Stopping this thing is hopeless (COVID-19)

I’ve been giving this some thought, using my knowledge of nuclear reactors and the Game of Life, and I think all of these measures that are being taken are really pointless.
Now, it might slow down the rate of growth, but it seems to be a really impossible task to stop the spread of a disease that is highly contagious and infectious for many days before showing symptoms.

I was eating lunch at a restaurant today, and I was observing all the myriad ways that surfaces and objects get contaminated.

So, it’s just going to have to “burn out,” or subside due to warmer weather, IMHO.

Consider the first US case of this disease. Covered in the NEJM, IIRC, he is a 40 ish years old guy with high cholesterol, and no other significant co-morbidities. Nonetheless, he got it bad enough to require mechanical ventilation for a few days. We simply do not have enough vents or CCU beds for everyone who would need them,* if everyone got this bug at once.*. So, spread out the spread, avoid crushing healthcare resources, and perhaps the US can keep this death rate at SK levels?

Social distancing doesn’t just slow growth. It also reduces the total number of people that will get it.

Herd immunity kicks in when 1 - 1/R0 percentage of people are immune. Right now the R0 is 2+, which means that ~50% of the population will get it before it burns out. If we can bring R0 to 1.5 through social distancing, then only 33% of people get it.

Wash your hands. Clean surfaces. Cancel events. It won’t stop this thing in a few weeks, but it will mean fewer sick overall. Not just fewer sick at one time so that hospitals can cope better, but actually fewer total cases.

And even if it didn’t, slowing things down is a goal in itself

Well, its official. My appointment books says, “3:30- PANIC!!! 5:00- Take dogs off-roading”

The more you slow it down, the more likely the U.S. health system is able to handle it. In other words, we only have so much medical equipment and so many hospital beds. If you slow it down enough that the ERs and hospitals aren’t flooded, it’s more likely that more people who need treatment will get it, resulting in less loss of life.

Was talking to a friend who is a Nurse Practitioner at our local watering hole earlier this evening who told the story of a doctor at the facility she works at discussing contingency plans. When the doc stated that everything will clear up here in Texas because of warmer weather, she reminded the doc about the cases in Australia, Israel and other warm weather locals. The doc’s response was “well, I’m just trying to be hopeful.”

The phrase that pays is “flatten the curve”. You don’t want a high spike, you want a spread out thing.

Sure, we’d like this all to be over right away but the health care system can’t handle that.

The two outstanding reasons are flatten the curve (so the hospitals won’t be quite so overwhelmed) and try to reduce R (so a smaller percentage of the population will have to get it before it dies out naturally). And hope for a vaccine.

An infectious disease specialist was on Quirks and Quarks this afternoon making the prediction that the reason NY and Seattle are seen as the hot spots now is simply that the NY and Washington state health departments are among the best in the country and that states like Alabama, Mississippi, and Louisiana could have just as many without being aware of it. That’s probably an exaggeration since NY and Seattle are main international destinations.

I’d be surprised if rural states had as many cases as urban ones because human density is so different. In fact, it seems like there should be a density factor used in predictive calculations of where cases will be bad. A person in a dense city like Seattle could easily cross paths with hundreds of people in a typical day. In a less dense place, that would be more likely in the tens or single digits. That alone seems like it would greatly influence the number of cases.

Aside from the point you make in the parts I didn’t include, there is another reason transmission may be a bit lower. Personal space expectations tend to differ by population density. Those in rural areas are more likely to be further away from people they interact with. The advice about maintaining greater physical distance when interacting to slow the spread is easy to follow in a lot of rural areas. They do that everyday.

With regard to the disease subsiding due to warmer weather, the experts say there is no evidence to support that.

I agree that R0 goes down with social distancing, thus lowering the herd immunity threshold; but if we go back to normal, the threshold goes back up. In the end, with a “normal” R0 of 2 or 3, you need a large fraction of the population to be immune in order for outbreaks to decay rather than grow. It will be interesting to see what happens in China as they relax the constraints. Will the virus have another surge?

It will blow over quickly. No new cases in Wuhan in ten days, and Chinas main concern now is to stop foreigners from bringing it back in .
it is under control in China, and soon will be everywhere else.

Nitpick: No new cases in Hubei province outside of Wuhan in ten days. Wuhan had four new infections today.

He’s a 35 year old who never required mechanical ventilation. He needed minimal supplemental O2 for a few days - 2L by nasal cannula. The decision to treat him with an experimental Ebola drug may have helped.

Nonetheless, your point about overwhelming the available healthcare resources is obviously correct.

The US is not China. Things are not being controlled here like in China. Not in the least. We aren’t even testing in significant numbers yet despite plenty of lead time to set all that up.

Shoot, we’re not even as on-the-ball as Italy and that’s a real mess.

Not going to be “over” any time soon.

You know what frustrates me? So much of the messaging is backwards. We tell people to wash their hands when they come home. I just read an article in the local paper where a public health expert talked about how she always sanitizes/washes her hands after she pumps gas, touches a grocery cart, etc. And then, as we all figure out our personal boundaries with this thing, people are saying “I’m willing to risk it”, where “it” is catching the disease. But that’s exactly wrong. We shouldn’t be worried about catching it, we should be acting like we have it and worry about spreading it. We should be telling people to wash their hands–possible completely shower–right before they leave their home, to use hand sanitizer before they touch the gas pump or the grocery cart. You should avoid touching railings in case you leave a trail of virus for a vulnerable person.

This is what we need a real leader to say to America. Assume you have it. Take the steps you need to take to keep it to yourself.

No not likely to be ‘over’ soon. However you can’t compare directly to China in numerous ways, some aspects of which make it more promising elsewhere. It was spreading there with no public health knowledge (or acknowledgment, doesn’t really matter which for this purpose) at all for quite awhile. That’s not happening other places now including the US.

Also testing has naturally become a focal point for discussion (and potential political blaming) but is not the way you slow down spread. The tests don’t necessarily show positive if you’ve been exposed, will develop COVID, but haven’t. The virus is contained or slowed, besides by general change in public habits, by public health depts finding who was exposed to people who had it (whether or not a test would show positive) and focusing on isolating those people. Testing is part of that but not all of it. And testing should also soon expand.

So there’s all kinds of upside public health wise to slow the spread by social distancing, and containing the outbreak at least in various places for awhile (before it comes back in the area from someplace else perhaps). It’s not as simple as picking an R0 value, there will be all kinds of path dependencies and variations by area.

But it could spread to the sometimes estimated 10’s of % of the population, if it does, over quite a long time if it’s dealt with effectively from here. Might slow down seasonally too (though as was mentioned that’s far from sure, Australia has had a fair number of cases in late temperate summer besides tropical Singapore). Could even be long enough that it reaches big %'s after some antiviral treatments or even vaccine is introduced in many months or year+. Besides not overwhelming the health system short term, which is the critical goal for now.

The other side of coin is mainly economic. How long can people put up with very depressed economic activity from govt actions (school closing which obviously affects the ability of parents to work, in my city now restaurants can’t serve sit down customers till further notice, etc). There may come a time when you have to accept faster/more spread for that reason, but it’s not now IMO. The prospects of avoiding a really bad health outcome are far from hopeless.