Sorry, my bad. I thought you were saying something else, but that’s on me. In my defense, I’m having a lot of trouble with the board lately, and I’m also short attention span, so we’ll just put it on me. My apologies.
You completely did not answer the question. What are you going to do with the tests? The tests will not stop more people from being infected. It will just tell you how is immune. Maybe.
How long do you think we can keep doing social distancing? You didn’t answer how long we need to wait, just “much longer than we’d like.” How long do you think people can go without a paycheck and no functioning economy?
The quarantine did not containing the virus. That isn’t flat out wrong. It spread, despite trying to quarantine people. Now we are trying social distancing. That maybe is slowing it down, as you said, but it will not stop it. No expert I’ve heard said social distancing will stop it. All they say is that it will keep us from overwhelming the medical system. Maybe. Some claim we’ll still overwhelm the medical system, but not as much.
I’m getting tired of the mischaracterization of my argument. Stop it. I’m all for social distancing, ramping up medical supplies and equipment, emergency measures where needed. Please find me one reputable source that thinks this will go away before we have reached at least 20% exposure. Find one source that thinks the only way we are going to end this in a way other than having herd immunity, either through vaccination or exposure. We need to face the reality that this thing is too virulent to be contained by your quarantining and isolation methods. We can slow it down that way, but not make it go away. It will only go away when we have herd immunity. A vaccine is 12 to 18 months away. yes, I don’t think our society can wait that long. That leaves one other option.
I answered. We will use the tests, identify who is infected, quarantine them. This will absolutely stop people from being infected. It has done so many, many times before.
I don’t know how long it will take. No one knows. That doesn’t mean it doesn’t work, which it does.
The quarantine Combined with distancing is containing the virus in countries where quarantine/distancing was very strict (China) where it was strict, eventually (southern Italy not being like northern Italy) , and where testing was wide-spread (S.Korea). It is even showing promising signs here in the US in some areas, though is too early to tell. And that’s just it - saying it isn’t working, when you cannot tell yet, is at best not understanding the concept, and at worst disingenuous.
Find me one reputable source who thinks deliberately infecting any sub-section of the population is a good idea. Or even an idea.
The fact is, quarantining and distancing has worked with many, many outbreaks in the past, and has worked with this one in other places.
When we had a handful of infected people in this country we tried to quarantine them and it didn’t work. Now we have tests and we are finding out who is infected and it is still spreading. Over 20,000 new cases/day. We cannot test fast enough to get ahead of this. It isn’t working.
You talked about an antibody test and how to use that. Again, we need a plan that goes beyond, “just find out who is infected and hide them away.” That isn’t working. We have nearly 200,000 infected in this country. If trying to isolate the infected would have worked before, it isn’t going to work now.
The quarantining with distancing is slowing it down. But it won’t end it. So again, that doesn’t end it. Just slows it down. It will need to end. Let’s suppose we take your method and implement it to near perfection for however long it takes. How does it end? When will it be safe to lift the safeguards and go back to life as normal?
The only proposals I’ve see are to either lock down everything or do nothing. There are others out there who have proposed this, but they aren’t epidemiologists or people I would consider authorities on infectious diseases.
I’ve not heard anyone with the right credentials talk about controlled exposure. There are a lot of details which would need to be worked out and it would be extremely difficult to undertake in a way that wouldn’t just end up worse than where we are. On the flip side, I haven’t seen debate about this topic, either. As you indicate, that could be because the idea is just insane and completely unworkable. If there were real discussions on why it wouldn’t work I’d be be happier, but certainly the fact no one has proposed it means I might be missing something obvious. I haven’t seen anything in these discussions which make it obviously unworkable. Mostly people just characterize the proposal as, “you just want to do nothing and let darwin sort it out??”, which I don’t.
On the contrary, I understand the dynamics of the situation very well. I assume I’m going to get this disease. I don’t know if it will be now or a year from now. I’m in my 40’s, decent health, but I also know that no age group is really safe.
That’s a moot question in my area, because the medical system is already at capacity if not over capacity. A bed and ventilator for me would mean a 2-4 hour ground transport to a nearby medical facility, where I would consume their capacity and increase their contamination risk.
The only reasonable goal here is to slow the hospitalization rate as much as we can. Your approach is not beneficial because it increases the hospitalization rate. Unless of course you volunteer to waive access to hospital care. Only in that case does your plan reduce load on the medical system.
i’ve made my case, so have others.
It’s why they talk so much about ‘flattening the curve’. It’s to try and spread or space out the infection so that our medical system can sustain the numbers and mitigate the deaths. Whereas if you overwhelm the system, more people will fall through the cracks for exactly the reasons you are saying here, i.e. we won’t have enough capacity to take the level of care we need for everyone. Guess who will be most likely to fall through the cracks?
If the area is already overloaded, there clearly is no benefit to adding more to it. I get that. On the other hand, the VAST majority of areas in the US are well under capacity at this point. Why wait until they are at capacity? How would it be of any benefit to me to wait for them to be at capacity? I don’t understand your logic. You say you expect you will get the virus, as do I. If I get it now, I can get hospitalization and not overburden the system. If I wait, it is more likely to be a time when the system is overburdened.
No, you didn’t. You claimed that testing will help stop this, but you don’t say how it will stop it. Testing will only work if we can stop giving it new hosts. That isn’t working. Anywhere.
You held up Ebola as an example. I asked how that was contained. You didn’t answer. Make your case about how we can contain this in the same way Ebola or SARS or MERS was contained.
There is no cure and no vaccine for this disease. That is a fact. Therefore, the only way it can be stopped is to stop giving it new hosts. Presently, the only way to do that is to make enough of the population immune, because it is obvious that trying to keep it from spreading isn’t and never will work.
Do you have another proposal on how this will end?
Well, time’s a wasting. NYC is already over capacity, and Detroit, much of Florida, Chicago, and Boston, to name a few, are right behind them. I suggest you go get your virus on asap as I think your window for under-capacity hospitals is closing in weeks not months. And you may find that others have already thought of this and will also be trying to move to less-hot spots. I can’t imagine you will be particularly welcomed.
The trouble with testing is simply that even now there physically are not enough test kits available to perform test and quarantine. The regime of test and quarantine has never been tried anywhere. The only people tested and quarantined were those who were already ill. That isn’t a true test and quarantine system. Testing has mostly been to sort out why a patient is critically ill, and to test contacts. Perhaps the only really useful mass test we have seen is the Diamond Princess. But they were only tested once.
In order to have a proper test and quarantine system you need to test every member of the population, and do it regularly. The logistics are impossible. There are not the test kits in existence, nor the medical staff to administer and process the tests. Test kits are becoming available in the units of millions, not in the billions. Even in just the US you may need over a billion test kits to try run test and quarantine as an active tactic. Test kits for mass testing may eventually become available, but they don’t exist yet. Even then, the emphasis of mass testing is likely to be for immunity, not infection.
It is of course the latency between infection, becoming infectious, and finally becoming symptomatic that is the problem. But that is hardly news.
I’m doing as told. My social circle is now the 2 people in my house. I go to the store about once ever 2 weeks. I exercise at 5:00 in the morning, alone, running on paths and roads that are empty.
Now imagine of those places had gotten 1/2 the people through this virus prior to now. Tada! No more over capacity because all that capacity that existed a month ago would have been used.
Systems thinking 101 - a system can either be optimized to maximize productivity or responsiveness.
If we prioritize productivity, then we load it at 100% capacity all the time, accepting that some of the clients will wait.
If we prioritize responsiveness, then we have to maintain some idle capacity so that someone can always serve the client. Unless of course capacity is elastic, and we can ramp it up. Our medical system isn’t very elastic, so we can rule out that option.
This disease is an acute respiratory crisis. Therefore our medical system needs to prioritize responsiveness, therefore every facility should have some unused capacity, therefore it would be irresponsible to put any avoidable load on the system.
That’s why we should not only be avoiding COVID, but painting on tall ladders, working with high-voltage wires, filming motorcycle stunts, eating expired sushi, anything at all that’s medically risky or optional. We all need to do our best to stay out of the medical system for a while, to the extent that it’s feasible.
This might be easier to understand if you accept that it’s not all about you, it’s about everybody.
You asked a great question to open this. How does this go from here?
I’m saying it can only end when we get to herd immunity levels, either through vaccine or people getting through it. I pushed it beyond that on ways I think we can get to that level sooner and with less stress on the medical system, but that was trying to answer the question of how this goes from here. That is one option.
Some unused, sure. But right now there is way more unused than is needed to be available. We can be utilizing that capacity NOW instead of backing up the system when it is overloaded in 3 weeks.
Yeah, okay. What good does it do to keep 1/2 the hospital critical care beds empty (or 40% empty) for the next 3 weeks and then have them at 150% capacity in 3 weeks? You’ve just killed responsiveness. If you put more through now, you increase responsiveness later.
So substitute “society” for “me” and you get the same answer. As I’ve said, it benefits society as a whole, and me in particular for me to be OUT OF THE SYSTEM BY THE TIME THE PEAK HAPPENS. How can you possibly be arguing that it is better for society that I also need treatment when the peak hits?
This is my last post on this.
Social distancing is trying to push cases to the back end of the curve because that must mean there will be more resources available later. Why is it so hard to grasp that we can also be utilizing the front end of the curve in exactly the same way?
Cmosdes, your idea might be practical (though I’m not sure that it could ever be organised fast enough and well enough) but a lot of official type people are going to find it very unethical. You know that some people you infect are going to die, and unless your quarantine is perfect, you risk spreading it to others who haven’t consented. Most places can’t even do assisted suicide for terminal patients and now you want the government to actively kill young, healthy adults. It’s a tough sell.
Plus no one is really sure how much time there is before things get out of hand. Expose you now and you might not get sick for 2 weeks. Who knows what things will be like in 2 weeks. Plus the 3-6 weeks recovery time.
What do they do with you now that you have recovered? Do you now go to work in aged care facilities, or as a delivery driver, or some kind of hospital job? Is that part of the contract? Good on you for being willing to risk your life, and change your occupation for the good of the community, but I don’t know how many people would be keen to do it.
- We’d be looking for volunteers, not draftees.
- We are better capable now of saving people who will react to this virus than we will be in 3 weeks.
- We could have been doing this in early/mid February. We knew damn well back then it wouldn’t be out of hand in 3 weeks.
- Things might be worse in two weeks. But there are no indications of that in most areas. NY knows it is two weeks from the peak, so don’t do it in NY. Same with a few other places.
- Yes, those infected purposely might infect others. But if we infect them purposely we keep them quarantined in designated areas and control that. That would actually reduce the number of accidental transmissions.
- Even if they do nothing after recovering, they are no longer vectors and accidental transmission is no longer possible. There is NO downside to having more people on the other side of this.
- What will people do in 3 weeks when this thing is ripping through communities? Those that were infected earlier can help, if they want, or they can sit at home. Either way, they are no longer going to be part of the problem, which they very well might be given our present course.
You are dead on correct that the optics of this make it implausible. And you are also correct that it is too late now to try and do this. Add to that all the variables we can’t control for and this idea is dead, at least on a concerted, organized level.
- There can’t be any volunteers because there is no testing.
- Yes, you are right, in two weeks things will be much worse.
- We could have been doing a lot of things in February that would have helped greatly, but that’s over. The Stupid won February.
- You are quite absolutely wrong. In two weeks things will be worse almost everywhere. Exponential growth doesn’t take long to get worse and the virus is in every state now.
There is no point in purposely infected people at all, as infection is happening much too fast to quarantine anyone.
This idea might – might – have had some merit at the beginning of February. But that window is closed and will stay closed forever. You may as well say, let’s get all the hospitals stocked with the hundreds of thousands of ventilators and all the PPE that they will need for this pandemic by February. An even better idea, eh? And yet, it is already April.
I think you’re grasping the core of the problem now, and neither of us really has any idea how much capacity is free, where the free capacity is, the logistics of utilizing it.
More importantly we don’t know when or where peak load is coming, how intense it will be, and when relief may come in the form of vaccines. We don’t even have test kits to know if we have areas that seem OK but may be ready to tip over.
Under some scenarios, you might be right that we could “shift left” as it’s called and try to get some clients through the system early. From where I sit, it looks like most large metros are already at or near capacity, and for the rest of the country the peak of the storm is soon to hit.