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tiggymalvern
A lot of governments around the world are taking a lot of flak right now over Covid-19. They're taking flak from other people in the government and opposition, they're taking flak from some of the health experts, and they're taking flak from people in the media and among the public who have Opinions.
The Governor of New York was on TV a couple of evenings ago demanding to know why the US Federal government isn't making more decisions. Why is it that one state is doing this and one state is doing something else, and decisions are being made on a city by city basis? Shouldn't the feds step in with a coherent plan and apply it everywhere? This problem shouldn't be being approached piecemeal, he said.
Well, unfortunately, he's wrong. It's easy to see why the Governor of New York would like the Feds to make the decisions, because then he wouldn't have to. The responsibility would be on someone else instead of on him. Wouldn't that be nice?
But the infection rate in Washington state or New York is completely different from the infection rate in Wyoming. Even within Washington state, the infection rate and population density in western Washington is very different from the situation in eastern Washington. One size doesn't fit all. The decisions have to be made on a local basis because the locations differ.
So what are the possible Coronavirus strategies?
You can try to keep it out and have zero cases. If you're a small island nation with one international airport and one major port for container ships, that works. You can ban all visitors. You can ensure the crews of the freight planes and cargo ships have no contact with your local workers who deal with the unloading. Within the borders of the island, life goes on as normal, and several Pacific island nations are doing this. They sit tight and wait until there's a vaccine, and then they can start letting the tourists back in again.
That's not going to work if you're Germany. Even if you immediately closed the borders to unnecessary traffic and tourists, you have thousands of lorries and their drivers coming and going with essential goods every day. You're not going to keep coronavirus out. You need a different strategy for when the cases start.
So what happens if you react to the first few cases by shutting everything down to stop the spread? You stop all people movement in the immediate area, and you succeed. You stop the spread. But then what? It's going to be a year or 18 months before there's a vaccine that's been tested and mass produced. You can't stay in lockdown for 18 months. You can wait until there are no cases of spread for a few weeks, you release the lockdown, and then new cases enter the country again and you find yourself right back where you started, having to go back into lockdown because nothing has changed. You still can't keep the virus out of the country.
So you accept that you're going to have the virus, and you accept that it's going to spread through the population. There's no changing that. Now what to do?
Well, you don't want to be Hubei or northern Italy. You don't want to have large numbers of the population catching it simultaneously and have the hospitals overwhelmed. So you want it to spread at a controlled rate that the medical facilities can deal with. And you want it to spread through the younger, healthier members of the population who are less likely to need to be hospitalised. You don't want it hitting the elderly and the people who are already sick with other things. So you have a partial lockdown - close the big entertainment venues and encourage elderly people to stay at home more while young people continue to go to work or school. And if the rate of infection is still climbing too fast, you lock down a little more - close the schools and pubs and the 'non-essential' workplaces and offices while the food businesses and the toilet roll factories stay open. You react in stages.
Boris Johnson said this was planning towards herd immunity and the media metaphorically lynched him for it. But whether you call it herd immunity or you call it flattening the sombrero or you call it delay and mitigate, it's exactly the same strategy. You're never hoping for the infection rate to be zero. You want it to be slow and steady among the healthy population.
If you go into lockdown too early, the disease doesn't spread much at all and you can't sustain lockdown indefinitely. Then when you relax the controls, everyone is still susceptible and you begin the cycle all over again. It's the same problem as with trying to shut down the disease immediately when it arrives in the country. But if you go into lockdown too late, suddenly you're northern Italy with a near 5% mortality rate.
Nobody's under any illusions. People are still going to die even when you work to limit the infection rate. A few of those younger and healthier people get unlucky and have a more severe reaction to the virus and they die despite not being in a risk category. And some people who are already elderly or ill are still going to catch it despite attempts to isolate them and they are more likely to die. There's no plan where your mortality rate is zero. The aim is to keep it as low as possible, which best case right now seems to be around 0.5%.
So how do we achieve that low mortality rate? When exactly is the right time to go into partial lockdown? Then to move to a stricter lockdown?
Well, that part's the bummer. We have no idea. There's not enough data to work from. We know that Italy left it too late. We know that South Korea got it about right, though frankly that was more through luck than judgement. South Korea had one super-spreader very early on (the notorious patient 31) so that case numbers jumped from 30 into the thousands in only a week. They went from a very cautious initial strategy of testing close contacts to full lockdown without having that protracted period of 'wait and count the cases and increase controls gradually' that most countries are experiencing. So sadly South Korea aren't a useful example for anyone else.
Even worse, the answer won't be some magical number that's right for every country. It's not going to be 'lockdown when your infection rate reaches x % of the population per day to minimise your mortality rate' because it's also going to depend on the healthcare capacity of your individual country - how many empty hospital beds and ventilators you have. For some countries, the 'ideal' rate of spread is going to be far lower than for others.
Nobody knows what the best thing to do IS right now. The governments don't. Their health advisors don't, which is why different health advisors and epidemiologists in different countries and even within the same country are giving different opinions. All anybody has is statistical modelling, with all its inherent fallibilites, given we have so little data to actually base the models on. All anybody can do is take their best guess. And some countries and states and cities will guess better than others.
Hindsight is a wonderful thing, and in about a year, we'll be able to say which strategies worked well and which went wrong. And when the next great respiratory virus pandemic comes around in 2120 or whenever, they'll have all of our data as a starting point to work from. But right now we have almost nothing. Everybody on this planet is currently part of an ongoing experiment to figure out the best way to deal with Covid-19, and every government making decisions about it is effectively running that experiment on its own citizens. Not because they're bastards, not because they want you to die, but because it's the only thing they can do. And if the advice they're giving you today is different from the advice they were giving yesterday, it's (in most cases) not because they're incompetent or they were lying, it's because new data has emerged and the models have changed and adapting to those changes is the right thing to do.
The one area where just about every government in the world is fucking up right now is by not doing enough testing. More testing means more data and improves the statistical models, which gives us a better chance of guessing right. Unless you live in China, South Korea, Bahrain or Hong Kong, your government needs to be doing more testing. Criticise them for that, it's entirely fair, and pressure on that front will make a difference. But maybe hold off on criticising them for what they're recommending or not re isolation strategies, or because they're not doing the same thing at the same time as the country next door. They don't know the right thing to do any more than you do, and right now the government's job is to risk lives based on best available guesses, and that job truly sucks. I'm glad it's not mine.
The Governor of New York was on TV a couple of evenings ago demanding to know why the US Federal government isn't making more decisions. Why is it that one state is doing this and one state is doing something else, and decisions are being made on a city by city basis? Shouldn't the feds step in with a coherent plan and apply it everywhere? This problem shouldn't be being approached piecemeal, he said.
Well, unfortunately, he's wrong. It's easy to see why the Governor of New York would like the Feds to make the decisions, because then he wouldn't have to. The responsibility would be on someone else instead of on him. Wouldn't that be nice?
But the infection rate in Washington state or New York is completely different from the infection rate in Wyoming. Even within Washington state, the infection rate and population density in western Washington is very different from the situation in eastern Washington. One size doesn't fit all. The decisions have to be made on a local basis because the locations differ.
So what are the possible Coronavirus strategies?
You can try to keep it out and have zero cases. If you're a small island nation with one international airport and one major port for container ships, that works. You can ban all visitors. You can ensure the crews of the freight planes and cargo ships have no contact with your local workers who deal with the unloading. Within the borders of the island, life goes on as normal, and several Pacific island nations are doing this. They sit tight and wait until there's a vaccine, and then they can start letting the tourists back in again.
That's not going to work if you're Germany. Even if you immediately closed the borders to unnecessary traffic and tourists, you have thousands of lorries and their drivers coming and going with essential goods every day. You're not going to keep coronavirus out. You need a different strategy for when the cases start.
So what happens if you react to the first few cases by shutting everything down to stop the spread? You stop all people movement in the immediate area, and you succeed. You stop the spread. But then what? It's going to be a year or 18 months before there's a vaccine that's been tested and mass produced. You can't stay in lockdown for 18 months. You can wait until there are no cases of spread for a few weeks, you release the lockdown, and then new cases enter the country again and you find yourself right back where you started, having to go back into lockdown because nothing has changed. You still can't keep the virus out of the country.
So you accept that you're going to have the virus, and you accept that it's going to spread through the population. There's no changing that. Now what to do?
Well, you don't want to be Hubei or northern Italy. You don't want to have large numbers of the population catching it simultaneously and have the hospitals overwhelmed. So you want it to spread at a controlled rate that the medical facilities can deal with. And you want it to spread through the younger, healthier members of the population who are less likely to need to be hospitalised. You don't want it hitting the elderly and the people who are already sick with other things. So you have a partial lockdown - close the big entertainment venues and encourage elderly people to stay at home more while young people continue to go to work or school. And if the rate of infection is still climbing too fast, you lock down a little more - close the schools and pubs and the 'non-essential' workplaces and offices while the food businesses and the toilet roll factories stay open. You react in stages.
Boris Johnson said this was planning towards herd immunity and the media metaphorically lynched him for it. But whether you call it herd immunity or you call it flattening the sombrero or you call it delay and mitigate, it's exactly the same strategy. You're never hoping for the infection rate to be zero. You want it to be slow and steady among the healthy population.
If you go into lockdown too early, the disease doesn't spread much at all and you can't sustain lockdown indefinitely. Then when you relax the controls, everyone is still susceptible and you begin the cycle all over again. It's the same problem as with trying to shut down the disease immediately when it arrives in the country. But if you go into lockdown too late, suddenly you're northern Italy with a near 5% mortality rate.
Nobody's under any illusions. People are still going to die even when you work to limit the infection rate. A few of those younger and healthier people get unlucky and have a more severe reaction to the virus and they die despite not being in a risk category. And some people who are already elderly or ill are still going to catch it despite attempts to isolate them and they are more likely to die. There's no plan where your mortality rate is zero. The aim is to keep it as low as possible, which best case right now seems to be around 0.5%.
So how do we achieve that low mortality rate? When exactly is the right time to go into partial lockdown? Then to move to a stricter lockdown?
Well, that part's the bummer. We have no idea. There's not enough data to work from. We know that Italy left it too late. We know that South Korea got it about right, though frankly that was more through luck than judgement. South Korea had one super-spreader very early on (the notorious patient 31) so that case numbers jumped from 30 into the thousands in only a week. They went from a very cautious initial strategy of testing close contacts to full lockdown without having that protracted period of 'wait and count the cases and increase controls gradually' that most countries are experiencing. So sadly South Korea aren't a useful example for anyone else.
Even worse, the answer won't be some magical number that's right for every country. It's not going to be 'lockdown when your infection rate reaches x % of the population per day to minimise your mortality rate' because it's also going to depend on the healthcare capacity of your individual country - how many empty hospital beds and ventilators you have. For some countries, the 'ideal' rate of spread is going to be far lower than for others.
Nobody knows what the best thing to do IS right now. The governments don't. Their health advisors don't, which is why different health advisors and epidemiologists in different countries and even within the same country are giving different opinions. All anybody has is statistical modelling, with all its inherent fallibilites, given we have so little data to actually base the models on. All anybody can do is take their best guess. And some countries and states and cities will guess better than others.
Hindsight is a wonderful thing, and in about a year, we'll be able to say which strategies worked well and which went wrong. And when the next great respiratory virus pandemic comes around in 2120 or whenever, they'll have all of our data as a starting point to work from. But right now we have almost nothing. Everybody on this planet is currently part of an ongoing experiment to figure out the best way to deal with Covid-19, and every government making decisions about it is effectively running that experiment on its own citizens. Not because they're bastards, not because they want you to die, but because it's the only thing they can do. And if the advice they're giving you today is different from the advice they were giving yesterday, it's (in most cases) not because they're incompetent or they were lying, it's because new data has emerged and the models have changed and adapting to those changes is the right thing to do.
The one area where just about every government in the world is fucking up right now is by not doing enough testing. More testing means more data and improves the statistical models, which gives us a better chance of guessing right. Unless you live in China, South Korea, Bahrain or Hong Kong, your government needs to be doing more testing. Criticise them for that, it's entirely fair, and pressure on that front will make a difference. But maybe hold off on criticising them for what they're recommending or not re isolation strategies, or because they're not doing the same thing at the same time as the country next door. They don't know the right thing to do any more than you do, and right now the government's job is to risk lives based on best available guesses, and that job truly sucks. I'm glad it's not mine.
no subject
Date: 2020-03-17 11:34 pm (UTC)The problem with their plan (which was based on pneumonia stats, which have turned out to be completely wrong for this situation) is that (a) people have been reinfected; (b) the virus is mutating so it's like herd immunity against the common cold (which isn't a thing, as you know); (c) until there's a decent vaccine, herd immunity is also not a thing; and (d) you're going to see an awful lot of people die first.
True, those will be the older, sicker, worthless people /sarcasm but they're still going to overwhelm healthcare systems before they drop dead.
The lack of testing in the USA is criminal, as they had viable tests available to them and refused to use them because of Trump's fears of losing the election.
It's the worst time to have incompetent, small-minded, talentless narcissists in charge of countries, but in Australia, USA, and the UK, that's what we've got. In China, the dictatorship is just as harmful.
The job sucks. But so do the people in the jobs.
(no subject)
From:no subject
Date: 2020-03-19 05:37 am (UTC)Thank you for a thoughtful, well-thought out post. With everyone at or nearly at a full-blown panic over this virus, it's good to read something that makes sense.
In the town I live in, thankfully, there's only one confirmed case so far. Despite that, the Governor (Polis), has ordered all restaurants to go take out/delivery only. No large gatherings, social distancing, etc. Many schools went on early Spring Break while some have closed for the rest of the school year. I think the latter is a bit of overkill but that's just my opinion in the face of not having enough information to opine otherwise.
Where I work, we're getting updates and changes nearly by the hour. Surprisingly, communication and transparency is actually being used instead of the usual, "we'll just make the decisions and keep quiet about it and no one will ever notice" approach.
For the most part, nearly all areas of our campus has been closed to the students and the public for the duration of our extended Spring Break. The powers that be are mandating that all employees who can must work from home while rotating a schedule so their areas are manned but only by one or two people per week day. This makes sense, which scares the bejesus out of me. XD
The two hospitals in our town began preparing ahead of the need. The grocery stores are empty due to the panic buying of the scared shitless but they're restocking as fast as they can while shortening their hours so their people can work and they can clean more stringently.
Most of this feel surreal right now. As much as I'm trying to keep calm, it's hard not to catch the additional stress thrown about by everyone else. Live your life like you normally do but with some modifications. Wash your hands, don't touch your face, maintain social distancing (I really like this one), and don't do stupid stuff. There. I think that covers it. :D
(no subject)
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