
The hard part of the economics of Covid-19 - chmaynard
https://thereader.mitpress.mit.edu/flattening-the-coronavirus-curve-is-not-enough/
======
riffraff
The article says expanding capacity has not been approached by any government
but I am not sure that's true, in Italy they are building hospital wings or
re-adapting abandoned hospitals in many places. Rome has 4 planned covid
hospitals as of now.

Also, the Italian government plans to hire a ton of medical and paramedical
staff, money has been earmarked.

I am quite sure other governments are doing the same.

~~~
seemslegit
> Also, the Italian government plans to hire a ton of medical and paramedical
> staff, money has been earmarked.

Where will this staff be coming from ? Are there medical professionals
currently unemployed in Italy or working in other jobs ?

~~~
fma
And the equipment...my understanding is that ventilators are critical for
those who have severe cases. Can't just magically wish for tens of thousands
of ventilators....

~~~
yulaow
In italy one and the only factory of ventilators which was selling worldwide
250 units per month is now producing 500-600 per month exclusively for the
italian hospitals (and past orders not yet sent abroad were blocked bt the
government and redirected to italian hospitals) for the next ten months.

[https://youtu.be/7Iz5tWb9f8A](https://youtu.be/7Iz5tWb9f8A) [hoping the
english subtitles work]

~~~
maxerickson
The translated subtitles seem reasonable. I had to go in and switch it to
translating to English.

------
voidmain
We know that sufficiently strong social distancing - and universal mask use -
can reduce Re below 1, causing the epidemic to shrink exponentially instead of
growing exponentially. Once it is small enough, good testing and contact
tracing should be able to contribute a significant reduction to Re, so that
you can back off on more costly measures.

As hard as it sounds for the economy to adapt to extreme social distancing for
a short time and moderate for a long time, it seems like a better bet to me
than trying to increase intensive care capacity - which already consumes a
nontrivial fraction of gdp - by orders of magnitude _and_ write off millions
of lives.

~~~
zambal
So what are you going to do when the virus is gone in your city/state/country,
isolate yourself from the rest of the world? Because the timeline/situation
will be different for many other places.

~~~
nostrademons
Return to travel restrictions + contact tracing, and if community spread
flares up again, reinstitute social distancing. Repeat until vaccine is
developed.

~~~
tempestn
I'm not sure why you're downvoted. That is exactly the right approach.
Implement serious social distancing measures to reduce R0 below 1, get local
outbreak under control, and then work on keeping it contained, increasing
measures when necessary. Once it's more established which countries are
effectively controlling the virus, travel could be more open with those
countries, and more restricted with those that still have active outbreaks.
(Which doesn't necessarily mean cutting off completely, but perhaps only
essential travel and cargo, or unrestricted but 14 day isolation on arrival.)

~~~
nostrademons
Interestingly, that comment started out as +3 and is down to -2 now.

I think it may be a good harbinger of the public's willingness to endure
repeated, long-term changes to their behavior. The way I see this going, we're
going to get lockdowns in most countries within the next week or so. After 6
weeks or so, new cases will be negligible, and we'll declare victory and pick
up our lives. The virus will silently spread from a few undetected cases
during the summer, but then take off again around October, when we get a
second wave. Assuming it hasn't mutated to become significantly less deadly
(pretty likely - see sibling threads), _that_ will be the real killer, because
instead of starting from 1 index case in 1 city it'll be seeded from tens of
thousands of sleeper cases across the globe. Public opinion won't support a
second lockdown then - people will just be left to die with their families.

~~~
rapnie
> Interestingly, that comment started out as +3 and is down to -2 now.

Is there somewhere to check that score, or is it a higher karma feature?

~~~
nostrademons
If you wrote the comment you can always see the score (0 now, FWIW). At least
I've always been able to; hidden comment scores arrived a while after I'd
already amassed a pretty high karma level.

------
dunkelheit
I've upvoted because the article encourages proactive thinking so that we
don't just sit in our homes congratulating ourselves how well we socially
distanced from each other. What is sadly missing is some back-of-the-napkin
math estimating the required capacity increase. Like, is it closer to x2 or
x100? is it feasible at all? What is the damage to economy from doing this
compared to lock-down for N months?

~~~
Zenst
One variable that is still not known and would make a huge difference is how
many people are asymptomatic and with that catch this and have no symptoms.
That effects infection rates and also getting a better grasp upon how many
recovered as well as infected.

Not just a case of testing those for infection, that cat left the bag in every
country on that end. Need to also test for those who are now immune without
being aware.

Otherwise may well see spreads more than expected due to these people
spreading the virus when they have no symptoms and also prevent paralysation
of those who are immune, isolating when they don't even know they had it
already.

So knowing that variable will become key in tackling this and currently we
have no idea upon that.

~~~
dougmwne
There have been a couple of population studies to try to measure asymptomatic
infections. It appears that about 50%+ of people are symptomatic, so
unfortunately significant percentages of people are going to need
hospitalization.

This study shows the number of symptomatic patients broken out by age group on
the Diamond Princess which was a very well-studied population.
[https://www.medrxiv.org/content/10.1101/2020.03.04.20031104v...](https://www.medrxiv.org/content/10.1101/2020.03.04.20031104v1.full.pdf)

------
asiachick
I'm curious what happened / is happening in Japan.

Here in Tokyo it looks __almost __like business as usual. Some companies are
letting people stay at home but most are not. While cities in the USA are
banning gatherings of 100 or more, here in Tokyo every train ever 3 minutes
during rush hour has 8 to 16 cars stuffed with 100+ people per car.

I have no idea what the actual infection rate here is or the ICU usage rate. 2
weeks ago Japan was considered the place to avoid. Now it's the USA and
Europe. Japan hasn't seemed to have taken any drastic measures so far or maybe
I'm just not paying attention.

~~~
seemslegit
Indeed, given what I remember of Tokyo's morning peak hour density in subway
cars it would have gone ballistic or will yet. Although they do use routinely
use masks even in normal times.

The cynical take is that aging demographic is one of the biggest problems
facing Japan today and this is _a_ way to deal with it.

~~~
lightgreen
> The cynical take is that aging demographic is one of the biggest problems
> facing Japan today and this is a way to deal with it

The problem is aging population are people who 40 or 50 now, not people who
are 70 and 80. The latter may die because of cv, but the problem of aging
population goes nowhere because people in 40 or 50 will get older eventually.

This my cynical response to you cynical take.

~~~
seemslegit
The current 65+ bracket is already pretty heavy - heavier than Italy, the
40-50 bracket at the top of the inverted pyramid and will become a big problem
couple of decades from now.

This is cynical nitpicking.

------
notJim
It's sort of weird to hear everyone talking about how social distancing is now
the norm, when in the last few days up through today, there have been viral
videos of massive crowds at airports, bars, and beaches. The governor of West
Virginia just held a press conference encouraging people to go out to eat at
restaurants. Several states are supposed to have democratic primary elections
tomorrow. I didn't watch the debates, but apparently candidates were
encouraging their supporters to go out and vote.

~~~
Waterluvian
That's still happening at a massive scale.

I think it's fair to say that advising social distancing is the norm. But
actually doing it very much isn't yet.

~~~
anchpop
Telling the population to do social distancing and hoping they actually follow
through is a fool's game. Several states have realized this and started taking
measures into their own hands. This includes closing all resturaunts, schools
and movie theaters. What they should do next is give the police P95 masks and
disposable gloves and train them to use them. This would allow them to have
the police drive around and distribute food to families that need it so they
don't have to go to the store. They should also heavily incentivize all
businesses to give their employees time paid off right now, or allow their
employees to work from home.

------
wwarner
This article is really important. He is not making an economic argument about
the value of social distancing. What's not being said often enough, because
it's pretty scary to hear, is that no matter how much we lower the curve,
_everyone_ will be infected with COVID-19. Angela Merkel stated it very
clearly last week, and this is why policy makers come to Jesus so quickly when
experts and eye witnesses explain to them what is going on in China and Italy.
Normal flu has some resistance in the population, but this novel coronavirus
does not, and so, to put it very plainly, without emergency medical
intervention 3% of the population will die. Curve flattening alone doesn't
change that in the slightest. Flattening the curve, as the author of this
article says, buys critical time right now, and we need to use it to increase
targeted emergency medical capacity _right now_.

~~~
Igelau
> this novel flu

COVID-19 is as much a flu as you are a fish. Probably less so.

~~~
wwarner
Fair. [https://www.hopkinsmedicine.org/health/conditions-and-
diseas...](https://www.hopkinsmedicine.org/health/conditions-and-
diseases/coronavirus/coronavirus-disease-2019-vs-the-flu)

------
Zenst
"Second, flattening the curve assumes that you actually don’t go too far and
that much of the population actually becomes infected and then immune.
Immunity from Covid-19 is still an open scientific question but, let’s assume
that is more likely to be true than not. If you reduce the infection rate too
far, then most of the population does not become infected and that means that
once you stop policies such as social distancing the virus can emerge once
more and we all have to do this again."

So timing of such measures important and too early can be more damaging than
too late, overall.

Guess more eye's will be upon the UK now after reading this.

~~~
notahacker
The logic of the UK position is well articulated in this very HN-friendly
article by a UK epidemiologist unaffiliated with the govt scientific advice
team [complete with graphs, the Python code of his illustratory models and an
appropriate caveat about the magnitude of the uncertainties of the assumptions
the scientific advisory team's models will have made]

[https://personalpages.manchester.ac.uk/staff/thomas.house/bl...](https://personalpages.manchester.ac.uk/staff/thomas.house/blog/modelling-
herd-immunity.html)

nb the UK has since issued stronger isolation guidelines and downplayed herd
immunity in the media. Longer paper about their current model
[https://www.imperial.ac.uk/media/imperial-
college/medicine/s...](https://www.imperial.ac.uk/media/imperial-
college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-
modelling-16-03-2020.pdf)

~~~
baq
the article hints at a solution:

> The reason that this happens is that social distancing measures do not lead
> to herd immunity, so once they are lifted the epidemic starts again. In the
> absence of a vaccine, it is therefore meaningless to speak about whether a
> policy 'aims' to get herd immunity or not, since every country in the world
> will reach herd immunity unless it is able to implement social distancing
> for an indefinite period of time.

i predict this is exactly what will happen: indefinite social distancing.
impact may be reduced with fast tests and large scale testing so isolation and
contact quarantining is immediate.

~~~
notahacker
It's plausible that COVID-19 will lead to behavioural change around hygiene
and remote work, greater travel restrictions and possibly even a degree of
acceptance of periodic lockdowns, but the idea humanity as a whole is going to
permanently shift towards social distancing after millennia of doing the
opposite stretches credulity. At risk groups moving towards social distancing,
maybe [for some old people that won't even be much of a change], but that's
where the theoretical possibility of herd immunity of the general population
not in permanent isolation comes into play.

~~~
baq
indefinite does not mean infinite. effectively until a vaccine is deployed
globally or global herd immunity is achieved after ten years of pandemic or
however long it takes.

~~~
notahacker
One of the few things epidemiologists can be certain of in their assumptions
is that our economy and society won't sustain indefinite lockdowns. Extended
localised lockdowns, until R0 drops below 1, yes. Repeated localized
lockdowns, maybe but decreasingly so. _Let 's wait until we have a vaccine or
something_, no.

~~~
baq
I agree completely, that’s what I had in mind, but wasn’t really precise
enough - basically whatever’s South Korea doing right now. Access to testing,
test all suspected cases, quarantine and isolate, and the economy can sort of
be back to pre-pandemic order of magnitude.

------
skatanski
It's not as easy as adding more beds. Each ICU unit has to have specific
amount of staff around it, resource, which cannot be easily increased by
planned economy.

There are workarounds and corners to cut, like making last year students into
doctors without exams, moving doctors from other specialities to intensive
care. But it's not exactly the same.

~~~
VectorLock
Its not as good as a doctors or even an RN degree, but I wonder could a crash
course for health care workers tailored specifically to the symptoms of this
disease be sufficient to fill that gap?

------
saurik
This same argument process--that to "flatten the curve" in the way all the
cutesy diagrams show isn't going to be sufficient to avoid chaos unless we
maintain social distancing for years, and that we are deluding everyone into
thinking this is "the solution" and that life is somehow going to go back to
normal in a couple months (which is where most of the people I know--normal
people, not all of my super paranoid friends ;P--are with their mental
timelines) to the point where we are not concentrating any effort on anything
else (to the point where believing "flattening the curve" is some panacea is
maybe even a "dangerous delusion"), including capacity expansion and explicit
tracing--was made by someone in an article on medium a few days ago. The prior
article had the same little modified graphs showing the true problem, but had
actual math to back up their back of the envelope calculations for why it will
take years. FWIW, that article was shat on... _hard_... by people here on
Hacker News, and was even flagged, because people even here are apparently so
bought into the narrative that they take arguments that it isn't sufficient as
somehow "so don't do it: social distancing is bad" (which is bullshit, and not
what either of these arguments were/are saying). It is absolutely frustrating
how much of an uphill battle it is to even get people to analyze this stuff
quickly: we keep having to wait until things get notably worse and then we are
willing to look at something only slightly more drastic. I have had friends
making this same argument for like a month now and everyone just treats them
as if they were literally insane or something :(.

[https://news.ycombinator.com/item?id=22575356](https://news.ycombinator.com/item?id=22575356)

[https://news.ycombinator.com/item?id=22581950](https://news.ycombinator.com/item?id=22581950)

~~~
smallgovt
I think you're conflating what the general public believes with what those in
control believe.

It is in the public's best interest for the general public to only worry about
what is within their control (so as to avoid panic). Therefore, the general
public is being led to believe that all is going to be OK after a couple
months of social distancing.

I guarantee you behind the scenes, those in control are scrambling to take
immediate and drastic action to ramp up our medical treatment capacity.

~~~
saurik
...but I am an elected government official (for a hyper local government,
though in a good position where I get to peak behind the curtain of the
regional government above me) and the vast majority of my friends work in
government; and when I present the argument about capacity expansion moving
the line on that cute graph upward as a critical thing we should be doing in
addition to moving the peak down and to the right using capacity expansion,
the reaction was literally "huh, I hadn't thought about it that way before"
:(.

------
js8
I think "flattening the curve" is often misunderstood, because on diagrams it
looks like both scenarios will lead to similar number of infected people. But
in reality, the flatter curve can actually lead to significantly less people
infected overall, because exponential growth is difficult to control if the
disease is everywhere. So it is even possible, it seems to me, that the
countries that flatten the curve more vigorously will actually deal with the
problem faster. But, as other people noted, we will see.

------
kiney
> It is very clear that capacity expansion has to be the priority now. It has
> not seriously been addressed by any government as near as I can tell.

Germany _did_ address this. Currently there are 25k beds with ventilator, the
federal government ordered 10k ventilators more from the largest local
supplier (Drägerwerke) and explicitly bypassed normal procurement laws. That
company is now extending manufacturing capacity, but it won't be fast enough.

~~~
kiney
Another thing they do is recruiting med students as emergency staff, but this
seems to be in an early phase. And we're still comparatively early in the
pandemic. In my perception our government is actually handling the situation
surprisingly well until now. We even overcame years long blockades of our
federalism.

------
solidasparagus
A little off topic, but I found this sentence to be incredibly odd - "by we I
mean the generation who were adults in World War II"

So all the people who are 90+ years old?

~~~
playpause
It threw me at first, but I think it is supposed to make this point: Although
this kind of forced economic shift would feel very new for most of us, humans
have managed it before. Specifically, and most recently, in WW2.

------
bitL
How much would mandatory use of mask reduce R0/virus spread? I see in all
Asian countries everybody with a mask by default and am wondering what % of
spread reduction could be attributed to that factor alone. Are there any data
on this?

------
SomeHacker44
I really don't like the cavalier attitude with which this author treats the
open question of Coronavirus immunity. "Let's assume it's more likely than not
going to generate immunity" (paraphrased) seems unfair, and that a fair
treatment would simply consider both alternatives.

~~~
jsight
I don't know who you are wanting to be "fair" to here. The stronger evidence
seems to be on the side immunity.

~~~
dwaltrip
Do you have links to solid evidence? I saw an article from an expert (I'm
blanking on the specific article right now) that other "cov" viruses are known
to have a limited immunity that lasts for possibly several weeks or so.

~~~
jsight
I wouldn't bet on "solid" evidence for a while. Hang around the /r/covid19
subreddit for the latest data. There have been very few reported cases of
someone getting it again and of those a lot of evidence points to relapse
rather than reinfection.

Given the large # of cases and their high concentrations in specific places,
it seems likely that we would see many cases of reinfection if previous
patients weren't immune.

------
RivieraKid
This plan has several serious drawbacks: many deaths, possible long-term
effects, the fear and anxiety of getting an illness with a 1% fatality rate,
the discomfort and pain of being ill, overloaded healthcare system even if you
build hospitals because then new bottlenecks like medical staff appear.

And probably more, this is just quick out of my mind.

Here's a better approach: Hardcore lockdown for 2 weeks, which stops the
spread and reveals the vast majority of cases. Then switch to high-volume
testing and targeted interventions (with would be much more efficient than now
because many of the processes can be improved).

------
partiallypro
Given that so many people are now staying home, working from home etc, I can't
see how we can't slow the virus. Right now, I assume the people coming forward
are those that have been possibly exposed a week ago before all the lock
downs. I have hopes that this thing is thwarted quick, when the President
(with info from the CDC) said this could last into July, I genuinely became
worried about the state of the world after this. The state of the economy, I
can't even say I'd have a job if it lasted that long.

------
mirimir
TFA closes with an interesting proposal, but somehow I doubt that we'll get
there before social collapse and martial law.

> Immunity from Covid-19 is still an open scientific question but, let’s
> assume that is more likely to be true than not.

Huh? What's the basis for that?

> The concerns are that China, Japan, and South Korea may have actually pushed
> social distancing too far. Israel and now Italy are going even further to
> keep the virus out altogether.

I see no date on TFA, but this statement implies that it's maybe a week old.

~~~
ComputerGuru
There have been sufficient reports of people who either got reinfected or else
had an extremely long “false recovery” period to cause the question of whether
or not immunity can be relied on to be debated. Various explanations are
available but none are as of yet proven.

~~~
mirimir
I was unclear. Sorry.

I was wondering why we even expect persistent immunity.

~~~
ComputerGuru
I agree, no one that knows that they are talking about expects persistent
immunity; the number I’ve heard floating about is along the lines of six
months’ immunity after recovering from the illness. I’m not clear on whether
the article is written with that definition of immunity or not (and based off
its suggestion that this would prevent a second wave next year, etc, I’m
assuming not) but I assumed it was questioning whether even six months of
immunity was on the table.

------
blackrock
I think we’re going to be in for a rough ride.

The mass exodus from Europe is going to bring back a bunch of infected and
asymptomatic people to America. Nobody wore a mask, or used gloves, or
probably even sanitized their hands. They were just all in one giant Petri
dish at JFK.

This, and flights from Seattle have been going on for over a month now, that
infected people were already traveling all over the country, and the world.

By the time 1 person is confirmed infected by a test, they have probably
already infected 10 to 20 other people, depending on their rate of social
interaction, within the past 5 to 14 days. The average number of days before
displaying symptoms is about 4 days. And it could go as high as 13 days.

The only way to stay safe is to avoid other people. And when you interact with
someone new, it restarts the clock again.

In another week, America might not have 1 Wuhan sized epicenter, instead, it
might have 50! And all the people rushing to Costco and Target, to hoard
toilet paper, are just going to make things worse. It’s your local Petri dish,
from just waiting in line, and re-breathing the same infected air from the
recirculating HVAC.

If you can wear a mask in public, I would highly advise you do so. It may be
imperfect, but it will at least help block something. This virus is airborne.

------
jokoon
For now I think governments should think about maintaining the essential
necessities: food, water, electricity, while shutting down everything else.
Stopping long range transports, including cars, should be a priority.

Anything that is not growing or transporting food or useful to treat patients
should be shut down. It's difficult to say this, but sometimes you have to
treat citizens like children. This is such a case.

------
threeseed
Surely it's better just to build as many ventilators as we can.

And then get old people to stay at home, perhaps with a family member or carer
to assist them.

------
nl
It's pretty clear that the economic impact of this is much bigger that the
2008 GFC, than 9/11 and the 1987 stock market crash. 2008 and 1987 were
financial/market crises which caused issues elsewhere.

9/11 shutdown the US economy for a couple of days.

This is shutting down production for weeks and global demand for many thing
for months. It's completely unprecedented that I can think of.

------
softwaredoug
Isn’t part of reducing cases now so we have time to get on a war footing for
those things?

At least I hope to god that’s what they’re thinking.

------
antirez
It it was possible to have a very reliable predictor of who will take the
infection in an asymptomatic way, or with very trivial symptoms, a plan could
be to infect all those, that are believed to be at least 50% of the
population, to create a solid immunity base in the society.

~~~
seemslegit
That's basically the UK "herd immunity" which experts think is kinda crazy,
also it's not even known that a long-lasting immunity is created for this
virus in people who are infected either symptomatically or not.

iirc it requires numbers closer to 2/3rds of a population.

~~~
antirez
Nope it's very different than the UK pseudo plan (apparently they don't really
have such plan). I mean, if there was a simple way to test _before_ people get
infected, if they'll develop just very mild symptoms, we could do it. Even if
you need more than 50%, 50% is still a lot of a barrier that lowers the virus
R0 a lot.

~~~
seemslegit
Even if there was - testing and controlled-infecting 50% of the population
would be a huge effort and probably not shorter than isolating old people and
allowing an uncontained infection to burn through.

But the big problem is that it might not even help, the worst case scenario is
that absent a vaccine the virus becomes just a more infectious and deadlier
cold that people risk getting every season.

------
wwqrd
Firstly, is a physical shortage of _beds_ the problem? Capacity is not just
physical, where do the doctors come from?

As for building additional capacity with a WW mindset... how about just annex
the currently empty offices and buildings?

...now to train some doctors!

------
microtherion
The part of the article I did not find compelling is handing things over to
the military. The army that I served in is not exactly led by the best and the
brightest, and armies in other countries can be actively malicious entities.

------
sershe
This actually sounds great. Why not basically have war economy for this, esp
given how many people are becoming jobless - forcing a dramatic capacity
increase could be a significant Keynesian stimulus.

------
cloudwizard
It seems like the countries that are doing the best are Taiwan, Singapore, and
HK.

[https://time.com/5802293/coronavirus-covid19-singapore-
hong-...](https://time.com/5802293/coronavirus-covid19-singapore-hong-kong-
taiwan/)

Taiwan can produce 10M masks per day in country of 23M

[https://abcnews.go.com/Health/taiwan-sets-world-fight-
corona...](https://abcnews.go.com/Health/taiwan-sets-world-fight-
coronavirus/story?id=69552462&cid=social_twitter_abcn)

~~~
jfnixon
Singapore and HK are cities, really, and the Singapore approach, aggressive
contact tracing with mandatory stay at home orders, doesn't scale.

Taiwan and Japan are outliers so far, and they are monocultures, with famous
compliance rates.

Korea is somewhat similar to Japan, but took a hit early, and has managed to
beat it back.

China appears to have peaked, but did this with massive application of
governmental policies which would never fly in the West.

Flatten the curve doesn't change that a large number of people are going to
get this disease. The best news is danger increases with age, unlike the
Spanish Flu. Africa is very young (media age), the US and China are roughly
the same, while the EU in general is older (Italy and Germany especially).
What matters is not hospital beds per capita, but ICU beds per capita. The US
does much better by that measure. You don't need an ICU bed to give oxygen,
which is what most serious clinical cases require. MIT Sloan gave a prize last
year for a less expensive, simpler ventilator designed for most cases in
countries with limited resources. We have options that aren't explored yet.

~~~
Noumenon72
I don't see why contact tracing doesn't scale. The only thing preventing
Google and Apple from producing a contact history for everyone is privacy laws
and people without phones.

------
cogman10
You know what I'm interested in? What will the effect be on non-corona
diseases with already lower RE?

Are we going to see some disease, such as measles, eliminated? What about
chicken pox? The flu?

I'm really curious as to how this ends up affecting disease in society. I
don't know if it will be enough to eliminate corona, but this may be enough to
kill off other diseases.

------
mxcrossb
I have also been thinking about having the military come in and start building
hospitals. The president seemed to have no qualms about using that power for
his wall.

But on the other hand, doing so might greatly decrease military readiness.
Let’s not add a major war to the list of catastrophes. But I’d love to hear
what military buffs think.

------
snori74
"we ....the generation that were adults during World War Il..." Ummm he's 98?

------
VectorLock
This is something that I've been afraid of for a while. I know a few nurses
that work in some of the most best staffed, well funded Magnet hospitals and
they say they run at 90% capacity on the best of days.

------
snewman
I am not sure I agree with the thrust of this article. The gist seems to be:
if we do a sufficiently good job with containment measures (e.g. social
distancing), we might succeed in limiting short-term infections, but we will
have to remain in this mode for years (with ruinous effects on the economy).
The offered alternative is to acknowledge that a significant fraction of the
population will be infected eventually, and so we should scale up hospital
capacity to accommodate that.

This doesn't seem like a very good alternative. Even with adequate hospital
care, the true fatality rate seems to be in the neighborhood of 0.5% to 1%,
which would be quite harsh if allowed to spread throughout the population.

I am hoping that improvements in treatment can make the difference. A vaccine
may not be available for quite some time, but drugs that reduce the fatality
rate might be ready sooner.

Of course the actual course of action must include some mix of all-of-the-
above: containment, new hospitals, new treatments.

EDIT: as voidmain notes, we might also hope to quickly reduce the number of
infections to the point where we can contain them with testing and contact
tracing, rather than blanket shutdowns.

~~~
Diederich
> remain in this mode for years

What's your basis for that? It seems like a vaccine will be available well
before years have gone by.

~~~
lbeltrame
Drugs (a few of them are in Phase III and trials are already ongoing, with
some results expected next month) will likely help first. If you can treat the
severely sick patients, and even just cut one week out of the 3-4 they need to
spend in the hospital, it would be a huge success. In fact I'd argue that
_most_ of the problems we are facing are because there is no appropriate
treatment.

Vaccines will likely take more time, due to long-term effects that need to be
investigated (as many mentioned in some other HN story today).

------
ck2
What I am still trying to understand is if we get variations of the flu virus
every year so dramatic that sometimes they guess on the vaccine completely
wrong (like this year) then why aren't we going to have a Covid-19 variant
this winter that everyone can catch again?

~~~
floe
My (low-information) understanding is that coronaviruses have much lower
mutation rates than flu viruses!

~~~
lbeltrame
They have a proofreading RNA polymerase, IIRC, which means that indeed they
have a lower error rate than other viruses.

~~~
ebalit
Apparently 30% of cases of the common cold are cause by coronavirus. And the
worrying thing is that the immunity we acquire for those is only temporary.

~~~
lbeltrame
At this point, I think it's just appropriate to say "we don't know yet". This
is a new virus, and not much is known about it yet.

And that is why drug development needs to go parallel with a vaccine. If a
vaccine fails, we can fall back to drugs to prevent people from going into
ICUs (hopefully).

------
kazinator
Article misses the angle that we could flatten the curve _and_ get herd
immunity via a vaccine.

------
nostrademons
It'll be interesting to see how Italy (lockdown) compares with the UK (just
let it infect everyone) compares with South Korea (extensive testing & contact
tracing, plus social distancing) in a couple months.

My sense is that the UK will probably fold and institute a lockdown once their
ICU capacity gets overwhelmed and healthy young people start dying in the
streets. Either that or they'll face a revolution and then have a lot more
problems. Of course, by the time it gets to either of those points it'll be
too late to effectively change course.

But it's interesting to see at least one country take the position that "Hey,
we're going to let this run its course, take our lumps now, and try to get
back to business as usual ASAP." I could be wrong, and maybe this is a genius
application of heartless logic. Time will tell.

RemindMe!2months ;-)

~~~
tjoff
Uk tactic looks very sensible to me. They will institute a lockdown long
before that. But they recognize a lockdown for a prolonged time is very
challenging in itself and there aren't many good reasons to be doing it too
early.

~~~
dforrestwilson
The UK backed away from this insanity and will be implementing social
distancing.

Thank god.

~~~
codeulike
They were always going to eventually, and they said so.

------
voidmain
Also... I hesitate to say this because it smells of ad hominem, but in this
view the enormous cost of extreme shutdowns is mostly the cost of a mulligan
for poor decision making and actions early in the crisis. This may make this
view less popular with the various organizations that made those mistakes.

~~~
makomk
This isn't a mulligan, that's the trouble. Previous contact tracing efforts
had the advantage that we knew where the initial cases were coming from -
China, primarily Wuhan - and could use that as a starting point. Those failed
in most countries. After shrinking the epidemic down, the initial cases are
basically just random people who have what looks like a cold. It'd be like
searching for a few needles in a massive haystack.

~~~
battery_cowboy
South Korea did just fine, they managed to prevent the exponential curve so
far. In the USA, the government just fucked up and did nothing, even actively
engaged in disinformation.

~~~
holler
Not quite, the U.S. began adopting measures almost immediately [0].

0:
[https://www.washingtonpost.com/local/trafficandcommuting/tra...](https://www.washingtonpost.com/local/trafficandcommuting/travel-
ban-halts-flights-between-wuhan-and-us-as-airports-prepare-to-screen-
passengers-for-coronavirus/2020/01/23/00c1f1aa-3e22-11ea-baca-
eb7ace0a3455_story.html)

~~~
humaniania
Blocking direct flights from a single region? What else?

------
Mathnerd314
Tl:dr also take over the economy and conscript people to make hospital beds

------
matchagaucho
Disappointed this article makes no mention accelerating development and
distribution of vaccines by relaxing FDA approval processes.

Sure, that may take 9-18 months. But preventing the "second wave" is more
important than reacting to it.

~~~
raphaelj
These approval processes are there for a reason though. If you are going to
inject some pathogen to millions of people, you better be sure that it has no
strong, even long term, undesirable effect.

~~~
matchagaucho
It's not so much the injections, but just allowing the development of
alternative processes that may scale much faster than the 70 year old egg-
based process.

When we look back in retrospective, the CDC and FDA will be under scrutiny to
take more preventative measures.

------
dirtyid
>There are nuances when it comes to ICUs and ventilators, etc. But the bottom
line is: Even in optimistic flattening the curve scenarios, the curve cannot
flatten enough.

This always felt intuitively true given exponential growth - realistically
flatten the curve was more platitude than practical, an desperate appeal by
media in democratic countries to position a "civilized" solution in order to
avoid mass panic and draconian measures. Now they're elevating Korea as the
exemplar response model when the country is practically an island like Taiwan,
Singapore, Hong Kong. It's simply not applicable to geographic realities of
most countries where borders can't be simply shut and where a lack of
infrastructure investment make the kind of techno-authoritarian solutions that
made agile responses in those countries possible. Canada doesn't even have an
official Corona dashboard, instead news media as to collate information from
an updated table using data from archive.org, people paying in cash, nothing
is getting wiped down, minimal mask use etc. If anything, countries without
Asian Tiger advantages need to crack down harsher to make up for these
deficiencies. No one is going to build enough triage hospitals and medical
material to outpace any variant of this curve. No developed country is
civilized enough to sacrifice this much for the greater good. This is a stick,
not carrot and certainly not rhetoric situation. If Corona is as bad as the
numbers project, flatten the curve is going to kill a lot of people in
retrospect because politicians can't stomach "lock it down".

~~~
SamReidHughes
Incrementally flattening the curve does save incrementally many lives. It’s
taken hold over “lock it down” because it rings better and is factual. You can
accomplish something individually by staying inside instead of being
fatalistic because nobody else will do it, and it isn’t just a platitude .

~~~
dirtyid
Incremental is not a proportional response to exponential. Compared to a lock
down, you're not saving incrementally more lives but allowing for
exponentially more death. The only rationale for it is to slowly acclimatize
the population to embrace more drastic action, i.e. panic management. Even
stringent, well organized quarantines in Chinese provinces with less infection
is running 6+ weeks with full compliance. Partial compliance means those who
adhere will be stuck inside for a long time, it's not tenable even assuming
the curve can be flattened in a sensible time frame in first place, which I
don't believe it is. Basically we're dragging past the point where shutdown is
a viable option with half measures, which will only leave to excess
fatalities. Obviously I'm not an expert and hope I'm wrong.

~~~
SamReidHughes
If the system is out of ventilators and you keep from infecting a person who’d
need a ventilator, that’s one death prevented. If everybody is going to catch
it, you want to maximize ventilator-hours, i.e. delay as much as possible or
flatten the curve. This makes it beneficial conduct to avoid social contact
whether other people are doing it or not.

------
mgleason_3
Certainly, it seems like there's more bad information than good.

E.g. The beds are already full EVERY flu season. Do the researcher's know
this? The flu has killed over 12,000 people every year in the US for the last
10 years _.

2 years ago_, the flu killed 61,000 people in the US.

So, the logical question might be: Why haven't we been "flattening the curve"
for years?

Roll forward to Coronavirus and a news media publicizing a "novel" flu that
spreads and kills and maims at about the same rate and suddenly we're all
running around like crazy trying to destroy the economy and our livelyhoods to
"flatten the curve".

Our politicians, who literally have no plan, are making grand pronouncements
bravely shutting down everything they can think of because they completely
f'd-up the testing and tracking of the coronavirus and literally have no idea
what else to do, but know they don't want to be the one at the center of one
of those circles showing the number of sick in each city.

*Source: [https://www.cdc.gov/flu/about/burden/index.html](https://www.cdc.gov/flu/about/burden/index.html).

~~~
dabeeeenster
"a "novel" flu that spreads and kills and maims at about the same rate"

It's nowhere near "the same rate"?

~~~
dboreham
And it's not a flu.

