|
Getting your Trinity Audio player ready...
|
Some say we need to keep sheltering in place until there’s a vaccine or a cure. Some say we need to restart everybody’s life, period. I’m describing a much more sensible, logical and focused middle path that gets people back to their lives and avoids overwhelming health care resources.
For COVID-19 to become history (even in just the U.S.), herd immunity has to be reached, or extensive testing (several million tests a day) and a potent antiviral medicine have to become available, or a vaccine has to become available to hundreds of millions. I’ve excluded tracking systems that enable targeted quarantines, as I believe American civil liberties and our culture of individuality will not allow those to exist broadly.
Thousands of antivirals have gone through clinical trials over the years, yet only a few dozen have ever been found safe and effective and approved to go to market (most of those target HIV, the result of decades of research and development). Getting huge volumes of a safe and effective antiviral targeting COVID-19 won’t happen soon.
Vaccines are even harder to get to market. They have to be proven both effective and super-safe. If they aren’t, the vaccine and the company that developed it are cooked, and more people will balk and become anti-vaxxers, which leads to horrible health outcomes, mostly for our children. The best-case timeline for a vaccine is the second half of 2021.
Herd immunity arrives when 60-70% of people have had the virus — whether asymptomatically or with mild to deadly symptoms. I believe that the federal government and state unemployment funding of people sheltering in place will soon be fatigued. Also, if shelter-in-place is allowed to continue for more months, layoffs will continue accelerating, and before long, many more companies will join those that have already gone defunct, their jobs not to return. Since neither a potent antiviral nor testing nor a vaccine are going to appear in huge volume soon, and since the financial downsides of further months of sheltering are untenable, we need a way to get to herd immunity ASAP.
A recent Stanford University study showed that only around 4% of Santa Clara County’s 2 million residents have had COVID-19. Other scientists believe the study was done poorly and is wrong. Some think that perhaps 20% or higher is a better number. But with the shelter-in-place and only a few dozen new cases a day being logged by the county Public Health Department, it will be a looong time before we reach herd immunity — waaay too long to be tolerable.
That said, if a lot more people are to get the virus to achieve herd immunity, we need to be sure that a lot more people don’t die from the virus. If you looked at Santa Clara County’s website on April 27, you’d see that 86% of deaths were people who had “comorbidities,” i.e., hypertension, heart disease, COPD, obesity, diabetes, etc. You also see that 63% of deaths were people over 70. Every year’s deaths from flu are concentrated in much the same population.
We take a key step toward normalcy by strongly suggesting to people with comorbidities (especially those over 70) that they continue to shelter in place or be majorly cautious when going out. And we have everyone else rejoin their lives. The very vulnerable will need to exercise this level of self-care or likely end up in the hospital or dead. And everybody else can take modest precautions as they see fit. This will result in lots of people getting the virus. But most importantly, it will restart people’s lives and income streams.
It’s really the most vulnerable populations who would likely overwhelm health care capacity if they were to exit shelter-in-place. The county does a great job monitoring health care capacity, and models exist that can help the county tell a few weeks ahead of time if there’s going to be a crunch — and to reinstall a higher level of shelter-in-place for a few weeks if necessary (but we’d still be on the way to herd immunity apace).
Moreover, a lot of the vulnerable older people are retired, so having to shelter in place isn’t different for them economically. And restarting the economy will certainly help vulnerable older people’s investments.
When kids of all ages go back to school and the workforce goes back to work, it will be a boon for almost everyone for obvious reasons. Yes, it’s true that some of these people will get a bad case of the virus and be sick for weeks, some even hospitalized. And a small number will die, just as they have year in and year out from the flu — but we don’t lock down the country for the annual flu season.
Still, it’d be best to avoid large gatherings, just so we don’t overfill doctors’ offices with cases spreading as happens in a bad flu season.
A really useful way to move forward is with pilot implementation. Santa Clara County is the perfect place for this. First of all, because of shelter-in-place, 86% of ventilator capacity and 44% of ICU capacity are available (18% of ICU beds are used by COVID-19 patients and 38% by typical ICU patients).
Second, now we know who is most vulnerable and we can avoid a demand surge on hospitals going forward.
Third, the county has excellent communication systems to reach residents (by phone, text and/or email). If there’s an unforeseen need to restart shelter-in-place, the county can communicate quickly.
The steps for other geographies: free up hospital capacity (through sheltering); safeguard the vulnerable; let others rejoin life and be able to communicate changes quickly.
Even if scientists conclude that there’s no herd immunity to be had for COVID-19, the above is still the best course of action until a safe and effective pharmaceutical solution arrives.
I urge Gov. Gavin Newsom and county Health Officer Dr. Sarah Cody to get this going — and soon. Thanks!
Palo Alto resident Andy Robin likes facts. He can be emailed at werdna39@aol.com.
At minimum, that approach requires much more reliable means for delivering groceries to shut-ins. I have totally given up on the delivery services.
The ‘professional shoppers’ who work for the major chain grocery store chains need to be better trained in how to select produce and meat products as many are clueless in their selection process. It’s one thing to grab a box of Cheerios off the shelf & quite another to scrutinize the overall freshness/crispness of certain fruits & vegetables + choosing the best cuts of the beef offerings.
As for coronavirus-related testing, it should be mandatory for all school admissions, pre-employment screenings and for those admitted to or currently sequestered in hospitals, skilled nursing facilities and assisted living communities.
Testing the remainder of the population poses a problem due to accessibility (i.e. the homeless), conservative/evangelical/constitutional rights advocates, and indifference/laziness considerations.
I completely agree with you. Well-said. Thank you.
We need some sanity and a voice of reason. This needs to be discussed calmly. Thank you for this article.
This column is madness. The flawed Stanford study in a revised report lowered their prevalence to 2.8% (https://www.medrxiv.org/content/10.1101/2020.04.14.20062463v2). Going to 60-70% exposed would at the low end lead to 5k-10k deaths in SCC. Right now we are at 127. We paid a huge price of SIP to avoid those deaths, and it has worked. As progress is made in treatment and then vaccines we never have to die in those numbers. Also herd immunity does not mean the disease is over (https://www.nytimes.com/2020/05/01/opinion/sunday/coronavirus-herd-immunity.html), nor will it fix our economy as many will not participate because they do not want to roll the dice. I do think we should loosen some as a tradeoff between the virus and economic and other factors, but not in this way.
I agree 100%. The level of fear is not justified by the numbers. And you will argue that the numbers are low because we have had such strong SIP which is true. But now that we’ve had time to get a better idea of those who are most at risk and affected, we know who needs to continue this strong SIP. But others need to start going out.
If you are not comfortable going out then don’t! I seriously respectfully do not understand why YOUR fear dictates my ability to get back to work? I am not afraid! I am beyond ready and willing to get back to living.
And to the argument that it’s going to spike dramatically if we do this then again, yes, we need to watch it with diligence and if it does then we pull back and adjust. But this SIP all or nothing…..we can’t, we just can’t.
I just wanted to remark on commenter Messifan’s numbers.
Currently we have 127 deaths, but with the plan from this article, we can assume the 88% of those who had comorbidities will continue to shelter in place until we reach herd immunity. Right now only 14 deaths in our county are people without comorbidities. Which, using the 2.8% current prevalence number and requirement of 60% exposed, translates into 285 more deaths before reaching herd immunity.
If we reached that in the next couple of months, it would save thousands of lives of the people with comorbidities that otherwise will be lost during the slow drain of an endless SIP.
First, Andy Robin, thank you for starting this conversation and thinking aloud to the rest of us. It can take an awful lot of courage to do that. Thank you for making it clear that it is a conversation and not a pre-ordained opinion, and inviting our community to join in.
@Messifan, thank you for that, I agree.
It’s really important in problem-solving/consensus-building conversations to always be aware of assumptions being made, and how solid are those assumptions. Andy, you have made a few assumptions with many unknowns.
First assumption, the idea that achieving herd immunity will fix things, i.e., let everyone get back to “normal” life. I’m asking this first question because I’m not a virologist:
How good of an assumption is the ideal that herd immunity could even be reached?
We don’t get herd immunity to the common cold, which is a coronavirus, and we don’t get it to “the flu.” We have vaccines for different flu strains that go around, and while it’s important to get vaccinated (and it helps reduce death etc), the flu vaccine is only 40-60% effective any year, so I don’t think herd immunity can be achieved even if everyone got vaccinated, at least not in the way that herd immunity prevents diseases like measles from getting around.
The closest comparisons are to other coronaviruses and to flus, so I question whether herd immunity is even a reasonable goal. A vain attempt to try to achieve it might only result in worse economic damage, less trust of leadership, and far greater death and social instability. And cost the chance to keep the disease from becoming endemic (present to a degree that it is self-sustaining in a population year over year rather than petering out completely as SARS 1 did).
Could allowing the disease to run unchecked also create more opportunities for more dangerous mutations? If that happens, all assumptions based on our experiences thus far go out the window and we may have to start all over.
Which brings up the second question I really don’t know the answer to: do we still have a shot (globally) at preventing Covid-19 from becoming endemic? If we do, that seems the greatest case for international unity and doubling down on getting to the end of the SIP road we are on.
Any assumptions upon which national direction are based must be solid. You have made another assumption that seemed rock solid until last week, that we can protect the most vulnerable by having just them shelter in place. But New York State is reporting that two-thirds of new hospitalizations are among people who have been sheltering in place at home. The point is that collective shelter-in-place has created a less complicated picture that may now allow pinpointing of why remaining groups get sick or behaviors lead to infections. If those can be figured out, we can start opening up in a way that allows continued honing of how to prevent illness without ongoing extreme measures of distancing. Kind of like going through an elimination diet to pinpoint the foods making you sick. Why go through the sacrifice to stop reacting and then just go back eating like normal hoping for the best?
We’ve made the collective sacrifices, and this moment in time gives scientists the best chance to track down why people are still getting sick in order to better hone instructions on avoiding infection and thus giving people the confidence to move forward. Your assumptions have missed the possibility of refinements and innovations in hygiene — which is the sum of things we do to prevent infection from spreading, not (as many people assume) indiscriminately killing germs or cleaning, although those can be important depending. Despite the comparisons with the flu, this is a new disease which seems to spread more easily than the flu, and a better understanding of how specifically to stop its spread would lead to better hygiene practices.
In New York, they seem surprised to find that the majority of new hospitalizations, at this moment in time, are among people at home, it wasn’t first responders or health-care workers. Can a refinement of understanding in how the infection spreads and develops stop those new cases, and eventually allow healthcare workers also to achieve the same results with less extreme hygiene measures?
Because the third assumption you can’t make is that opening everything up again will lead to restoration of a “normal” economy. Everything has changed. People’s behavior will change regardless of which is the way forward. Just as with your very good point that coming out too soon with a vaccine that doesn’t work will make people more afraid of future vaccines, opening up in a way that spikes death and contagion will create more fear and make it that much harder to restore normalcy no matter what is done later. We need more steps that lead to real, not false, confidence.
Some areas of our economy are not going to come back the way they were, regardless. You can’t bully people into not being afraid, especially if more and more of them lose loved ones. Perhaps instead of trying to restore things the way they were, proactive steps to help people find a new productive, stable normal might ultimately be more successful.
I’m not arguing that people shouldn’t go back to work. If healthcare workers can avoid coming down with new cases of the disease, we know other workers can, too. That’s where new hygiene practices come into play, because it’s not realistic for the public to suit up like healthcare workers in the hospital.
But the seismic shift has created lost opportunities and new opportunities, such as manufacturing drugs stateside again, or making PPE stateside (especially biodegradable or safely-incinerated-for-energy PPE?) or creating more nimble, cheap manufacturing in the US again, or in connecting farmers who are dumping crops with people who are selling freeze-dried emergency food and are perpetually sold out and unable to meet demand, or supporting microbusinesses, or supporting ordinary people who create solutions to problems that are cropping up (reservation system for shopping with lists given to stores in advance for fewer frustrated trips to the stores, anyone?) I’m just giving some examples. Regardless of whether they are good examples or not, I think the idea that things can just go back to normal and that we can just protect the vulnerable in order to “restore things to normal” is speculative at best, and there are too many uncertain assumptions.
Can we prevent Covid-19 from becoming endemic? It seems to me that’s the way forward that will lead to more rapid “normalization” of societies globally (with hopefully some changes to retain some of the benefits we’ve seen). Whether that’s possible or not, having better understanding of best, targeted hygiene practices will be necessary to give people confidence to lead life more “normally” again.
And lastly, I hope in this conversation we can reassess the assumption that it’s okay for so many people to die from the flu every year. Is it really acceptable for so many people to get sick, hospitalized and die every year, if we can prevent it easily? A new understanding of best hygiene practices could change everything for flu transmission, too. It’s another topic altogether, but a popular misinterpretation of the hygiene hypothesis led to so much relaxing of education and practice of good hygiene (and wrongly conflating it with hypercleaning), that research papers were written about serious avoidable illnesses in children and calls to rename the “hygiene hypothesis.” There is a lot we can do in the area of hygiene education and innovation that will help restore confidence to move forward.
@purple
I don’t have the exact number on comorbidities but according to the CDC 40% of the US adult population is obese (https://www.cdc.gov/nchs/fastats/obesity-overweight.htm). We in SCC are probably below the US average in obesity, but when you add in diabetes, hypertension, heart disease, asthma, etc., I would guess over half the adults have a comorbidity. We can’t think of those with comorbidities as a small group who can SIP. They are us.
Arguments for herd immunity are not the same as arguments for ending the extreme SIP in which we find ourselves. We need to find a middle place.
For a person who signs off claiming to like facts, here is a fact for you that undermines your premise. We do not know if once you have the virus you are immune. Thus we do not know if herd immunity can be achieved for this outbreak.
We now know that those who were previously infected have antibodies. The next step is to determine if antibodies confer immunity and for how long. https://www.nytimes.com/2020/05/07/health/coronavirus-antibody-prevalence.html
^ or whether your second Covid infection is more serious or less serious.
“the numbers are low because we have had such strong SIP which is true. But…”
Can’t have it both ways.
BUTTTTTTTTTTTTTTTT……
Nah, bruh.
Andy thank you for your article it’s refreshing to hear a point of view that’s not heard often enough,
33 million people have filed unemployment insurance the last 2 months. This morning our unemployment rate in America was announced at 14.7% the worst since the great Depression!!. With lost jobs and shuttered small businesses comes not only financial hardship but “deaths of despair” depression, Suicide, Drug and Alcohol abuse , broken families….
There has been too little talk about the relatively tradeoffs of SIP in saving lives vs destroying or even losing other lives. I think people have been too naive in believing SIP was an easy sacrifice to make. Yes perhaps for a few weeks but we are nearing the end of our 8th.
Just wait till the impact hits home as cities, counties, states have to cut back services due to the economic collapse. Then I’m sure all of you will begin to realize SIP came with a huge cost.
I’m not suggesting go back to normal. Please wear masks, social distance , protect the elderly and those with other conditions but the rest of us need to get back to the “new normal” and live with the risk.
thank you again
@Andy Robin:
First, you seem to assume that isolating the older (pick an age) population is doable. Maybe I know the wrong people, but, a large number of my friends and acquaintances live in two- or sometimes even three-generation households. Few of the houses are set up for internal social distancing.
Second, you mention “normalcy”, but, it is difficult to extrapolate to a future state where businesses like the old “Gordon Biersch” exist. That world is gone. Read this:
“The things we miss most about our pre-pandemic lives—dine-in restaurants and recreational travel, karaoke nights and baseball games—require more than government permission to be enjoyed. These activities are predicated not only on close human contact but mutual affection and good-natured patience, on our ability to put up with one another.”
https://www.theatlantic.com/politics/archive/2020/05/is-flying-safe-coronavirus/611335/
The following tables provide some insight into what it would take in terms of time to test the nation at least once, using existing test technologies, assuming that a test could be completed in a day–
Tests Time to Test
per day Nation
(Months)
——— —-
200000 55
300000 37
400000 28
500000 22
600000 18
700000 16
1000000 11
1100000 10
1200000 9
1300000 8
If the testing were to be really increased-
Time to
Tests Test Nation
per day (Months)
——- —-
500,000 22
1,000,000 11
2,000,000 6
3,000,000 4
4,000,000 3
These numbers don’t consider the costs—which could easily run to $30+-50+B (or more) each time a complete testing of the nation is required.
Without a paradigm shift in testing technology, and a national registry of people who have been tested—then all of this testing will not necessarily provide much in the way of controlling the pandemic.
There are a lot of people in this country who probably will not willingly volunteer to be tested. Will the various Federal/State/Local governments end up mandating testing—with failure to comply ending up in forced testing and/or incarceration?
I think the cost to the economy is huge. Already Palo Alto is talking about needing to close a library, cut hours at libraries, eliminate activities such as Chili Cook Off and other events. When city maintenance projects start lagging and the bike/pedestrian bridge stalls because of lack of funds we will all feel it. Some of the businesses that are closed will not reopen again and we will be left with shuttered businesses all over town.
Some are hurting because they are not able to pay their rent/mortgage, pay bills or feed their families.
Some are hurting because of domestic abuse, particularly in homes where this has not been a problem before.
Some are hurting because living 24/7 even with people you love dearly becomes tiring and little things like whose turn it is to empty the dishwasher can become huge. Tempers flare, doors slam and hurtful things are said, not because the people no longer love each other, but because tensions are so tight with no chance of release.
Suicides, drug/alcohol use, divorces, will all increase. The elderly who live alone are struggling with loneliness. A virtual hug is not the same as seeing a friend for coffee, spending Sunday morning at church, or having a grandchild playing around your feet while you babysit.
And yet, some think that it is no big deal telling the population to shelter in place, give up all that is of value outside the home, and don’t worry because you are saving lives. For many, the lives lost will not be due to Covid symptoms.
Posted by Resident, a resident of Another Palo Alto neighborhood
>> And yet, some think that it is no big deal telling the population to shelter in place, give up all that is of value outside the home, and don’t worry because you are saving lives. For many, the lives lost will not be due to Covid symptoms.
I don’t know a single person who thinks it is no big deal. Even the most introverted are feeling cramped. But, SARS-CoV-2 particles don’t care about that.
“SARS-CoV-2 particles are spherical and have proteins called spikes protruding from their surface. These spikes latch onto human cells, then undergo a structural change that allows the viral membrane to fuse with the cell membrane. The viral genes can then enter the host cell to be copied, producing more viruses. Recent work shows that, like the virus that caused the 2002 SARS outbreak, SARS-CoV-2 spikes bind to receptors on the human cell surface called angiotensin-converting enzyme 2 (ACE2).”
https://www.nih.gov/news-events/nih-research-matters/novel-coronavirus-structure-reveals-targets-vaccines-treatments
“The researchers are currently working on vaccine candidates targeting the SARS-CoV-2 spike protein. They also hope to use the spike protein to isolate antibodies from people who have recovered from infection by the new coronavirus. If produced in large quantities, such antibodies could potentially be used to treat new infections before a vaccine is available. In addition, NIH researchers are pursuing other approaches to treating the virus.”
In the meantime, you might want to read this about how to stay safe as things partially re-open: https://www.theatlantic.com/family/archive/2020/05/restaurants-stores-reopen-dos-and-donts/611314/
Another interesting bit of info: This published paper says that the percentage of population required to have antibodies in order to reach herd immunity from COVID-19 could be as low as 20%.
https://www.medrxiv.org/content/10.1101/2020.04.27.20081893v1
@ purple,
That is indeed a really interesting point. What has to happen in order for researchers to know whether that is true or not?
@Resident,
You certainly bring up valid concerns. It is essential not to make assumptions, though and look at the whole picture, what benefits are there, what problems and risks are created, and is it possible to mitigate them in other ways. A lot of anxiety is around uncertainty, for example, and that’s something that needs to be dealt with regardless of the path. Many of the reported stresses have to do with pre-existing problems in society, like the uniquely excessive cost of and lack of access to healthcare in this country, or predatory economic circumstances that favor the wealthiest and give the poor and middle class no recourse, so they have nothing to fall back on during disruptions like this. Those can be addressed, though it will take political will and support.
And the mental health picture is mixed (and will likely change over time).
There has been a phenomenon of less anxiety among many:
https://www.theguardian.com/commentisfree/2020/apr/29/coronavirus-lockdown-anxiety-mental-health
And many children reporting being happier (and no, this doesn’t have to go away after things open up, and is not about learning versus not — many people say this report is just like actual non-pandemic homeschooling):
https://www.cnn.com/2020/04/27/health/children-mental-health-quarantine-coronavirus-wellness/index.html
Many are happier working from home
https://www.nytimes.com/2020/05/05/business/pandemic-work-from-home-coronavirus.html
@Resident (continuing my point)
The lockdown has increased opportunities and decreased isolation for many people with disabilities and shown what has been possible all along:
World Economic Forum
https://www.weforum.org/agenda/2020/04/covid-19-isolation-disabilities/
Lockdown is the normal for over 1.3 billion people, the lockdown shows what was possible all along to include them.
Workplaces can be stressful for people with disabilities
https://www.npr.org/sections/health-shots/2016/07/13/485261651/workplaces-can-be-particularly-stressful-for-disabled-americans-poll-finds
Many disabled people and the elderly benefit from access to telemedicine, more meetings online, and more opportunities for entertainment and being a part of the rest of the world.
Most importantly, even if lockdown lifted, most Americans won’t resume life as normal, so it’s crucial to support evidence-based steps to mitigate the valid concerns:
https://www.forbes.com/sites/jackbrewster/2020/04/14/even-if-us-lockdown-was-lifted-today-most-americans-wouldnt-resume-life-as-normal-new-poll-finds/#6b8b1c3c7764
For example, how leaders and the media talk about suicide and depression has a huge impact on the most vulnerable. Please encourage leaders to show their true concern by taking the lead from mental health experts in this national conversation rather than adding unnecessarily to fear, and to support mental health care parity:
https://citylimits.org/2020/04/07/early-insights-on-covid-19s-impact-an-mental-health-and-suicide-risk/
I’m not saying the above to extol the need for lockdowns, or even to disagree with you, maybe you are correct. Thus far, there has not been an increase in those things, but if there might be, it’s crucial we rely on known science to make decisions about how to mitigate them. I just want to caution against making assumptions.
Andy thanks again for raising a valuable debate
Our politicians and elected officials keep moving the goal posts. When we first asked to SIP in March there was a consensus that was the right move but let’s be honest did everyone think it would be 8 weeks and counting
The initial rationale for SIP was to flatten the curve and keep our hospitals from being overwhelmed. I haven’t seen too much of any footage from our local media (that would love a good story) about hospitals being over run.
So now it’s we need testing and of course now we need to hire thousands of tracers. But that won’t be good enough as Andy opines it will evolve into a need for a vaccine which may never come. I’m sorry but life is full of risks, protect the most at risk the others need to get on with life.
Posted by got all the story?, a resident of Barron Park
>> Our politicians and elected officials keep moving the goal posts. When we first asked to SIP in March there was a consensus that was the right move but let’s be honest did everyone think it would be 8 weeks and counting
Let’s be honest and admit that we weren’t all-in like South Korea and New Zealand. http://91-divoc.com/pages/covid-visualization/
Was the first goal-line to keep things under control to avoid NYC/Italy situations? Yes. Personally, I’m really glad that we didn’t overflow the ICUs. Now it is time to figure out how to proceed from here.
>> The initial rationale for SIP was to flatten the curve and keep our hospitals from being overwhelmed.
It worked here!!
>> I’m sorry but life is full of risks, protect the most at risk the others need to get on with life.
So, what exactly are you proposing? I think a lot of businesses will be able to open under social-distancing guidelines, but, at this point, I would consider establishments like Gordon Biersch/Dan Gordon’s to be doubly-obsolete. They weren’t making money before COVID-19, and now they have way too much touching. Real problems to solve? The Warriors I guess — indoors, basketball audiences like the packed tightly excitement and cheering. Anything approaching social distancing would be boring and uneconomic. Are you proposing that “we” accept the risk? The problem being that you might accept the risk and I might suffer the consequences.
The only way you could reopen without killing off 1% of the population is to force everyone to wear a mask and drag anyone who appears in public without a mask to a constitutionally approved quarantine camp until the pandemic is over. The government has extremely broad powers when it comes to quarantines and this has been affirmed repeatedly by common law. The only reason they haven’t been used is because the authorities are incompetent.
MIT Professor Jeffery Harris conducted a study that found “The Subways Seeded the Massive Coronavirus Epidemic in New York City” http://web.mit.edu/jeffrey/harris/HarrisJE_WP2_COVID19_NYC_24-Apr-2020.pdf
“New York City’s multi-pronged subway system was a major disseminator –if not the principal transmission vehicle –of coronavirus infection during the initial takeoff of the massive epidemic that became evident throughout the city during March 2020. The near shutoff of subway ridership in Manhattan –down by over 90 percent at the end of March –correlates strongly with the substantial increase in the doubling time of new cases in this borough. Subway lines with the largest drop in ridership during the second and third weeks of March had the lowest subsequent rates of infection in the zip codes traversed by their routes. Maps of subway station turnstile entries, superimposed upon zip code-level maps of reported coronavirus incidence, are strongly consistent with subway-facilitated disease propagation. Reciprocal seeding of infection appears to be the best explanation for the emergence of a single hot-spot in Midtown West in Manhattan.”
If we closed down the trains, buses, and airlines could we open up the rest of our economy and still maintain an acceptably flattened curve? I don’t know the answer to this question, but somebody should look into it before we have more people dying from economic effects than the virus.
Dear Andy,
Another major assumption you’ve made, is that post infection, COVID-19 is similar to flu. But Kovic 19 seems much more similar to SARS & MERS, which had significant long-term post infectious problems.
This article seems to do a thorough job covering what is known about long term damage caused by Covid-19, including among those who experienced only mild acute infections.
https://www.vox.com/2020/5/8/21251899/coronavirus-long-term-effects-symptoms
@purple
The article indicates another reason to avoid aspiring to herd immunity by infection (rather than vaccine): a significant percentage of the population would experience long term disability, including some who initially experienced only mild acute illness.
If you change the underlying assumptions based on facts and new information, the case for switching lanes and trying to go for herd immunity is less persuasive not more.
I think the best route forward economically is to accept that things have changed and will not just go back regardless of which path we choose. How do we then move forward to do the best for our nation?
Nice article.
Open up California now!
Correction. Of course I meant
“But Covid 19 seems much more similar to SARS & MERS, which had significant long-term post infectious problems.”
Using voice to text…
I’ve read a few articles of shopping malls reopening — and shoppers aren’t returning. As said, before the lockdown, restaurants were losing attendance, suggesting that the assumption that the economy will resume if the lockdown is lifted is just that, an assumption.
The worst-case scenario is that with a premature lifting of a lockdown, the economy does *not* resume and more people succumb to the virus. A contagious virus doesn’t have to be lethal to prevent people from working.
Hokkaido Japan lifted their lockdown, to disastrous effects. Essentially, they negated all the early efforts they made in combating the virus. Like in the United States, they lockdown was lifted because of economic interests. The article specifically says, “Without sufficient data, doctors based their recommendations on the idea that the coronavirus spread like influenza.”
Malls: https://www.dailymail.co.uk/news/article-8300661/Malls-America-resemble-ghost-towns-despite-reopening-public.html
Hokkaido: https://time.com/5826918/hokkaido-coronavirus-lockdown/
This article made me laugh. A 70 year old man wants everyone younger than him to go back to work while he stays at home sheltering in place. My guess is his 401k has been hurting or his tenants can’t pay. There isn’t a lick of selflessness in this piece.
I’m curious if Mr. Andy Robin would give up his ventilator for me since I’m younger and would have a better chance at survival. This is, of course, strictly fact based.
I agree with you, Andy! As long as hospitals and staff will not be swamped and be in danger, let’s start thinking more about the individual human faces behind huge unemployment #s and many businesses closing their doors forever.
NYC found that most of it’s cases were coming from home infection. So what you’re suggesting is that anyone who is co morbid be a sitting duck for all the other people released back out to achieve herd immunity. This hasn’t at all addressed the risk and that hospitals will avoid being overrun by all those at risk at home. It doesn’t sound like this solution is adequate, seems oversimplified.
@Middle aged
But the swamping of hospitals is not the only risk here. Please read this article about the long term consequences of infection.
https://www.vox.com/2020/5/8/21251899/coronavirus-long-term-effects-symptoms
Covid19 is absolutely not like flu. The idea that we could be protected from herd immunity is also predicated on an assumption that people recover like after the flu, which doesn’t appear to be a safe assumption. A large percentage even of those who show no symptoms may have impacts in the lungs. Almost half of those who are hospitalized will have a need for ongoing medical care, some for years or the rest of their lives. Allowing the virus to spread unchecked will create a large segment who are unnecessarily and permanently disabled. There is an economic and human impact of that as well.
Would the article author give up his ventilator for me? After all, I’m younger and the facts show that I’m more likely to survive.
This reminds me of the Texas Lt. Governor saying “there are more important things than living”. You’re willing to sacrifice my life for your financial gain.
People who don’t want to shelter in place nor wear masks might have advance health care directives marked “DNR/DNI” “ do not intubate” such that if they present at the hospital with likely COVID-19 and go into arrest they would be given morphine, thereby freeing up a ventilator for someone else.
They could wear these documents around their necks and give each other knowing, arrogant nods as they pass each other in the parks. If it’s reported that tens of thousands have joined this “MAGA/DNI” movement, maybe it would encourage our public health officials and epidemiology specialists to give in to the urging of the crowd or herd.
So how many of the comments are by the article author?
Couldn’t agree more. Cure is worse than the disease, with rates of depression, anxiety, and stress skyrocketing from the isolation and massive job losses, which leads to suicides, heart attacks, strokes, and other diseases.
House prices are down and falling. Cars go unsold. Major purchases are delayed. This is only the beginning. We’re looking at years of economic depression which may lead to millions of deaths. It was estimated that 2008 Great Recession alone caused approx 280,000 extra deaths.
I’m afraid people are so frightened psychologically from this virus that they will continue sheltering and distancing for many weeks and months after we unlock. The media played a large role in that and cannot let it go and so did the state and local officials.
This is the biggest mistake our country has ever made. May we never, ever lockdown again.
Allow me to address a few of the angry comments against the author.
Posted by Anon
“This article made me laugh. A 70 year old man wants everyone younger than him to go back to work while he stays at home sheltering in place. There isn’t a lick of selflessness in this piece.”
He never said that. His reasonable solution is to protect the old and frail with comorbidities, which represent about 95% of the deaths, while the healthy move on with their lives.
Posted by ajl
“Covid19 is absolutely not like flu. The idea that we could be protected from herd immunity is also predicated on an assumption that people recover like after the flu, which doesn’t appear to be a safe assumption.”
Covid is safer than flu for children, and over 95% of infected have minor or no symptoms at all. At most, 5% are hospitalized, and of that 5% maybe 1% die. These are people who were very sick to begin with.
I find it implausible that the US represents 4.25% of the world population but over 28% of all Covid deaths. We’re over-reporting every death associated with Covid as caused by Covid.
Posted by ajl
“A large percentage even of those who show no symptoms may have impacts in the lungs. Almost half of those who are hospitalized will have a need for ongoing medical care, some for years or the rest of their lives. Allowing the virus to spread unchecked will create a large segment who are unnecessarily and permanently disabled.”
This is pure conjecture not based on any evidence.
Posted by Millennial
“Would the article author give up his ventilator for me? After all, I’m younger and the facts show that I’m more likely to survive.”
Ventilator is a death sentence for 85% of Covid patients. I don’t want to speak for the author, but I’m sure he would gladly give up the ventilator.
Posted by Eye roll
“This reminds me of the Texas Lt. Governor saying “there are more important things than living”. You’re willing to sacrifice my life for your financial gain.”
This is worst comment of thread. Finances and life are on both sides of the equation. When you lose your job and income, when you’re isolated and kept away from friends and social acquaintances, when you’re having a heart attack but afraid to go to hospital from fear-mongering about Covid, when you can’t get your annual mammogram, or your chemotherapy treatments because the doctors and staff have been furloughed, when you can’t hold your dying mom’s hand in the ICU or give her a proper burial, can you not comprehend all that has economic and life consequences too?
@Alvin, excellent commentary. Hopeful that people will read with open minds.
The hardest thing to reboot in our economy is the human spirit behind productivity and consumption that fuels the economy. Whether it be layoffs, illness or fear, the level of productivity and consumption won’t be the same, no matter if we open now or later, though later will be exponentially worse.
There are very few countries in the world that have escaped this with their economic confidence intact, largely in East Asia and Western Europe that have highly functioning government that caught COVID-19 before it spiraled out like it did in here. I don’t know what it will take to reboot American economic confidence.
Plus side is that productivity and consumption have always had a major toll on the environment.
I just lost my baby brother to Covid-19. He was buried today. He was 57, in excellent health , worked in civil protection thus more able than the majority to assess risk. He was also a former marine and naval officer with a wealth of knowledge in medical matters. A business trip seems to have been the viral point of contact. After a little over two months in the ICU with fantastic health care, he succumbed to a lung hemorrhage as a result of the virus. So forgive me for thinking that limiting social contact is a good thing. The economy will improve as we feel safe and confident, not because shops are open or closed. Yes, many shops will not reopen. Neither will anyone who dies of Covid-19 come back to life.
We don’t know enough about the virus to formulate what will or will not result in heard immunity. But what I know is that many times people will formulate opinions that reflect their political views. Bleach cocktail anyone? are the bars open yet?
“Take the shutdown skeptics seriously” from The Atlantic: https://www.theatlantic.com/ideas/archive/2020/05/take-shutdown-skeptics-seriously/611419/
It doesn’t say skeptics are right. But it does say we do not know because it’s unknown how long it will be to a vaccine or effective treatment. “The last global depression created conditions for a catastrophic world war that killed roughly 75 to 80 million people. Is that a possibility? The downside risks and costs of every approach are real, frightening, and depressing, no matter how little one thinks of reopening now.”
I am fortunate to be able to work from home in these times, so my comments and opinions come from a place of privilege. I am believe in the SIP so that I and my family do not become vectors that spread the virus. We have family and friends with diabetes, CF, heart disease, and elderly relatives. I will do what it takes to keep them healthy. I am not afraid of the virus for myself, but I am afraid to be the one that spreads it.
Thanks for the great column Andy. I agree with just about everything you said. The one thing I would add is a discussion about masks. We all will need to use them for doing many things for quite a long time.
Regards,
Howard
I have news for everyone. The horse is out of the barn.
The American public is undergoing a massive exposure experiment. We will learn much more about the May-June-July virus characteristics and who it hits and misses.
Grand American individualism is underway in almost every communities with slightly different demographics, viral loads and transmission vectors. This will give us real info about herd immunity and mentality. Today assumptions will be clearer and less risky.
However, we wont learn much about the seasonal Covid characteristics or unknown human vulnerabilities during the fall/winter “flu” season.
It is very interesting that some people are so concerned about unemployment among the poor and minorities, who are the people most likely to be sent into dangerous work environments and become sick themselves and create another surge.
Could these comfortable Palo Altans have an ulterior motive? It is like the people who had no problem sending the poor and minorities to fight our wars.
Clearly, we need to reopen slowly and carefully so that unhealthy work and social practices can be identified and corrected.
This needs to be done in conjunction with increased testing and 100% tracing. The US needs to learn from others rather than thinking we are exceptional and we can get away taking shortcuts because we are not willing to make any sacrifices.
How would the current generation have performed in WWII? That generation made much greater sacrifices than we seem to be willing to make today. The US is a rich country and can make sure that nobody goes hungry.
We don’t need herd immunity, but rather herd compassion. Because those with preexisting conditions, or older are more vulnerable to dying or must suffer from long term problems because of having COVID-19, does not mean they can be sacrificed for the good of the herd.
The major problem we as a country faced from the beginning of this pandemic, which by the way, may have been last December (such a case was discovered in France), is a dysfunctional response from those who govern this country. The lies and excuses are too, too long to list. But, any idiot who would recommend injecting household disinfectants as a possible way to stop this virus can only be considered to be an idiot.
The lack of compassion for the doctors, nurses and other members of the medical community is totally lacking at the highest level of our government. They go to work knowing they may not return. This is not a part of their job description. The lack of and continuing difficulty to acquire PPE by these amazing human beings is beyond intolerable when the leaders say all is well on that front. Without belaboring these issues, its time for Americans to wake up and understand the inconvenience of SIP, social distancing, and wearing a mask is well worth the number of lives that will be saved.
Taiwan, New Zealand, and Hong Kong have stopped this virus in its tracks by early action and minimized deaths. Taiwan never shutdown either the economy or the schools. Yes, masks, social distancing, massive testing, taking temperatures, and quarantines were and are still required. But what a win. It makes me wonder what’s missing in America.
This strange willingness to coerce workers to remain in meat processing plants without doing the required testing and safe distancing is insane. The workers were poor and need the money. They have super high rates of infection and death. Hopefully, they’ll all abandon their jobs until the proper work environment is in place. That is asking so very little.
The US has the world’s worst response PERIOD. Be thankful Gavin Newsom is our governor, and remember this simple fact. Each infected person on the average infects at least 2 more and perhaps 3.
So, the infections go 2, 4, 8, 16, 32, …, 1,048,576 after the 20th level of this expansion. One stupid kid at the beach can cause a hell of a lot of damage.
Economies come back, the dead never do.
> Another major assumption you’ve made, is that post infection, COVID-19 is similar to flu.
Japan assumed CoVid spread like the flu, and now Hokkaido, one of the earliest areas to react to the virus, has opened prematurely and has had to return to lockdown. It’s the nightmare scenario that relaxing a lockdown not only further endangers lives, but backfires and shuts down the economy. You can’t go back to work when you’re sick.
“Experts say restrictions were lifted too quickly and too soon because of pressure from local businesses, coupled with a false sense of security in its declining infection rate. …
Hokkaido’s two main industries—agriculture and tourism—had been devastated. Farmers watched produce rot because restaurants and school lunch programs stopped buying it. An estimated 50 food processing companies went bankrupt. And Hokkaido’s dairy industry was hit so hard that the Ministry of Agriculture launched a video campaign featuring a ministry official dressed as a cow, to encourage people to drink more milk. …
On March 18, Suzuki assembled his advisers and decided it was time to ease restrictions. Nagase, the doctor who helped coordinate the government’s response, says that at that time, officials had only a limited understanding of the virus and how quickly it could spread. “Hokkaido was the first big outbreak here, so we were really operating in the dark.” Without sufficient data, doctors based their recommendations on the idea that the coronavirus spread like influenza. Nagase says he now regrets not pushing for more testing from the beginning. …
On April 14, Hokkaido was forced to announce a state of emergency for a second time. The island had 279 reported cases, an increase of about 80% from when the governor lifted the first lockdown less than a month before. As of Wednesday, there were 495 cases in Hokkaido.”
Hokkaido: https://time.com/5826918/hokkaido-coronavirus-lockdown/
*****
Natural herd immunity also assumes, well, immunity. This news article of May 8th says we do not yet know how long someone infected by CoVid will be immune to the virus. Until we study CoVid more, we do not truly know what percentage of the population needs to be infected, nor how often someone has to be re-infected to continue to create antibodies. It’s entirely possible that, if the immunity granted by the virus loses its efficacy, no natural herd immunity can be achieved. Seems like people have forgotten that Great Britain considered herd immunity, and decided against it.
“But what happens long-term is still unknown. A study from Chinese researchers on healthcare workers who recovered from SARS — which is also a coronavirus — in 2002 found that the number of SARS antibodies in their bloodstreams rose for the next few years, peaking in 2004, then declined after that until the study ended in 2015.
Although that research also hasn’t been peer-reviewed yet, it raises questions about whether recovered SARS patients had “complete protection” from reinfection years later. Because the new coronavirus shares 79.5% of its genetic code with SARS, it’s possible that antibodies for the new coronavirus might behave similarly.
Immunity: https://news.yahoo.com/actually-know-still-dont-know-185200201.html
> Palo Alto resident Andy Robin likes facts.
Too bad he’s making conclusions when we don’t have enough of them.
* We don’t have enough testing kits to determine the actual percent of the country infected.
* Test kits from China, including Chinese kits sold through American and other countries, are not accurate, and those from the CDC had contamination.
* We do not know how long natural immunity lasts from an infection, nor its rate of decline in effectiveness after an infection.
* We do not know how many deaths are caused directly by the virus versus comorbidity (death caused by the virus on a vulnerable victim). About 1/3 of Americans are obese and over 2/3 are overweight, suggesting that many Americans are vulnerable to the virus.
* We do not have information from those who are not seeking medical attention from lack of health insurance (eg. lower socioeconomic classes) or fear of infection at hospitals.
* We do not know well the less common effects of the virus on victims, such as heart attack and skin discoloration (“Covid toes”). The virus has been found in the brain stem and even semen of a few victims, but what danger, if any, this means is not known.
* We do not know the long-term effects of the virus. Concerns include damage to the lung and heart. Additionally, since the virus attacks the immune system, it is possible for someone infected by the virus to be vulnerable to another disease.
Obesity: https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity
Johns Hopking article: https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/what-coronavirus-does-to-the-lungs
Why is this person not advocating for strict tracing and isolation?
Why would anybody have any more confidence in Andy Robin than Donald Trump?
People have no confidence in leadership and adding more unsophisticated opinions to the mix is not helping?
If, as Dr. Cody said early on, most people will be infected before a vaccine is available (if one is ever available), what are we waiting for now? Originally, it was to expand hospital capacity. But not only was that goal achieved, we’re now removing an excess of beds (at the Convention Center). So, it seems like it’s time to get on with things. I’m not saying I don’t care about people dying, I’m just being logical. Why procrastinate, when infection is all but inevitable for most of us (again, according to our health experts)?
Boris Johnson has outlined plans to reopen Britain’s economy, citing decreasing coronavirus hospitalizations and deaths, but is encouraging those who will need to return to work “to avoid public transportation and to bike, walk or drive instead”. New rules will also require travelers arriving in the UK by air to enter quarantine for 14 days.
Did we shut down the wrong businesses? Why are the trains, buses, and airports still wide open? If we shut down these crowded and poorly ventilated transportation system where “accelerated transmission” takes place, could we open up the rest of our economy?
TimR,
You may not realize how racist you are being. You want the poor to go to work in dangerous conditions to satisfy some need that you have which you have not made clear.
Why not advocate for sufficient testing, tracing, and isolating which the successful countries have done? You are trying to aid and abet the massive failure of the US public health system. The US is rich enough to demand and implement an effective public health system.
A New York Times opinion published May 11 says, “People can work in two-week cycles, on the job for four days then, by the time they might become infectious, 10 days at home in lockdown.” The authors are Uri Alon, Ron Milo and Eran Yashiv, two of whom are professors of computational and systems biology at the Weizmann Institute of Science in Israel. From the article:
“Models we created at the Weizmann Institute in Israel predict that this two-week cycle can reduce the virus’s reproduction number — the average number of people infected by each infected person — below one. So a 10-4 cycle could suppress the epidemic while allowing sustainable economic activity.
“Even if someone is infected, and without symptoms, he or she would be in contact with people outside their household for only four days every two weeks, not 10 days, as with a normal schedule. This strategy packs another punch: It reduces the density of people at work and school, thus curtailing the transmission of the virus.
“Schools could have students attend for four consecutive days every two weeks, in two alternating groups, and use distance-learning methods on the other school days. Children would go to school on the same days as their parents go to work.
“Businesses would work almost continuously, alternating between two groups of workers, for regular and predictable production. This would increase consumer confidence, shoring up supply and demand simultaneously.”
Link: https://www.nytimes.com/2020/05/11/opinion/coronavirus-reopen.html
Vaccines are not safe. Vaccine manufacturers have total immunity from lawsuits, even death by vaccine. As a business owner I find that astounding. If I had total immunity from any harm my products caused, and the legal backing of the state that you must use my products in order to go to school, I would be filthy rich!
Guess what that is exactly what is happening now in California. Kids must take vaccines in order to go to school, creating forced profits for the vaccine companies. vaccine companies are immune from lawsuit meaning they can be as lax as they want and put anything they want in there and you cannot sue them.
Now they have government by the barrel of the gun forcing you to stay home until a vaccine comes out. Follow the money! This pandemic could not have been better for the vaccine profit industry.
I know vaccines are not safe as my son suffered encephalitis from his 6-mth shots. Vaccines are not the answer and It is a crime to make them mandatory to go back to work and to school. Vaccine manufacturers are exempt from lawsuits! What incentive do they have to make anything safe?
Posted by Small Business Owner, a resident of Adobe-Meadow
>> Vaccines are not safe.
I like to hear lots of opinions, even when they are wrong-headed. In this case, though, your opinion is irresponsible garbage. You ought to be ashamed of yourself.
Posted by Midtown mom, a resident of Midtown
>> A New York Times opinion published May 11 says, “People can work in two-week cycles, on the job for four days then, by the time they might become infectious, 10 days at home in lockdown.”
Interesting idea. It certainly could apply to many service jobs. I note, though, that while it applies to the employee side, there doesn’t seem to be an obvious equivalent for the customer side. Some longer-cycle variant of even-odd license plate restrictions based on– birthdays, say?
@Anon,
That’s really intriguing.
There could be an equivalent on the customer side, if we had software enabling us to make reservations at local businesses to shop (and if those reservations allowed us to let the business know what we’re planning to buy so they can manage stock to ensure people get what they need). I would be thrilled to go back to being able to bulk-buy and only do that once every two months. If my reservation were attached to some kind of personal information that ensured fairness, this could help on the customer side.
Could it allow people to resume sit-in at restaurants safely?
^ Fairness is in the eye of the beholder.
“Herd immunity arrives when 60-70% of people have had the virus — whether asymptomatically or with mild to deadly symptoms.”
Clearly this author does not understand what they are writing about.
First, while it is very well established that deadly symptoms reliably produce permanent immunity, such immunity is always so highly localized that it contributes nothing to the herd immunity.
Second, where does the 60-70% number come from?
Third, what is the cost of achieving actual herd immunity?
Fourth, who decides that that cost is acceptable?
There may never be a vaccine for COVID-19 (aka SARS-CoV-2).
They still have not been able to make a vaccine for Middle East Respiratory Syndrome (MERS-CoV), Severe Acute Respiratory Syndrome (SARS-CoV), or the common cold.
I attempted to start a thread to discuss reopening Santa Clara County. Unfortunately they have not printed it yet.
I read about how Europe is reopening, with dates, timetables, schedules and even including the start of professional sports (albeit without fans). Santa Clara County was the first to close and as yet has done nothing apart from releasing rules on outdoor workers such as gardeners and construction, to reopen the economy. We are suffering and if we don’t reopen or at least get a timetable soon, there will not be any small businesses left to reopen.
@Resident, what is of even more concern is the general presumption that we need to make these huge changes in our shopping, travel, lifestyles in general as if this virus is going to be around forever. What a horrible thought that we move forward living in our respective little bubbles, sanitized and separate from everything. What a dystopian outlook and frightening that so many are almost gleefully planning for it!
The mental health and developmental impact on school children is being ignored. I personally find this abhorrent that we’ll “cancel” life with endless lockdown while ignoring the very real second order effects.
Posted by Wake up!, a resident of Mountain View
>> @Resident, what is of even more concern is the general presumption that we need to make these huge changes in our shopping, travel, lifestyles in general as if this virus is going to be around forever.
What if it is? What if a vaccine proves infeasible? And, what if it takes 2-3 years, even with the multiple crash programs going on now? How will we keep the fundamentals of the economy running for three years in the meantime?
>> What a horrible thought that we move forward living in our respective little bubbles, sanitized and separate from everything.
What if we don’t have any choice?
>> What a dystopian outlook and frightening that so many are almost gleefully planning for it!
Let’s look at it from a different angle. Minimizing the deaths and the disabilities (a distinct possibility given some of the outcomes so far) due to SARS-CoV-2 infection, is an extremely high priority to me. Minimizing the extent of “physical distancing” seems to be extremely high priority to you. (I’ve had one very disappointing experience in this regard this month also, but, I’m coping with it because I have to.) Perhaps there is some combination of measures that will work for both of us?
Ahem,
“They still have not been able to make a vaccine for Middle East Respiratory Syndrome (MERS-CoV), Severe Acute Respiratory Syndrome (SARS-CoV).”
Not true. No vaccines for those made it past phase 1 trails because the funding was cut, but many have been “made” (just not fully tested). And yes, others did fail. But given the similarity of the now infamous spike protein on both SARS-CoV-1 and -2, there’s even a possibility one of those old -1 vaccines will work on -2. Tests are ongoing as we speak. But in general, based on all the past work, researchers are very confident the that spike protein in SARV-CoV-2 can be “nuetralized” with a vaccine.
Article on vaccination says, “It is unclear what percentage of the population would need to be vaccinated against SARS-CoV-2, but in general, you need to immunize between 80% and 95% of the population to have effective herd immunity.” So even initial estimates of 60% to 70% for “natural herd immunity” may be too low.
A protective vaccine for SARS-Cov2 is likely to be the most effective public health tool to get back to that world. : https://www.inverse.com/science/what-needs-to-go-right-to-get-a-coronavirus-vaccine-in-12-18-months
Should mention that, if you intentionally infect Californians, the “young” range of Californians between 20 and 54 is about 48% as of 2018. This range, however, includes those with pre-existing conditions, who would not count for the “healthy” requirement of an intentional infection. With 1/3 of Americans being obese alone, a “young and healthy” percentage would be about 16% of California, a percentage lower than even the optimistic 20% I’ve seen to achieve “natural herd immunity”. This number is further reduced by other pre-existing conditions, and multigenerational households, including children.
Conversely, this means that if you do not intentionally infect Californians, you will not achieve even 20% infection unless you infect children, the elderly, and those with pre-existing conditions. Ethical issues should be obvious.
Census demographics : https://censusreporter.org/profiles/04000US06-california/
> @Resident, what is of even more concern is the general presumption that we need to make these huge changes in our shopping, travel, lifestyles
I actually just read an interesting argument today that, while a lockdown is necessary, it is only necessary to reduce the contagion rate to about zero. At that point, we can then relax lockdown standards suchthat the contagion rate is lower than one. The article is called “Hammer and Dance”, a fancy way of expressing suppression as the first step in containing an epidemic, followed by close monitoring of the spread of the infection. Note, of course, that allowing the contagion rate to increase increases the likelihood of any individual contracting the virus.
“It all turns around the R. If you remember, it’s the transmission rate. Early on in a standard, unprepared country, it’s somewhere between 2 and 3: During the few weeks that somebody is infected, they infect between 2 and 3 other people on average.
If R is above 1, infections grow exponentially into an epidemic. If it’s below 1, they die down.
During the Hammer, the goal is to get R as close to zero, as fast as possible, to quench the epidemic. In Wuhan, it is calculated that R was initially 3.9, and after the lockdown and centralized quarantine, it went down to 0.32.
But once you move into the Dance, you don’t need to do that anymore. You just need your R to stay below 1: a lot of the social distancing measures have true, hard costs on people. They might lose their job, their business, their healthy habits…”
Coronavirus: The Hammer and the Dance :
https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-the-dance-be9337092b56
*****
On the economic side, we can look at how Taiwan is doing. Unlike most western countries, Taiwan and other Asian countries acted in January, so these countries did not necessarily have to resort to lockdowns. They should be seen as a cautious warning to the assumption that, if we end the lockdowns, western economies will return to normal.
“The economic damage inflicted by the coronavirus pandemic has been relatively muted in Taiwan by regional standards, largely thanks to the country’s quick and organized response to contain the viral outbreak. … However, plunging global demand prospects indicate that Taiwan will not remain immune from the wider economic slowdown, with domestic demand likely dampened as a result of deferred consumer spending. As such, the government announced further stimulus funding in early April, taking the potential total to USD 35 billion—around 5% of GDP.
Taiwan : https://www.focus-economics.com/countries/taiwan
Taiwan : https://fee.org/articles/why-taiwan-hasnt-shut-down-its-economy/
@C, the current value of R looks close to 1.0 for California. The number of new cases per day has been jumping around between 1500 and 2000 for a couple weeks now. If R were 0.5 we’d cut new cases in half every 6 days (what time constant should we use?) or down a factor of 32 in a month. I don’t see it happening for California as a whole. Do we want to enforce smaller geographical areas?
Sorry Tim, you don’t have a vaccine until it has been tested, and confidence is just something researchers need to have to get funded.
Too bad investors didn’t have the same confidence in the SARS vaccine as the researchers. A little something to do with results in animals that indicated the “vaccine” might cause harm in humans.
> For COVID-19 to become history (even in just the U.S.), herd immunity
> has to be reached
Please, all you people with claims about how to react to C-19 would carefully and explicitly define and explain what they mean. Specifically, how is this defined? How do we measure it? What are the consequences of going there under different circumstances?
As of this point we do not even know for sure if there is such a thing as “herd immunity”. If there is then what does it mean in terms of sick people and fatally sick people?
> That said, if a lot more people are to get the virus to achieve herd
> immunity, we need to be sure that a lot more people don’t die
> from the virus.
Yeah, there’s always a catch somewhere ain’t there? Wave you hands some more! Perhaps a magic wand would come in handy?
I don’t think these herd immunity claims and theories are well thought out, or even thought out at all. I think they are emotional reactions to try to push people to a place where they are forced by peer pressure to agree to take unknown risks.
One important thing about risk management is that you really have to have a clear idea about the risk you are talking about.
I have a friend who is a Belgium virologist who is stuck in a flat in London.
He came down with Covid-19 during the herd immunity period in the UK. He has been suffering for almost 2 months with lingering symptoms. Fever, exhaustion, pulmonary clots. He had been hospitalized twice. He wouldn’t wish this to happen to any person. He told our group “to hell with herd immunity”. He is not sure that he will recover. He is 71 – slim and physically fit. I am not sure he will be able to go back to work in the lab.
‘The price you pay’: Sweden’s ‘herd immunity’ experiment backfires
“Initially, Sweden saw death rates from COVID-19 that were similar to other European nations that had closed down their economies. But now the Scandinavian nation’s daily death toll per 1 million people is 8.71 compared to the United States’ 4.59, according to online publication Our World in Data. Sweden’s mortality rate is the highest in Europe. …
Scientists estimate herd immunity for the coronavirus is reached when 70-90% of the population becomes immune to a virus, either by becoming infected or getting a protective vaccine.
Despite its relaxed response, Sweden is nowhere near to hitting that goal. Tests on 1,118 Stockholm residents carried out by Sweden’s Public Health Agency over one week in late April showed that only 7.3% had developed the antibodies needed to stave off the disease.”
https://www.sfgate.com/science/article/Sweden-herd-immunity-experiment-backfires-covid-15289437.php?utm_campaign=CMS%20Sharing%20Tools%20(Desktop)&utm_source=reddit.com&utm_medium=referral
One issue I have with the “natural herd immunity” percentages (which range from over 60% to 20%) is that I’m not clear on what basis of how long the immunity lasts these articles are using. Obviously, a “natural herd immunity” that lasts a lifetime will have a lower percentage than one that does now. An initial study suggests that immunity lasts six months, and that depending on how many strains there are for the virus (possibly two for now), you may need a separate immunity from each of them.
New study suggests COVID-19 immunity might only last 6 months, so how safe are you? :
https://www.wtsp.com/article/news/health/coronavirus/new-study-suggest-covid-19-immunity-lasts-6-months/67-9e806e0f-f7b5-4348-b7be-ba95a06988e5
Coronavirus: Why hand-washing and distancing might be ‘insufficient’ – and herd immunity now looks ‘unachievable’
All this comes after further doubt was shed on the possibility of herd immunity earlier this week by an updated Lancet study showing that just five per cent of Spain’s population has developed antibodies, despite having one of the world’s highest death tolls. Given that seroprevalence of at least 60% would be required, it was concluded that “herd immunity through natural infection is not only highly unethical, but also unachievable”. It is unclear what degree of protection antibodies actually offer anyway, as the study – the largest in Europe to date – also found that over the course of eight weeks, 14% of participants who had initially tested positive for antibodies had no trace of them by the end. That is not to say they are not immune – they could have cellular immunity instead – but it is another of the virus’ conundrums.
Meanwhile, increasing evidence is also emerging about the long-term consequences of infection with Covid-19. Studies have found high rates of lung scarring – even those who had mild symptoms – and of blood clots leading to strokes, heart attacks, lung embolisms, and limb amputations. Abnormal blood clotting has even been reported in patients who appear to have recovered. Neuropsychiatric complications have also emerged, with a study of 125 hospital patients in the UK finding that 39 patients suffered an altered mental state, including encephalitis (an inflammation of the brain which can cause confusion and mobility problems); 10 had a newly diagnosed psychosis; and six had dementia-like symptoms such as short-term memory deterioration. Half of those who experienced altered mental status were younger than 60.”
https://www.heraldscotland.com/news/18569865.coronavirus-hand-washing-distancing-might-insufficient—herd-immunity-now-looks-unachievable/