
Beware second waves of Covid-19 if lockdowns eased early: study - swat535
https://www.reuters.com/article/us-health-coronavirus-wuhan-secondwave/beware-second-waves-of-covid-19-if-lockdowns-eased-early-study-idUSKBN21D1M9
======
refurb
The government is in a real conundrum when it comes to relaxing the lockdown.

There are a few things we do know:

\- It's impossible to keep the lockdown in place for long enough to completely
eliminate the virus. Why? Because there are still essential workers out there,
giving it to each other and their families.

\- Because we can't eliminate the virus, the main goal to limit spread so that
our existing medical resources can handle it.

\- End the lockdown too early, and like a wildfire, it will spark up again in
a few weeks and we're back at square one (or close to it).

\- Keep the lockdown too long and the impact to the economy will only get
worse, requiring massive gov't bailouts/support. The longer we're locked down,
the longer it's going to take for the economy to recover.

What seems to make sense to me is, keep the lockdown in place long enough to
get in front of it. Basically, enough testing so that new cases can be
immediately identified and quarantined. That alone will have a big impact.

Then start to identify other essential services and slowly relax restrictions
while at the same time keeping up the early identification and isolation of
new cases. If things flare up, stop and get in front of it. Then continue to
relax the lockdown.

The only way I can see a rapid end to the lockdown is if we either get a
vaccine approved (and mass vaccination occurs) or a very effective treatment
is found that takes the pressure off of medical resources.

~~~
heavyset_go
> _The longer we 're locked down, the longer it's going to take for the
> economy to recover._

The economy would take a serious hit if suddenly millions of people overwhelm
the medical system, people collapse in the streets and bodies pile up in and
outside of morgues.

There's a weird false dichotomy I keep encountering where people insinuate
that we either quarantine and hurt the economy, or we don't quarantine because
of the damage it would do to the economy. The economy is going to take a hit
no matter what.

~~~
hodgesrm
Also, there are other solutions like serological testing, aggressively
developing ways to manage the illness, testing vaccines, etc. It's not just
quarantines, folks

It's almost as if the US government does not have a coherent plan. /s

~~~
tathougies
The FDA has started vaccine tests?

~~~
slenk
14-month trials.

------
drtillberg
I read the article to say: lockdowns don't solve anything, the virus still
lurks. Lockdowns are a public policy cul-de-sac. The Korea solution of
extremely aggressive testing is the only way for a nation to function
effectively while also guarding against the novel coronavirus.

~~~
CivBase
How exactly does the Korean model work? They aggressively test people... and
then just quarantine individuals? Isn't one of the supposed problems with this
virus that it spreads rapidly before symptoms show?

~~~
bosswipe
They test everyone that might have had contact whether they have symptoms or
not. Though they haven't been able to squash it they've able to keep the
growth rate linear instead of exponential like it is everywhere else, which
might be the best you can hope for.

------
kurthr
Run your own model... play the scariest game!

[https://neherlab.org/covid19/](https://neherlab.org/covid19/)

Presented recently as Show HN:
[https://news.ycombinator.com/item?id=22616456](https://news.ycombinator.com/item?id=22616456)

------
Zenst
The virus is growing at different rate in many continents so whilst one may
get things under control, the issue shifts and south america and africa do
seem to be worrying for many.

There will be many waves ahead.

~~~
pen2l
I'm amazed that it's spreading so fast in US.

US is a huge place. Okay NY has a high population density so that makes sense,
but outbreaks in Seattle et al. is surprising me and I can't figure out why
it's faster than other countries.

~~~
sanguy
Canadian living in the US here.

It is amazing (and absolutely terrifying) as to how belligerent Americans are
to any sense of being told what to do. A good % of them will purposely do the
opposite just to exercise their freedoms.

So in a situation of lock-downs, shelter in places, and generally strong
advice to socially distance you have:

\- Neighbor's continually inviting us to BBQ's and dinner parties

\- Bars are closed so people are having tailgate parties outside of the local
liquor stores with friends

\- Nobody respecting 2m distancing at groceries, even with tape lines to
indicate safe spacing

\- Assholes purposely coughing and as they do so muttering "corona" in public
places treating it like a joke

\- Young people on tiktok and other social media doing things like spitting,
licking, or coughing on others/foods.

Unfortunately this is not selective in that those acting like idiots are not
the only impacting themselves, but they are helping the spread and impacting
others.

~~~
pdonis
_> it fully deserves what occurs_

"It" is not one person, "it" is a country of 330 million people. Many of them
are not behaving in the ways you describe. I personally have not observed any
such behaviors in my neighborhood or on the (rare) occasions over the past few
weeks when I've had to go to the store (we stocked up early on to minimize the
need to shop).

Also, while we Americans do tend to distrust authorities and we like to
exercise our freedoms, we also have (or at least some segment of us have) a
strong sense of personal responsibility. That means, first, that you are
perfectly justified in not going to neighborhood BBQs or tailgate parties and
explaining that you don't think it's safe, telling people sharply in stores
(after you've backed away to a safe distance) that you are keeping your
distance for your _and_ their safety, publicly telling assholes who treat it
like a joke in public that it isn't a joke, publicly criticizing people who
post obviously stupid things on social media, etc. You are responsible for
your own safety and you don't have to accept what others are doing as normal
or right.

Second, personal responsibility means that all those people who are doing
stupid things should suffer the consequences of their actions. If they feel
bad because you spoke sharply to them to protect your own safety or to call
out obviously stupid behaviors, tough. And if they get sick because they
didn't take proper precautions, you don't owe them sympathy.

Unfortunately, many Americans do seem to have lost sight of the whole personal
responsibility thing in recent times. Perhaps this is an opportunity to re-
emphasize it.

~~~
sanguy
Thanks, edited as was too pointed with the "it"

But I also do not agree fully. I have seen altercations in supermarket lines
where someone oversteps the "tape separation" line and has been asked nicely
"please step back" to get told off, or better yet spit on.

Things are not right. This is not how civilized people interact with one
another.

~~~
pdonis
_> I have seen altercations in supermarket lines where someone oversteps the
"tape separation" line and has been asked nicely "please step back" to get
told off, or better yet spit on._

At that point I'd be calling for the store manager, and if they didn't tell
that person to leave, I'd be calling the cops. Particularly if someone was
spit on; under current circumstances that amounts to reckless negligence.

 _> This is not how civilized people interact with one another._

And letting it happen without imposing consequences is not how civilized
people maintain the standards and norms of civilization. The people you
describe are uncivilized barbarians and should be treated with the appropriate
contempt.

~~~
justforyou
>> At that point I'd be calling for the store manager, and if they didn't tell
that person to leave, I'd be calling the cops. Particularly if someone was
spit on; under current circumstances that amounts to reckless negligence.

Good luck getting the cops to show up, and good luck not getting ktfo while
you try doing so.

~~~
pdonis
_> Good luck getting the cops to show up, and good luck not getting ktfo while
you try doing so._

If you really live in an area where you can't depend on other people to abide
by and help enforce obvious rules of civilized behavior, then you do not live
in a civilized area and should consider moving.

If the store manager really tried to kick me out under the circumstances
described, instead of the person who spat on me, I would tell him in no
uncertain terms that he would never get my business again, nor that of anyone
else I could convince. I suspect that a few well-placed Internet posts, not to
mention phone calls and emails to every local and national news organization,
would convince a lot of people.

------
DeonPenny
I think NYC might of solved it with the antibodies test. They plan on letting
people with the antibodies go back to work. Plus the test is easier to make
that the test for the virus.

~~~
jeremyjh
That doesn't really solve anything. If 20% of our population got the disease
in the same six month period the health care system would collapse entirely
and we'd be looking at up to 10% CFR. Millions and millions of people dead.

~~~
bagacrap
99% of cases are mild as per Korea's data, so no, we would not have 10%
mortality

~~~
jeremyjh
You can have a 1% CFR if your health services are functioning. The point is
that they won't be if everyone gets it at the same time. In any case 99% are
_not_ mild; at least 20% are serious and require medical intervention. If you
stop treating them...they die.

~~~
DeonPenny
The data doesn't show 20% need medical treatment. 1% need that. 19% are
getting as sick as the flu at most. 80% literally couldn't tell if they were
sick or not.

~~~
xref
I haven’t seen any numbers of confirmed infections that match a 1%
hospitalization rate. Heck I haven’t even seen an ICU rate that low. Have a
link?

~~~
bagacrap
[https://www.worldometers.info/coronavirus/country/south-
kore...](https://www.worldometers.info/coronavirus/country/south-korea/)

99% of active cases in Korea are mild. There is some difference between
countries in terms of reporting but typically "mild" indicates no
hospitalization, "severe" requires hospitalization and "critical" indicates
ICU.

It's hard to estimate true hospitalization rate when you don't know the spread
of the disease, and we don't have good data for that anywhere. But here is a
repo with the data we do have:

[https://github.com/beoutbreakprepared/nCoV2019](https://github.com/beoutbreakprepared/nCoV2019)

------
DoreenMichele
It doesn't have to be a disaster to extend the lock down (aka some
restrictions). Remote work exists. Contactless food delivery exists.
Homeschooling is easier than ever.

We just need to focus on helping people make those transitions. We need to
stop focusing on "just say no" and start focusing on "You can say yes to
_these things_. We can help you make that choice."

~~~
bagacrap
this is a very white-collar centric view of the world. Anyone who's living
paycheck to paycheck in an hourly job, or a small business owner, is unlikely
to be able to work from home. And how do you work from home and homeschool at
the same time? Anyway, even if you personally can get by, there will be mass
failures to make rent in both commercial and residential sectors which will
destroy financial markets and that will actually affect you even if you have a
cool tech job in SF.

~~~
DoreenMichele
I have known people who homeschooled to make life easier. I was one of them.

[https://news.ycombinator.com/item?id=22681334](https://news.ycombinator.com/item?id=22681334)

Takeout is allowed. Food delivery is allowed. Amazon and grocery stores are
hiring. Those are not white collar jobs.

I've been dirt poor for years. I do remote work. I'm a freelance writer, not a
programmer.

It helped me establish an income and pay down debt _while homeless._

If you think remote work is only for the privileged few, that's your bias
showing, not mine.

I have been promoting remote work and gig work as a solution for homeless
people for years. I run several websites and a few reddits supporting that
model.

I've never gotten traction. Maybe I will never get traction. But I've
absolutely done all of the above and not because I have some privileged upper
class life.

Quite the opposite. I've done it to accommodate my health problems and the
needs of two special needs kids.

------
ck2
This isn't even the beginning of the first wave except for a couple front line
states like Washington and NY

[https://covidactnow.org/state/NY](https://covidactnow.org/state/NY)

------
anonsubmit2671
Watch thunderf00t's videos and Paul Beckwith's.

Without a vaccine and pervasive testing, isolation resets the clock on the
pandemic curve and it starts like Groundhog Day all over again, but at a
potentially lower level. It will keep happening over and over again,
especially spreading N <\--> S hemispheres with the seasons. It will keep
happening until either everyone is infected, resulting in hundreds of millions
of cumulative deaths, indefinite isolation, or a vaccine is widely-deployed.

That is reality.

~~~
marcosdumay
> especially spreading N <\--> S hemispheres with the seasons

Temperature seems to have no impact on transmission rate in Brazil.

~~~
kgabis
Isn't it too soon to assume that? Viruses decay faster at higher temperatures
so it should have some effect on R0. With other measures like social
distancing, masks, and remote work it might lower it below 1.

~~~
marcosdumay
There are already dozens of severely ill patients on many cities in Brazil,
what is the easy to compare metric. The rate of growth of cold and hot cities
isn't very different, and hasn't been very different from the untreated growth
on the rest of the world.

------
dmfdmf
FWIW, I will throw in my two cents. This shutdown needs to end immediately.
This is absolutely crushing the middle class and the economy. I'd bet that
many of the small shops and restaurants I used to go to will never reopen.
These low-margin businesses cannot cope with a week long closure, let alone
four. We are already looking at waves of rent/debt defaults followed by
massive layoffs and then a deep recession if not a depression. And if the
government's response is unlimited money creation (for the banks or for
individuals, it does not matter) then we are looking at a potential monetary
or dollar crisis.

This decision to shutdown the economy has been made on the misguided
assumption that you can save the healthcare system in isolation from the rest
of the system of production in which it resides. It is also assuming that
saving lives supersedes any other consideration, especially money or
economics. We are hearing this now from the media who already pre-attacking
Trump for hinting he wants to end the shutdown -- that he is valuing
billionaires or dollars over lives. This is shear non-sense and ignores the
fact that people are not ghosts, we need to work in order to stay alive and
live. I am reading on many forums about people who are about to lose their
business that they spent 20 years building or their homes if they cannot get
back to work soon. This is not just narrowly about lives lost to the virus but
living for everyone. Of course we will do everything reasonable to help the
afflicted but shutting down the economy should not be one of them.

If you want to still hold to the assumption that only lives matter in this
decision then think about this. Think of how many alcoholics will be created
or relapse from spending days on end with nothing to do, bored in their home.
How many of those will eventually die of alcoholism or kill people with their
car? What about anorexics who recover but under quarantine and the anxiety of
virus scaremongering relapse and ultimately starve to death? If the economy
goes into a recession or depression (a fait accompli in my view) then how many
people are going commit suicide which always goes up in bad times? How many
people will die in just these three examples 100K, 200K, 1M people?

These are not fantasy deaths, it will really happen but they will never be
blamed on the shutdown. It is a real hidden cost, as real as those who die
from CV19. There are real life-and-death altering consequences beyond just
those unfortunate to get this virus.

~~~
DanBC
I don't know much about suicide in the US, but I do know a lot about suicide
in the UK.

Over here about 6500 people die by suicide each year. This is with the broad
definition used in the UK. Let's imagine a massive rise of 20% to give us 7800
deaths next year.

It's much harder to get numbers for people who die when eating disorder is the
underlying condition. Here's one reliable source. These numbers are likely to
be much higher, so let's say the real numbers are ten times what's listed
here. That would mean about 200 to 300 people die each year from eating
disorder in the UK.
[https://www.ons.gov.uk/peoplepopulationandcommunity/birthsde...](https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/adhocs/008099deathsinvolvinganeatingdisorderenglandandwales2001to2016)

So that's about 8500 per year, if we massive inflate the numbers.

The argument goes that covid-19 is about the same as flu. (That's wrong. It
kills more people and it hospitalises more people). Flu in the UK kills about
17,000 per year. So, if covid-19 killed half as many people as flu does it
overtakes our 8500 deaths to suicide and eating disorder.

> but they will never be blamed on the shutdown.

I don't know about the US, but in the UK our statisticians are pretty good at
pointing to the wider determinants of health. For a while they've been saying
that economic downturn in 2007 caused extra death by suicide.

> Think of how many alcoholics will be created or relapse from spending days
> on end with nothing to do, bored in their home. How many of those will
> eventually die of alcoholism or kill people with their car? What about
> anorexics who recover but under quarantine and the anxiety of virus
> scaremongering relapse and ultimately starve to death?

Your point here loses direction. You appear to be wanting to count these
deaths as shutdown deaths, but definitely not as covid-19 related death.
People with substance misused disorders or eating disorder are unable to have
face to face meetings because of covid-19.

~~~
totony
I think you are focusing onthe wrong metric. Suicides are generally done by
younger people more than they die of flu/covid.

The years of life comparison probably is more in favorable to suicide.

------
crazygringo
The NYT published a simulator yesterday that shows infections/deaths over time
according to lockdown lengths:

[https://www.nytimes.com/interactive/2020/03/25/opinion/coron...](https://www.nytimes.com/interactive/2020/03/25/opinion/coronavirus-
trump-reopen-america.html)

The first two graphs show the incredibly dramatic reduction in infections and
deaths if we lock down for 2 months as opposed to just 2 weeks.

But what scares me is the sudden uptick at the end of the period shown. And
the article addresses it:

> _A skeptic will note that these measures don’t seem to prevent a surge in
> infections so much as delay them (in some cases so that the impact is pushed
> beyond the period that this model tracks). There’s something to that: We may
> see a resurgence whenever we let up, at least until we have a vaccine or
> herd immunity._

But this is what scares me. Whenever the lockdown ends, it's almost like we're
back to square one.

Yes, of course we have time to manufacture more ventilators and masks and
everything else. But I don't think anyone's contemplating a year-long lockdown
until a vaccine might be ready.

So somebody correct me if I'm wrong, but doesn't developing herd immunity
seems like the only realistic scenario here? Which basically means just enough
lockdown to "flatten the curve" but then essentially give the virus free reign
-- accepting that people will die, but still saving many more lives than right
now (because enough ventilators, etc.).

Yet virtually nobody seems to be talking about this -- about herd immunity,
about how there's zero chance of a lockdown eradicating the virus, about
coming to terms with what "flattening the curve" really means and when we
decide it's been flattened enough.

I suppose that's where the national conversation will have to go in the next
couple weeks/months... but it seems better to be having it up-front.

~~~
pdonis
_> Whenever the lockdown ends, it's almost like we're back to square one._

The part they're not telling you is that that conclusion is not an output of
the model. It's an _input_ to the model. The model tells you cases will surge
up again after lockdown ends because that assumption was put into it.

More precisely, the underlying assumption is that, even if you get to the
point where there are no new cases and you've waited long enough that the
incubation period has passed, so everybody who was exposed to the virus is
either symptomatic and being quarantined or asymptomatic and has no issues, it
is still possible for new people to get infected. But if the incubation period
has passed and everyone is either quarantined or asymptomatic, how is anyone
new supposed to get infected? The people who are symptomatic are quarantined,
so they can't, and the people who are asymptomatic shouldn't be contagious any
more, because the incubation period has passed. Yet the computer models
predict new cases. So the models are assuming that somehow people can be
exposed to the virus, never develop symptoms, but stay contagious
indefinitely. That doesn't seem to be a realistic assumption.

~~~
crazygringo
> _But if the incubation period has passed and everyone is either quarantined
> or asymptomatic, how is anyone new supposed to get infected?_

Because that's obviously an unrealistic assumption.

Realistic lockdown still has tons of people mixing at the grocery store, at
the doctor's or hospital, with all the essential services. During lockdown
_tons_ of new people are getting infected constantly. There's zero way to
bring that down to zero. Lockdown is just about reducing it.

And of course, even if a single country managed to achieve the impossible and
bring it to zero -- somebody from another country is going to visit at _some_
point and reintroduce it.

~~~
selimthegrim
Asymptomatic people can transmit - you can have a small minority be
responsible for the majority of new cases

~~~
pdonis
_> Asymptomatic people can transmit_

For how long? If I was exposed to the virus last week and am asymptomatic,
will I still be contagious in another week? A month? A year?

~~~
selimthegrim
Until you seroconvert I guess, I don’t think there are prodromes and shedding
like herpes

~~~
pdonis
_> Until you seroconvert I guess_

Ok, so how long is that?

------
united893
Link to the pdf?

~~~
mtmail
[https://www.thelancet.com/journals/lanpub/article/PIIS2468-2...](https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667\(20\)30073-6/fulltext)
(PDF link on the top-right of the page)

