The problem with your proposal, or just one of them really, is you’re assuming that this can be controlled in some precise manner. I’m pretty certain that it cannot. Trying to dial in “controlled” exposure and match it to some theoretical 85-90% hospital capacity is almost certainly an impossible task. Not with an infection this contagious, not with an impossible to assume and loosely random serious illness rate, not with an utterly impossible to gauge random hospital load from other sources at any given moment.
The only thing I can see your proposed program doing is accelerating infection rates while sorta hoping for the best. I can’t see any likelihood that would turn out well.
ETA: Not exactly ninja’ed, but I didn’t read that last post carefully enough. But essentially what HMS Irruncible said.
Vaccines are a year to a year and half away. Hoping for that miracle is the absolute worst way to try to fight this.
This thing does flare up, but not overnight. When there were 6 cases in a state, we could have been starting on this. There would have been no chance of going from 6 cases to an overwhelmed system that fast.
I cannot wrap my head around the concept that we don’t want to use known unused hospital capacity now because there is a very, very small chance we would under estimate critical care rate, so instead we are going to just wait, knowing we will be overwhelming our hospital systems later with the very same patients would could have treated earlier when we had capacity.
Can you present some numbers as to how a “controlled infection” could possibly be done that is helpful for building herd immunity, but doesn’t overwhelm the medical system? If it is true that 20% of people who contract it will be in serious enough condition to require hospitalization, then you can “controlled-infect” 5x the number of ICU beds that you have per day. The number of ICU beds in the entire US is <50,000, with potential to expand that to ~100,000 by repurposing other beds. So if you could magically infect 500,000 people per day, in exactly the locations where the 100,000 who need serious medical care can take the beds of those people who just recovered… to get to 50% of the American population having contracted it, it would take almost an entire year (327 days)! And this magically requires:
-Ability to precisely control the spread of the disease (so, quarantine people who volunteer to contract it immediately until they recover)
-Ability to immediately fill the bed of a recovered patient with a newly seriously-infected patient
-Have the controlled-infection cases spread out across the country exactly distributed where medical treatment can support them
-This is also assuming 100% of these ICU beds can be dedicated to covid-19 patients!
Unless you can show me otherwise, I see no way to do a “controlled infection” that meaningfully builds up herd immunity in a community quickly enough to be relevant. I don’t see how starting it early helps with anything - you can still only infect a small % of people at a time without overwhelming your medical capability. Perhaps in theory, if you could identify the people who would be “super spreaders” and infect and quarantine them early, that might help, but I don’t know how you would go about identifying these people (plus, I take it they would all have to volunteer to get infected and be quarantined?). And even that wouldn’t necessarily help if large gatherings of people are allowed. The best thing I could see on paper is that you could infect all the most critical workers (health care workers?) early on to ensure that they could get care and have the best chance of survival before hospitals get overwhelmed. This also doesn’t seem to make much sense because the people who you infect intentionally MUST be quarantined (or else they will be spreading it uncontrolled), which means that you’d be losing a significant portion of your critical workers, each for 10-14 days (or more) - again to do this in a way which doesn’t significantly affect your healthcare system’s capability would take ages.
Regarding the thread OP, the most convincing article I’ve read so far is The Hammer and the Dance, which suggests the best approach is to do a hard lockdown to get the number of active cases down to a minimum, then slowly reintroduce measures to try to allow society to get back to as normal as possible while keeping R<1. The hard lockdown might only need to last 3 weeks - but the “dance” will have to last until there’s a vaccine. Right now it’s not clear what level of measures is necessary to keep R<1 - it might be possible that large gatherings will have to be banned but most other activities can resume, if there is adequate testing/quarantining/contact tracing occurring around the residual cases that exist.
I’ve been trying to find ICU numbers for the various age groups, but all I can find are numbers that show the percentages of the people needing ICU care. That doesn’t help in this case because I don’t know the total infected. As I’ve said elsewhere, if you infect 10,000 people and 2 of them are over 80, then if 1 person of 80 and 1 other person end up in the ICU, 50% of the ICU patients are under 80 but only 0.01% of them needed ICU care. If you can point me to a source that indicates ICU rates by age I can try to run some numbers. You are likely right that even with a controlled exposure we can’t really get a significant number through. I still think getting some through is better than waiting, even if we can’t get to herd immunity before the wave crashes over an area. But the number might be so small as to not be worth the logistic hassles.
Doesn’t that sound an awful lot like trying to have a controlled infection?
The bottom line seems to be that people with an underlying condition that involves cardiovascular problems or problems that relate to CV issues are making up the vast majority of those that need hospital and ICU care. No such problems and you have a really significantly lower chance of needing care. Three times lower chance of hospitalisation, and close to tens times lower chance of ICU.
Of course, for the USA, CV problems are endemic, as is type 2 diabetes, so the issues with Corvid-19 are not so trivial. It seems quite possible that a large part of the age related distribution is the increasing likelihood of these co-factors with age.
Unfortunately that doesn’t include age as a factor. According to the table in there, 2% of ICU cases had none of those risk factors. I’ll have to get better numbers, but my wild guess is that we would need fractions of a percent ICU rates to keep from overwhelming the ICU in a given area. Oregon has 4m people and just over 200 ICU beds. If the ICU rate for the exposed group were 0.1%, we could expose 200,000 people and be on the edge. That is 5% of the total population. Not bad, but not where we need to be for herd immunity. It still gets 200,000 through early, which will slow the spread when the peak arrives, but isn’t enough to stop it. And that only works if we can find a group with only a 0.1% ICU rate. Still seems plausible to me.
If you think that cuts thing too close, expose half that number. The 100 people that get into trouble early is 100 fewer people that are in trouble when the wave hits.
Other interesting bits:
" Italy’s National Institute of Health found that 99 percent of people who died from COVID-19 had at least one preexisting condition"
For some reason, former smokers have a 20% chance of ICU while current smokers have 5%. Any hypothesis as to why?
Any idea whether or not the fact that a condition is being treated matters? E.g.: If someone has high blood pressure but that blood pressure is within a healthy range while taking medication, is the prognosis the same?
Yeah, I thought that was a curious one. The only thing I could think of is that these were people who hadn’t willingly given up smoking just because it was a nasty filthy habit. They were people who had been forced to give up smoking because they were seriously ill. So having given up smoking is a marker for some other bad condition.
That really is the question isn’t it? It probably depends on a whole host of other questions, including the underling pathology of the condition. Not enough information around at the moment.
Ebola (and to a lesser extent SARS and MERS) are much more containable because they are more lethal.
A bug that kills its host within a week, had one week to spread. Less, if it disabled the host within 2 days from becoming contagious, as Ebola does.
Ebola was contained by preventing sick people from reaching healthy people, and by rigorous quarantine of the people exposed to it. This worked fine in civilized countries. In less civilized central africa, it was contained by killing off everyone it touched, before they could reach healthy populations by foot.
Covid-19 is hard to contain, because it becomes contagious before you display obvious symptoms. Because a significant percentage of people are contagious but show no symptoms. Because many cases are so mild as to appear like a common cold(which is what Covid is, really. Just one with potentially nasty complications). And because even if you get a bad case, you are still mobile and contagious for a week+ before the virus disables you.
In an area as dense as the US, it would seem 2 days of being infectious is an eternity. Think of how many people you can interact within 2 days on a plane, at Disney, a concert, subway, etc. There must be something else besides just the lethality of the disease which allows it to be contained. Lethality works in rural areas, not in densely populated ones.
Ebola and Covid-19 have approximately the same R0. Lethality doesn’t explain the difference in containability, so something else is at play here.
And this is where I think the big difference is. With Ebola, if someone shows ANY symptoms you contain them. With this? We can’t do that. If we knew who had the disease we could contain them and keep them from spreading it. As it is, we don’t know who has it and so we are trying to keep as many people spread apart as we can. That will work to a degree and is our best option.
But, in addition to that, if we were to introduce a controlled infection, where we are purposely taking a group of people and trying to infect them, (which is, in essence, what a vaccine does) we would keep them isolated until they had developed the disease and then recovered. People seem to have the idea that those purposely exposed would be free to wander around. Of course you wouldn’t do that.
Covid-19 cannot be contained in the same way Ebola or SARS or any of the others were.
All a moot point, though, as April is going to be an ugly, ugly month.
Keep the political comments out of this forum. We especially don’t need conspiracy theories here. Further comments of this kind in this forum will be liable for a warning.
I’m 63 and have lupus, so I’m in two high-risk groups despite my careful diet and rigorous work-outs. If I understand what the majority here are saying, I will either have to continue self-isolation for the 18 months or longer before a vaccine is available or I will almost certainly get COVID-19. Is that accurate?
I’m hoping someone will correct this if I’m thinking about it wrong.
We are using social distancing to slow the rate to keep the medical system from being overrun. That means there will be a low level of the virus running around for a long time and would mean you’d need to self-isolate until a vaccine is available. Maybe eventually testing will catch up and we can isolate all carriers and have it die off that way.
Other ways this could end is if it mutates into something less deadly. Viruses tend to do that.
It could end by enough other people having been infected that it runs out of hosts, even if testing never catches up.
I don’t think there is a definite answer to any of this.
Keep in mind that healthcare will get better at treating COVID over time and that while some factors are aggravating, other factors (like diet and exercise) could be ameliorating. I started exercise in 2018 and haven’t sick once since then so your exercise could help you fight it too.
Sadly, I’m not. I was on hydroxychloroquine, but docs yanked me off it because it apparently damaged my retina. Hydroxychloroquine helps some lupus patients and not others. Many lupus patients are on immune-suppression drugs such as methotrexate, cyclosporin, or steroids and are not on hydroxychloroquine.
