out of the ER. I believe her body is still in the morgue and is likely still contagious. If you’d like I can have my colleagues in the pathology department send you a small vial of her pulmonary exudate- it should do the trick.

Yancy, that's madness given how quickly a vaccine or drug therapy that improves survival rates may be developed. You think they're sleeping in Shanghai, snoozing in Sydney, or dozing in Dusseldorf?

Well, okay, they were dozing in Dusseldorf, but they're awake now!

Already partially out of date, and likely to be irrelevant by Monday.

One thing i do not understand in any of the policy responses. Since the issue is capacity of the health care system and icu beds, why dont we dedicate massive amounts of resources to expanding that capacity before the virus peaks. Like convert existing buildings into icu hospitals, manufacture ventilators en masse, retrain healthcare workers in other fields to be able to work in icus and so forth.

This. Anyone with 2 hands can make a flu mask from old clothes and rubber bands in...15 minutes? Probably 5 minutes once you get good at it. I'd estimate 1-3 million hobby clothiers in US.

Based on Tyler's posts, neither oxygen concentrators, nor ventilators are very complex devices. Nothing fancy, but enough to keep a person breathing. A small team of chemists, mechanical and electrical engineers could likely make a few of them a day.

US Army employs around a million people. There are ~20 million paper pu....public employees in US. Why not mobilize these people?! Western countries have done nothing; and are already out of ideas.

Flu masks cannot be made with old clothing. You need certain pore sizes and adequate lateral coverage.

Ventilators are very complex machines. The ones we need can control breath shape, duration, pressure, partial pressure of oxygen, and dynamically change that due to patient respiratory effort, and those are just the basics. We could actually dramatically increase our capacity if we could find a way to ventilate two patients with individual vent settings from a single vent.

Thank you for the clarifications. Although it does sound like "it's not perfect, therefore useless. Let's do nothing instead". The emergency might call for compromises and expedient solutions. Though it's likely that might disrupt medical protocols and do more harm than good.

What's your opinion of this device (admittedly, it's MIT claiming MIT is awesome):
http://news.mit.edu/2010/itw-ventilator-0715

Just out of curiosity, in an emergency would it be effective to supply homemade oxygen to someone who has breathing difficulties -- assuming I take care not to set them on fire?

The US already has vastly more ICU capacity per capita than any other country.

I only know numbers of hospital beds and Australia has about one quarter more per capita, France has twice as many, while Japan and South Korea apparently have 4 times as many. This is not the same as ICU beds, but it does seem a concern.

What a dumb idea. The UK can't build hospitals like China they'll be swamped in good time.

At a 1% mortality rate, that's almost half a million dead Brits. The math seems to be working against them.

Without understanding the long term effects of COVID and whether true immunity can be built against this virus (anybody immune to AIDS or SARS yet?), this becomes a dangerous shot in the dark. There are rumors of multiple re-infections and reduced lung capacity in the survivors in China. The UK's gamble could potentially create a generation of cripples.

Pete, they are starting from the reasonable assumption that the spread can't be stopped, it can only be delayed and that delay beyond Summer is only a reasonable policy if there is a vaccine available by that time. They don't quite come out and explicitly say it because it might deepen the panic, but their testing to date has probably been carefully analyzed and shows that the 95% probability is that there were 60,000+ already infected, but only 1/10 of them identified. There is no way to bottle this up with that many already infected- it probably wasn't even possible at 6,000.

I'm not sure the UK response is right, but saying "we are going to lose people" at the start shows they aren't a bunch of bliss ninnies who are aiming for the least-bad outcome, instead of trying to (impossibly) avoid any bad outcomes.

It is a relief to see that a commentor at MR is agreeing with the PM of the UK said to a national (international too, one would have assumed) a couple of days ago.

Yes, recovered patients did develop antibodies to SARS. HIV is a different virus. it’s really not that contagious. It’s straightforward to protect yourself and it doesn’t kill quickly. In most cases it lies dormant for a long time to evade the immune system.

If you couldn't develop anti-bodies to Cov19, then the whole idea of quarantining people in the short term until a vaccination develops is somewhat doomed anyway (how are we going to get a vaccine if that's the case?), and every country is doomed to secondary flare, repeat infection and death in the longer term in any case. A Covid19 which does not have acquired immunity is apocalyptic.

The 0.9% mortality rate is not the "swamped" rate. That's the good scenario.

The data suggest containment, however painful it is, is working.

China has closed 13 temporary hospitals in Wuhan, and the official infection count is 81,000, not 500 million.

As the current rate of growth, Italy will stabilize around 30,000 diagnosed cases and 2,000 deaths--not 40 million cases and 2 million deaths.

The notion is the virus will go through the whole population is not borne out by the incoming statistics.

Depends on the number of unrecognized cases. And asymptomatic spread seems actually common (try a shocking 50% of recognized cases), according to early data from China and Singapore.

The virus is likely much wider spread, and unrecognized during a normal time for colds and flus.

The proportion of pre-symptomatic transmission was 48% (95%CI 32-67%) for Singapore and 62% (95%CI 50-76%) for Tianjin, China.
www.medrxiv.org/content/10.1101/2020.03.05.20031815v1

Thanks for posting an interesting paper. It goes against the other observations of a/pre-symptomatic transmissions being rare.

Regardless, masks, social distancing, compulsive hand washing, quarantine, and general germphobia are efficacious against asymptomatic transmissions, too.

I would add that even if the Chinese are lying through their teeth and there are tons of asymptomatic cases so that the total numbers are 100x the 80,000, that only means 8 million unofficial cases. A far cry from 80% of the population. If any major Western country gets even half of its population sick with this virus, it will surely be because of unwillingness to do the hard containment now.

If you haven't read this Adam Kucharski St's The rules of contagion (order it internationally from the UK site of amazon because its not available I theb US til September) then you're missing out! He's an LSHTM epidemiologist.

Here is a link to the recent modelling or you can read some guy making shit up on Medium https://mobile.twitter.com/AdamJKucharski/status/1238418007824764930

Even the WHO admits that the banning of large gatherings has a limited effect on stopping the spread of the virus in a population with no immunity. This is not flu we do not have a vaccine we cannot stop it we can only mitigate its impact by spreading out infections and reserving medical interventions for those who are most likely to recover from serious infections.

People can pretend that the science supports containment but it’s gone beyond that because the Chinese government hide the initial impact until it had been spread across the globe.

We have no idea what the real infection rate is in China but it’s likely to be producing mild symptoms in hundreds of thousands if not millions of people already.

"limited" as in but there's still some effect...

There might be different strategies, based on an expectation of either 50 or 80% infection over time.

But 80% seems really high. Especially combined with the idea that you are somehow creating group immunity at the same time.

It doesn't sound like much group immunity to be honest. It almost sounds contradictory.

80% is the reasonable worse case scenario from the modelling which forms the basis of a response plan. 50% would be great but you don’t plan on that basis.

I listened to a bit of the tape. At around 34 minutes the guy says you can't stop everyone from getting it, but you want everyone to get it, because that gives you group immunity.

As I say, that sounds like a contradiction. If everyone gets it, the *group* part of immunity didn't really matter. All you're doing is accepting the first wave, and being thankful that anyone who survives has increased survivability in the future.

It's easy to imagine an alternate scenario. You reduce transmission enough that not everyone gets it (this spring) and then you have a vaccination (by fall).

It is very much the reason we don't say "nobody needs a flu shot, la la."

There is an old phrase, Dunkirk mentality

https://www.gracefellowshipofaugusta.com/pastor-wades-blog/post/dunkirk-or-normandy

Lower numbers here:

"Without containment, the virus becomes endemic, and leading epidemiologists like Marc Lipsitch (Harvard) and Christian Drosten (Charité Berlin) estimate that between 40% and 70% of the population get infected until we develop some degree of herd immunity."

The rest of the piece talks about aggressive containment being necessary:

https://medium.com/@joschabach/flattening-the-curve-is-a-deadly-delusion-eea324fe9727

Normandy mentality.

Sounds more like the Barbarossa mentality. But then they did lose.

“A guy named Ian”

The reinfection risk is understated. Why do some people who are infected have few or no symptoms while others quickly develop serious symptoms. The path for the latter seems to be a brief period of improvement followed by rapid and fatal decline. It's as though the body initially produces effective antibodies, but they don't last (or can't defend against the second attack). Then there are children, who seem least vulnerable. Why is that? Is it because they have stronger antibodies (that have not been called into action), or is it because they have fewer antibodies. Maybe it's the antibodies that kill the patient not the virus. No, I'm not parodying Trump, just pointing out that we know so little about this virus, which makes developing a strategy for containment, treatment, etc. very difficult. As for the strategy of wide-spread closures, what if after two weeks the virus shows no signs of containment? Do we extend the period or try something different? Anyone who is a fan of the show (Dr.) House will see what I mean. In the show, Dr. House has a patient with an illness that is difficult to diagnose and, hence, difficult to treat. Most of the show is devoted to House trying to diagnose (he heads the department of "diagnostic medicine" at the hospital), often using various treatments that can make the patient worse as a way of narrowing the patient's illness. I there a real-life Dr. House (played by a British actor but who hides his accent because his character is American).

People die because of their immune response. It seems if your immune system is good -- as it normally is in young people -- the virus doesn't get much off a foothold and is beaten off. But if it does hang around too long your body develops a massive immune response to it that can kill.

> ”to allow the virus to pass through the entire population so that we acquire herd immunity.”

We are going to see the largest eugenic experiment in the world. The observed trend of COVID.19 infection, whether it is causal or just correlation is beside the point, it is the observed results from real empiral data. COVID.19 will systematically infect those with gene variant ACE.II, permanently damage the function of the lungs, kidneys and brain and may be also exterminate the infected, those with high IQs. The remaining unsusceptible or immuned population will be dominated by those with gene variant ACE.DD who have high physical endurance, adaptive to high altitude like the Nepalese Sherpa. So far some populations are observed to be immuned or little infection to CORVID.19. It will be the SJWs', athiests' and Jocks' paradise. The population demographics will also be drastically changed. The "herd immunity" is an illusion. It had been shown that on average the SARS.COV2 virus mutates once ever two "infection generations", i.e. about 14 days. Pretty soon the so called "herd immunity" so treasured will be practically useless.

https://i.ibb.co/9HLSR2R/acecovid.png

https://www.nature.com/articles/s41586-020-2012-7_reference.pdf
"Importantly, we have confirmed that this novel CoV uses the same cell entry receptor, ACE2, as SARS-CoV."

https://www.sciencedirect.com/science/article/pii/S0735109703006429
"The ACE/DD genotype is associated with the extent of exercise-induced left ventricular growth in endurance athletes"

https://bedford.io/blog/ncov-cryptic-transmission/
"Cryptic transmission of novel coronavirus revealed by genomic epidemiology"

"We are going to see the largest eugenic experiment in the world."

It is the largest math quiz in the world.

"The New York Times has managed to get their hands on the still-not-public CDC projections. One model estimates 160 to 214 million infected in the US, with 200,000 to 1.7 million dead."

What is the frontline way not to be in the dead group? Try not to be in the infected group.

You are going to get a eugenics experiment out of this even if the UK didn't exist.

> You are going to get a eugenics experiment out of this even if the UK didn't exist.

There is the question of the extends or scales for the various strategies. The three strategies can be approximately proxied by the situations in Wuhan China, Diamond Princess, and Daegu Korea though the Wuhan case has to be discounted slightly as they were the first one to deal with the unknown and the lockdown could have came a bit late when the infections already had momentum. Otherwise enforced quarantine at the personal level might be enough. The Diamond Princess and Daegu situations have prior example from Wuhan and their infection started with a single patient.

https://i.ibb.co/YPY8L19/covidext.png

Because of the lax control the situation in Diamond Princess resembled with the strategy of UK. Daegu Korea has the problems of dealing with the secretive and evasive cult and they did not know who to quarantine and who were the contacts so they have the strategy of massive testing.

The Diamond Princess case was different from the proposed UK startegy in that the infected were taken off the ship and the situation terminated early when some or all the passengers were repatriated. And with 14 proven infected Americans in the same Jumbo Jet with 300 other repat passengers, four more infections were detected after the 10 hours trip back to US. Still the per capita infection rate for Diamond Princess is about 100x larger than that for Wuhan and Daegu. The Wuhan case started early and it is already in the phase of reducing the pool of the active live infected. Because of the lockdown and enforced self quarantine there are little new infection. After one and a half month Daegu still has problem tracking the infected cult members who are mostly females with jobs in large teams that usually massively dealing with the public like health-care workers, teachers, etc and there are still considerable number of new infection per day. In Korea the number of infected females nearly double that for the males. It is still not known if the active live infection pool will ever be decreased.

So it is a case of whether you want the whole or a small part of the population to go through the filters. As I asserted this will change the population demographics and hence the political situations in the country. In India the infected seems to be mostly Italian tourists. They might have the real "British Exit".

As to the "herd immunity", the H1N1.09 Swine Flu started in 2009 and killed 3433 Americans and about 300,000 globally. After 10 years the Swine flu still has yearly recurrences in US. https://i.ibb.co/zGNbtkm/h1n1recur.png

This whole thing is based on the assumption that the vast majority of people who get it won't be very ill at all. But that in some populations the effects are severe.

I don't quite see it working, other than a recognition that it is basically uncontrollable no matter what you do. Any decisions or policies can only make it worse, not better.

I don't see any focus on what I think is the serious challenge here; keeping hospital systems from becoming the source of the infections.

From what I've seen so far, testing is a PR exercise. It would be nice to have population level testing but that is impractical. Even tests for everyone who wants one won't happen. Some level of sample testing is helpful more as a management tool; likely there is almost enough data now to estimate the infection rates from a small number of test results.

This is very interesting. I'm watching the world go mad in my little town where there are no infections as yet, and only 64 in the province of a population of 5 million, where 6300 people have been tested. One death.

My estimate for when the Media turns on a dime and starts wailing about the over reaction is thursday next week.

Look at chart 8 here:

https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3d9cd99ca

"act-today" Sir Humphrey: We must do something. This is something so we must do it.

"-or-people-will-die": whatever you do people are going to die. The question is what to do. Hysteria is one strategy but there are probably better available.

That's the Dunkirk Spirit my old (American) dad warned me about.

(If you had looked at chart 8, you'd know that different countries already show us which strategies work. "The British approach" is to reject them.)

Don't be daft. We have no idea what works - what if China goes back to work and it all flares up again? What if China gets a huge repeat next winter, ...

It'll be two, or even five, years before we know what's worked.

I just drove across LA. Every transit sign had the same message:

COVID-19

LESS IS MORE

AVOID SOCIAL GATHERINGS

We can compare notes in a week or two. News is also that USC medical center is setting up tents in the parking lot.

Maybe I'm not clear on terminology, but I think it goes like this:

1) containment : identification of carriers, their isolation, and contact back-tracing.

2) social distancing : you know it got loose enough in the community that #1 doesn't work anymore. Try to slow the spread with voluntary measures.

3) lockdown : whelp, #2 didn't work, it's time to say "nobody move!"

China held the disease at #3. Italy is in #3, but maybe they started too late.

"The British Approach" is "we won't even try #2?"

The UK emphasized people staying home when sick and washing your hands. It looks like they are still trying #2.

They said phase #3 will last 11-13 weeks, if I recall. That is tough, but if we can hold off it gives people more time to get ready for it, and it also means we can limit it to 11-13 weeks instead of "indefinitely."

This time Boris, listening to experts, surprises me.
I live in Sweden and Sweden has more or less the same approach. We have now over 900 cases and only 2 deceased, both elderly with other difficult diseases.
Denmark just closed the borders with the Swedish head epidemiologist criticizing the decision because the evidence shows it is more or less totally dumb. The Danish head epidemiologist, allowed to speak after half a day, confirmed the Swedish one's view and more or less said that the Danish politicians are scared and panicking and being irrational.
The Swedish approach is to postpone the contagion and drumming to anyone with a cold to stay home, stay home and stay home a little more. Make a lot of sense. If it will work we don't know but it is at least based on some scientific ground.

"This time Boris, listening to experts, surprises me."

Why are you surprised? Boris is a highly intelligent chap, has a comfortable working majority in the House of Commons, and probably needn't face an election again for nearly five years. I hope he holds his nerve against the pressure to start grandstanding and stop following the advice of his Chief Medical Officers and Chief Scientific Adviser. We shall see.

Umair Haque does not seem to be responding to the information in the Gardian article???

The UK approach implies a very different assessment of the relative costs of spread prevention vs. case management compared to the US and many other countries. I'm glad someone is experimenting with an alternative policy. It should help with the response to the next pandemic.

One thing loud and clear is that COVID-19 has brought all of the "illiberal" types out of the woodwork, justifying how the virus legitimizes this and that idea that they have. By "illiberal" I don't mean the liberal-left of the democratic party. I mean classical liberalism as defined by John Locke. I guess these illiberal types never want to let a crisis go to waste.

Butt-plug say what?

If you read alt-right/traditionalist right blogs you will encounter a lot of rhetoric about how we have to change our lives and give up personal liberties, like freedom to travel and freedom of association, not just for the duration of the outbreak, but for all time. Its like some of them advocate some sort of neo-feudalism.

I know it all sounds crazy as a rat in a shithouse. But I can assure you that I am not making this up.

Thanks for confirming.

Reminds me a lot of how the left says we have to give up air-conditioning and suburban living to save the planet. Which just reinforces how unlibertarian BOTH the left and right are. :/

On a high meta-level, I'm glad different countries are trying different things. It's easy for everyone to follow the same path, but if they have sat down and seriously thought this is the better plan, good: we will see afterwards which is best.

about half of the british sociology narrative
contradicts the sociology fact that they canceled the London marathon!

The double peak is a feature, not s bug, of the social distancing containment model. The idea is not necessarily fewer total cases but to spread out new cases so that neither peak is big enough to overwhelm hospitals. I don't know enough to say with certainty which is better, but there is a rationale. There may also be an argument that the British model has higher expected meet benefits, but also higher tail risk.

The more important thing is the british model has a lower economic cost.

I suspect Trump declared an emergency solely to stop the stock market from falling. Like he basically just tests the waters with one policy after another, waits to see what the stock market does, and keeps switching policies until it rises.

UK already have NHS their sacred cow to protect.

USA have and playing out cross purpose about desirable health system

This has not aged well.

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