
Harvard epidemiologist: my colleagues assumed UK coronavirus plan “was satire” - knzhou
https://www.theguardian.com/commentisfree/2020/mar/15/epidemiologist-britain-herd-immunity-coronavirus-covid-19
======
jrochkind1
> Is everyone in a high-risk group supposed to withdraw themselves from
> society for six months until they can emerge once the (so far entirely
> imaginary) second wave has been averted?

OK... but... isn't that what _everyone_ is being advised to do right now? So
maybe not a great example of something unrealistic to ask? Since in fact the
UK would be asking it of _fewer_ people than... many are saying it needs to be
asked of -- although the US government isn't actually telling us to... yet?
But that's the alternative those who who think the UK's plan is madness are
suggesting, right? Asking _everyone_ to withdraw from society for months?

I can see the desire: Wait, could we _just_ ask high-risk people to withdraw
themselves from society for months, instead of asking _everyone_ to do that?
Cause that'd be a lot less disruptive to our social and mental health maybe
it'd be just as good? (There are real costs to mental health and social
functioning of asking everyone to avoid all contact with everyone else; it
might be the best option anyway, but it's definitely not without it's own
health risks and consequences).

But I'm no expert. It kind of sounds like the experts are saying "not really,
that isn't a good idea, everyone has got to do it". Sometimes what we are
called upon to do is not easy or pleasant.

One of the frustrating and anxiety-producing things here is that we aren't
getting very consistent messaging from the governmental authorities and
experts. It seems like really a failure of the kind of consistent and
pervasive public health educational messaging that would actually maximize
compliance. Instead it's "everyone picks what forwarded chain letter on
facebook makes sense to them" and we all know how well that works...

~~~
masklinn
> OK... but... isn't that what everyone is being advised to do right now?

No. What everyone is advised to do right now is not to _withdraw_ from
society, it's to perform basic hygiene and social distancing in order to slow
down the spread. Social distancing doesn't mean living like a recluse eating
spam cooked on a gas burner, it's not getting into large crowds and trying to
stay some distance from other people (outside spitting / coughing range). WaPo
has an article with a "social distancing" simulator:
[https://www.washingtonpost.com/graphics/2020/world/corona-
si...](https://www.washingtonpost.com/graphics/2020/world/corona-simulator/)

"Self quarantining" is closer to what you're talking about, but it's for
people who are at risk or likely to have been infected, not the general
public.

Of course the latter you start the more it's already spread and the harsher
measures have to be. And the more you'll have to ramp them up as you realise
your initial measures were not sufficient, or your citizens have decided
"freedom or death" is a good choice and decide to just ignore it.

FWIW Taiwan's already reopened its schools and life has gone back to something
not entirely dissimilar to normal (people do have to wear masks and get their
temperature checked to step into public buildings or businesses but they can
move around just fine).

~~~
derefr
> it's not getting into large crowds and trying to stay some distance from
> other people (outside spitting / coughing range)

...which presumes you don't live in a place with high-enough urban density
that going outside your home immediately puts you into a large crowd.

Like, what are you supposed to do if you live in Manila? Mumbai? Dhaka?

Pretty much the only way to "practice social distancing" in those sorts of
places is to never go outside.

~~~
massysett
No, it means don't go to football matches. Don't go to cinema. Don't go to a
convention. Don't ride on a train for a leisure trip. That the distancing
can't be done 100% perfectly does not mean that all distancing is worthless
and therefore that NO distancing should even be attempted. Even slowing the
spread of the illness may be worthwhile.

~~~
jrochkind1
Don't go over to friends houses?

I am getting mixed messages, I'm not sure why I think asking for another
opinion on the internet will help, but there it is.

~~~
baq
you want to be a part of this effort? don't go.

~~~
spookthesunset
Link to an established authority saying not to occasionally visit friends or
you are spreading panic.

~~~
jrochkind1
It's not that it's necessarily "spreading panic" but that "believe whoever you
want on the internet" is not an effective public health communications
strategy.

But that appears to be what we've got.

The shaming approach of "you want to be part of this effort?" (whatever that
means) is unlikely to be an effective communications strategy either.

I don't know why I asked, I already had my choice of various opinions on the
internet (usually given from a position of moral superiority and judgement).

I seriously don't understand why the U.S. public health infrastructure is
failing so horribly here; if you want to maximize compliance, it seems obvious
that you should be giving consistent and pervasive instructions, there should
be literally a planned "marketting" campaign, with a consistent message. If
people are getting different messages from different places of _course_ they
will be confused and compliance will be less.

Instead, we have "which chain letter on facebook and/or shaming and blaming
comment on HN does my gut tell me seems right?" What the fuck America.

~~~
baq
i'll clarify: the effort in question is to stop being a potential carrier of a
novel disease for which nobody is immune for and thus has potential to put
great many people in a hospital for weeks at a time putting strain onto a
system which is hardly idle. you might catch the virus and probably won't be
able to tell the difference from common cold or flu. somebody you meet might
end up intubated and anesthesiologically paralyzed for a week. or dead.

so don't go if you don't want to be that person.

------
GrantZvolsky
To say the government opted 'to encourage the flames' is disingenuous.
Presumably their statistical model indicated they won't be able to contain the
spread which is why the current stated aim is to delay the spread[0]. Delay,
not encourage.

The article's suggestions seem to be in line with the government's stance. The
main difference is timing with Dr William Hanage saying measures should have
been adopted weeks ago while the government claims their modelling tells them
to adopt measures later.

The government should be challenged by questioning whether it truly is/was
impossible to contain the epidemic and what the best time to introduce
different measures is. This article, however, adds very little to that debate
with hand-waving in place of evidence.

[0]: [https://www.gov.uk/government/news/covid-19-government-
annou...](https://www.gov.uk/government/news/covid-19-government-announces-
moving-out-of-contain-phase-and-into-delay)

~~~
YeGoblynQueenne
>> Presumably their statistical model indicated they won't be able to contain
the spread which is why the current stated aim is to delay the spread[0].

What statistical model? They're talking of "careful modelling". In the article
you link, they don't mention anything about statistics, or, say, a simulation
etc. You're assuming too much when you're assuming a statistical model, or
anything based on data, or any concrete sort of model at all. "Modelling" can
just mean a bunch of officials sitting around having tea and brainstorming
potential scenarios.

~~~
GrantZvolsky
> "Modelling" can just mean a bunch of officials sitting around having tea and
> brainstorming potential scenarios.

Good point, but it doesn't seem to be the case. From the Coronavirus action
plan[0] published on March 3 2020

> The UK is a world leader in the field of outbreak modelling and data
> analytics. The NIHR HPRU in Modelling Methodology led by Imperial College
> London has developed novel analytical and computational tools which exploit
> novel data streams on infectious diseases such as COVID-19. This group and
> other leading academic groups have developed tools to prepare for infectious
> disease outbreaks, which include real time infectious disease models,
> allowing policy decisions to be made using the best possible data and are
> actively modelling questions of relevance to dealing with the COVID–19
> outbreak.

[0]:
[https://assets.publishing.service.gov.uk/government/uploads/...](https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/869827/Coronavirus_action_plan_-
_a_guide_to_what_you_can_expect_across_the_UK.pdf)

~~~
YeGoblynQueenne
Well, Imperial is a fine research institution indeed, but this still doesn't
cut the mustard. Sure, Imperial boffins may be creating "real time infectious
disease models" and those models may "allow" policy decisions to be made, but
this tells us nothing about what we really want to know: whether these models
were actually used to take the decisions we're discussing, instead of some
other process.

Really, the claims of having done "careful modelling" absent any evidence of
that modelling (say, a graph or a table of the results) is a really bad sign.

------
knzhou
I'm posting this because of the narrative on this site that all experts agree
with the UK's plan. To the extent that there is a consensus, it's a consensus
against it.

~~~
chimprich
I'm not sure there is a consensus against it. I've seen a few articles like
this (which is worrying) but articles in favour of the status quo tend to not
get so much prominence.

I really hope the government knows what it's doing. They have promised to
publish their models, so hopefully that will give some more confidence.

~~~
mytailorisrich
The government has somewhat changed the message and they are now saying that
their priority is to save lives, which does sound like contradicting their
previous message of rapid herd immunity.

~~~
grey-area
They’ve never had a message of _rapid_ herd immunity, unless by rapid you mean
spread out over 6-8 months. The whole point is to avoid either a slow burn
(where it comes back at the worst time in winter) or a fast burn (where health
services are overwhelmed).

Maybe their models are wrong, maybe other approaches will work better, but I
like they are having an honest grown up discussion about it instead of
insisting eradication is possible, or that there are no tradeoffs to be made
and total global lockdown of society for 6 months is the answer (which apart
from being of questionable efficacy would certainly cause another Great
Depression and more deaths from poverty).

~~~
londons_explore
The fact they haven't published their models worries me.

At a minimum, I'd like to know what their models are optimizing for. Is it
"Minimum number of deaths" or "Minimum economic cost", or "Minimum economic
cost taking into account a cost of $XM per death".

Minimum number of deaths probably isn't a smart metric, because the solution
to that is to tell 99% of people to stay home in bed for the rest of their
lives. Hard to catch a disease if you never leave bed.

Minimum economic cost (with a factor for cost of a death) is hopefully the
model they've used, but it's politically suicide to accept that grandpas life
was 'worth' $X.

~~~
sgt101
It's pretty challenging to get a model published in the time span required - I
believe that the team at Imperial College are racing to do this, but given the
behaviour of the virus is still a topic of research it's unsurprising that
they are not out there at this time.

~~~
tigershark
A model has nothing to do with the underlying data. If they thought that the
model was good enough to justify the deaths of hundreds of thousands of people
they should release it right now, so we all can take a look at that
abomination and decide for ourselves if they should be prosecuted for mass
murder in a couple of months.

~~~
sgt101
It's here now : have a look.

[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)

~~~
mytailorisrich
Is that the one that seemingly a U turn under the pretence of "new data"? [1]

Because the government already knew that rapid herd immunity would cause a
huge number of deaths.

[1] [https://www.theguardian.com/world/2020/mar/16/new-data-
new-p...](https://www.theguardian.com/world/2020/mar/16/new-data-new-policy-
why-uks-coronavirus-strategy-has-changed)

~~~
sgt101
It is new data - the assumptions that were in the model showed that the surge
capacity of ICU could cope in a social distancing scenario, but once they
factored in the rates from Lombardy they got a different result. The horrible
truth is that this thing is going to cause a huge number of deaths, I wish it
weren't so.

------
petilon
Sir Patrick Vallance, England’s chief scientific adviser, said the government
was looking “to build up some kind of herd immunity so more people are immune
to this disease and we reduce the transmission.” [1]

Britain’s chief scientific adviser ... said that about 40m people in the UK
could need to catch the coronavirus to build up “herd immunity” and prevent
the disease coming back in the future. [2]

Sir Patrick told Sky News that experts estimated that about 60 per cent of the
UK’s 66m population would have to contract coronavirus in order for society to
build up immunity. [2]

Read more:

[1]
[https://www.nytimes.com/2020/03/13/world/europe/coronavirus-...](https://www.nytimes.com/2020/03/13/world/europe/coronavirus-
britain-boris-johnson.html)

[2]
[https://www.ft.com/content/38a81588-6508-11ea-b3f3-fe4680ea6...](https://www.ft.com/content/38a81588-6508-11ea-b3f3-fe4680ea68b5)

~~~
baq
for reference, at this moment there are 21,157 (according to john hopkins map)
confirmed cases in Italy, which probably translates to anything between
50k-500k infections total. lombardy healthcare is near collapse and there's
1.5k people dead already. multiplying by 80-800 (best-worst case to get to
40M) left as an exercise to the reader. at that point the government might not
only buy all ventilators on the market but also all diggers.

~~~
enitihas
But if the UK government can managed to isolate elder people, and can get
those 40M to contain almost exclusively younger people, won't the fatality
rate be far lesser?

~~~
petilon
> _if the UK government can managed to isolate elder people_

You also have to isolate young people with preexisting comorbidities such as
cardiovascular disease, diabetes, chronic respiratory disease, and oncological
diseases.

There is also no guarantee that the immunity will last. You can catch common
cold (which incidentally is also caused by a coronavirus) multiple times. We
don't know if that's true for Covid-19 as well.

~~~
cameronh90
Common cold is caused by hundreds of different rapidly mutating viruses,
sometimes infecting you simultaneously, and it's usually a rhinovirus not
coronavirus.

It has been studied and determined most people cannot catch the same cold
virus again within a short-medium time frame.

------
boshomi
Two Women Fell Sick From the Coronavirus. One Survived.[1] Sui-Lee Wee and
Vivian Wang, nytimes.com March 13, 2020

[1]
[https://www.nytimes.com/interactive/2020/03/13/world/asia/co...](https://www.nytimes.com/interactive/2020/03/13/world/asia/coronavirus-
death-life.html)

------
Leary
UK government behavioral psychologist: Telling people to social distance won't
work for the long term because they'll get tired of it.

Also UK: People won't react negatively when hundreds of thousands of people
die. Keep Calm and Carry On.

------
xhkkffbf
I spoke with one doctor neighbor from England who now lives in the US. He said
he felt much more optimistic about the UK plan because the government was
doing a better job of consulting experts. He seems to think the US plan is
"satire." But let's not get too political.

~~~
DFHippie
It's nice to hear there is a US plan.

------
Engineering-MD
The problem is the alternative is even less feasible. Containment is very
unlikely to work, and slowing the epidemic too much leads to it happening in
winter.

The only thing which they should have done is delayed a decision on this. They
are a few weeks behind other countries, and could have observed effectiveness
of social distancing in arresting spread. If it worked, it could be copied
(ina modified form) and if it failed, it would be much easier to sell to the
public. Currently it’s a brave (but likely correct) position it would seem.

But then again, what do I know. While I’m a doctor, I’m No specialist so my
opinion is of limited value, and experts seem to disagree with each other.
This is what makes this so difficult, no one seems to know what is the best
option this current data.

~~~
joe_the_user
_The problem is the alternative is even less feasible. Containment is very
unlikely to work, and slowing the epidemic too much leads to it happening in
winter._

Containment has worked in Wuhan. Containment is being attempted after-the-fact
in Italy. Containment is possible, it's just a matter of how extreme gets. But
even the most containment does not look the hundreds of thousands or millions
dead that letting everyone be infected looks like.

~~~
cameronh90
It's possible to contain it with extreme measures, of course. But what happens
when you release the lock down and it's still burning through the rest of the
world, especially Africa and India? Do you ban every foreign visitor for the
next year?

~~~
baq
from a high risk country, yes. from a low risk country, test every single
arrival.

~~~
Engineering-MD
But the tests have a high false negative rate. Let them through and it can all
re occur.

~~~
baq
Current ones, yes. New ones are in development and keep appearing weekly.

------
YeGoblynQueenne
It's interesting to contrast the UK approach to -everyone else's approach.
Everyone else is asking _infected_ people to do the socially responsible thing
and self-isolate to protect those around them. The UK is asking (or will be
asking) the _vulnerable_ people to self-isolate to protect themselves.

It is very hard to avoid thinking of it this way but: what happens if a
vulnerable person fails to isolate, for whatever reason (stupidity, ignorance,
accident, etc)? Is the blame on them? They were told to protect themselves and
they failed, so it's their fault?

if I think of it this way it very much sounds like the UK government is
planning to just er, wash its hands of vulnerable people and refuse to take
any responsibility for their fate.

------
Gatsky
Well satire is a bit strong. But I think the plan seems unwise, due to
unvalidated assumptions (especially that immunity will last during a second
wave) and the nature of their health system. If an effective treatment
emerges, they will also have made a mistake.

------
Donald
The main issue with the UK's approach is approximately 10% of young people
need acute medical care (e.g., ventilator access). There aren't enough
hospital beds in the NHS system to meet that demand.

~~~
JamesBarney
I thought 10% of the general population required hospitalization. With a
smaller number of people needing ventilators and a even smaller % of young
people needing ventilators.

~~~
knzhou
At this point, hospitalization basically implies ventilation. Hospitals are
crowded. If they were just going to give you a bed and some pills, they'd have
you do that at home.

France reports that half their patients in critical care are under 60, which
is supposed to be the "low risk" group.

------
gentleman11
I’m anxiously waiting for the news that we will block travel from the UK to my
country. If they are deliberately making their people into pathogen spreaders,
we can’t let them visit us

~~~
tim333
There are a fair few restrictions already and I'm sure they'll ramp up over
time. At the moment quite a few countries (eg Singa, OZ, Taiwan) require 14
day self isolation for arriving brits.

------
confeit
I think "herd immunity" is a euphemism for: This virus will see community
spread of around 30% to 70% and it is long impossible to contain. The U.S. is
preparing for 30%, The Netherlands for 50%, and Germany for 70%.

Herd immunity will be hard, since antibodies for coronaviruses last only about
4 months.

Even the strictest quarantines possible in the West don't compare to the mild
quarantines in the East. The laws don't allow for contact tracing with GPS
coordinates and credit card purchases, like they do in Singapore.

Quarantine methods put selective pressure on the strain types that are more
infective and severe, since such mutations and recombinations are the only
ones able to escape quarantines.

So the plan seems to be to turn this into a community virus, much like herpes
or HIV. Then the selective pressure is for the mortality rate to drop and the
disease becomes manageable. It would seem silly to damage your economy with
heavy quarantine methods when local community cluster spread continues to pop
up.

Of course, the UK government can not come out and straight up say this, but
they seem one of the few governments that is realistic about facing this virus
and its impossible to contain infection rate. I am guessing they ran the
numbers from the Italy quarantines and based their decision on that.

~~~
JamesBarney
> Quarantine methods put selective pressure on the strain types that are more
> infective and severe, since such mutations and recombinations are the only
> ones able to escape quarantines.

Mind sourcing this? This seems the exact opposite of what I'd expect. I'd
expect quarantines to s left for milder strains that are harder to detect.

~~~
confeit
> Human intervention may have placed more severe selective pressure on the L
> type, which might be more aggressive and spread more quickly.

Harder to detect I would see in a strain that has a longer asymptomatic spread
period. The only way for a virus to escape a strong quarantine and survive is
to survive on surfaces longer, be asymptomatic longer, cause more severe
illness (spread through cough and sneezes, especially in hospitals), linger in
the air longer, etc.

~~~
riffraff
> cause more severe illness

on the contrary, more sever illness makes it less likely to spread, no?

You are always spreading germs around, if you have high fever or start
coughing blood you'll get isolated but if you just have a runny nose you will
keep living normally and the virus will happily keep infecting other people
when you shake hands.

~~~
confeit
During quarantines people are not shaking hands. I am not saying quarantines
necessarily select for a higher death rate (a dead host can not spread), but
for a more severe disease (the main drivers of a spread are when people
ultimately develop severe symptoms).

Community viruses mutate to see a lower mortality, severity, and
infectiousness, since there is no selective pressure to have an r0 much higher
than 1. For a community virus there is also no selective pressure to mutate to
a vastly different strain, so the antibodies for other strains don't help,
whereas if the virus is confined inside a city like Wuhan, the only way to
reinfect is to mutate to a vastly different strain.

------
toohotatopic
Aren't masks and other stuff on short supply? At least Italy didn't have
enough and France is restricting exports. Even if it is a good idea to
restrict the economy as little as possible, how do they prepare for the moment
when there are no masks and nurses will drop out en masse due to being
infected?

------
adrianhel
In Norway we just slipped from the 2nd most infected per capita to the 3rd
after government warnings. If your country has >= 1 infected, you should
follow the advice at fhi.no/en.

~~~
dirtydroog
"This page isn't feeling well"

(LOL in Norwegian)

------
lightgreen
This article is "fake news" and FUD.

Quoting the article:

> The UK should not be trying to create herd immunity, that will take care of
> itself.

That's a clear blatant lie.

UK is NOT trying to create a herd immunity. UK is trying to flatten the curve.
And UK is admitting that 60% population will get invected. And then the UK
will get herd immunity.

For example, it is explained (again) in this video:
[https://www.youtube.com/watch?v=2XRc389TvG8](https://www.youtube.com/watch?v=2XRc389TvG8)

Feel free to downvote, that's a popular sport here on HN.

~~~
DanBC
You keep saying the aim isn't to create herd immunity, but that was the way
the government introduced the delay phase.

They've pulled back a bit from it because they've seen the vehement public
reaction to it.

Cummings may well be evil, but he's not stupid.

~~~
lightgreen
> They've pulled back a bit from it because they've seen the vehement public
> reaction to it.

They did not.

I watched an hour long full press conference by PM and two adisors.

[https://www.youtube.com/watch?v=xRadMzCKnCU](https://www.youtube.com/watch?v=xRadMzCKnCU)

I also watched an hour long Chris Witty Q&A for MP following day.

[https://www.youtube.com/watch?v=IfJcwDaZrsA](https://www.youtube.com/watch?v=IfJcwDaZrsA)

Both of these talks were about flattening the curve because of NHS capacity
etc etc.

The scientists mentioned herd immunity couple times, but not like they are
intentionally trying to create it. It was rather like: herd immunity will
happen in several months.

> Cummings may well be evil, but he's not stupid.

Likely he got his information from dishonest journalist articles and started
self-promotion.

But it's a shame that smart people on HN continue to retransmit this fake.

~~~
tigershark
Maybe you were quite distracted while watching it. As far as I remember the
only advice they gave during that press conference was to stay at home for 7
days _only if you have a cough_. Does it look like flattening the curve to
you? To me it looks like “let’s increase the contagion and the deaths as much
as possible” compared to what every other country was doing at the time.

~~~
lightgreen
Yes, I remember that. They told to do so because otherwise economy will be
hurt and people get tired of self-isolation. Not to intentionally create herd
immunity.

------
adrianhel
Take action now.

------
elorant
I doubt this plan will be long lived. Once the bodies start piling-up there
will be a riot.

~~~
nknealk
Bodies piling up is a lagging indicator. I think there’s some consensus that
once the bodies start piling up it might be too late to do anything

~~~
jacquesm
That's roughly three weeks from now. Once ICU capacity is saturated it goes
downhill very fast. In Italy that took less than three weeks because their
population skews elderly, so in the UK it might take a bit longer.

~~~
k__
They also only had half of the beds of, for example, Germany.

~~~
Taek
Some areas of Italy had a doubling rate of once per 2.4 days.

So Germany, with twice as many hospital beds, gets 2.4 days extra of reaction
time.

Exponents are terrifying.

~~~
CraigJPerry
It’s not an exponent, it’s a logistic. That may or may not change the outcome
but you can’t just ignore the part of the trace line that doesn’t fit the
scare narrative right?

~~~
baq
but that's the part that only stopped going exponential after the lockdown
hammer dropped right?

------
thu2111
The Guardian is such a rag. Why does it still have readers? Finding academics
who will criticise anything this conservative pro-Brexit government does is
easy: Johnson could make any announcement at all and within 24 hours the Graun
would have found a contemptuous academic to tell their readers why it's stupid
and bad.

People can agree or disagree with the British government's logic. Only someone
very biased would treat it as inherently absurd.

So let's look past the headline at what this guy is actually saying.

He starts this piece by asserting his authority as an expert. But he isn't
revealing any new information or critical analysis that would change anyone's
minds. In fact as you read further down you find he's actually agreeing with
the government's policies.

The key points of the article are:

• Herd immunity will happen anyway and shouldn't be a goal.

• A second wave may or may not happen, it shouldn't drive policy.

• Be like South Korea and close everything for an unspecified period of time.

• Close the schools! But keep children away from Nana and Grandpa.

The entire article says nothing that hasn't been said elsewhere; the only
benefit this guy's epidemiology experience seems to add is credentialism. But
there are also major logic problems in the argument.

Let's start with his last point about children and schools. He obviously
realises children shouldn't come into contact with grandparents, but fails to
apply the common sense knowledge that many parents can't stop working to take
care of them e.g. because they work in the healthcare system, or logistics, or
grocery retail, or pharmaceuticals, or government, etc. So those children will
all go to their grandparents, assuming they have some: the one place you don't
want them to be. This is a point the scientific advisors to the government
made in their announcement press conference but he fails to address it.
Children need to be kept away from grandparents and in the presence of young,
fit, healthy adults. These conditions can be found in schools.

He says:

 _Second waves are real things, and we have seen them in flu pandemics. This
is not a flu pandemic. Flu rules do not apply. There might well be a second
wave, I honestly don’t know. But vulnerable people should not be exposed to a
virus right now in the service of a hypothetical future._

The belief a second wave is likely has nothing to do with how flu-like the
virus is. Saying flu rules don't apply is a non-sequitur. Second wave is a
simple observation based on the fact that stopping infected people coming in
and out of the country isn't possible, nor will it be possible going forward.
International travel isn't going to remain shut down for long, which means
even _if_ the government could somehow wipe out COVID-19 purely via social
control policies, it would come back the moment those measures ended and
normal life returned. The only way to stop it permanently is if most people
are immune so it can't spread.

Also, just saying "this might or might not happen, who knows" is a poor basis
for policy making. This guy is an expert, where's the probabilities?

He says:

 _The UK should not be trying to create herd immunity, that will take care of
itself_

But the UK isn't "trying" to create herd immunity. What would that involve,
actually? Encouraging chicken pox style virus parties? It's not doing anything
like this.

Believing that requires an especially bad-faith reading of a (perhaps poorly
phrased) statement by a fellow scientist. The goverment understands that herd
immunity is going to happen sooner or later, it's the only way to end this,
and that's why reaching it with as few fatalities as possible is the stated
aim.

Finally, his recommendations are useless. He just recommends social distancing
and shutdowns without any time frames attached. Does he believe people can
self isolate and schools can remain shut indefinitely? If not, if he believes
these measures don't last for long, then there is a question of when the
optimal time to deploy them is. And trying to answer that question is how the
government arrived at its current policy.

I have to say, reading this makes me glad the government has better scientists
than this guy advising it. Maybe Dominic Cummings is onto something after all.

~~~
CraigJPerry
That was an extremely long post to avoid addressing the actual concern - that
there aren’t enough hospital beds to support a country that doesn’t
aggressively and ruthlessly implement social distancing and contract tracing
right now.

~~~
thu2111
It was addressed, along with all the other points.

You are implicitly believing that those measures can last for a long period of
time if implemented _right now_. The government is arguing that there are
inherent limits to how long that can go on for and that if they must be used
at the right time, when more people are infected than at the moment.

The author of the article makes the same mistake. He writes as if social
distancing is something you just switch on, and then the outbreak ends.
There's no concept that normalcy must return, and so that there's some kind of
planning involved in when and how to ramp it up/back down.

~~~
CraigJPerry

        $ grep bed https://news.ycombinator.com/reply?id=22591395&goto=item%3Fid%3D22586451%2322591395
        that there aren’t enough hospital beds to support a country that doesn’t aggressively and ruthlessly implement social distancing and contract tracing right now
        $
    

Nope, you definitely didn’t address it and still haven’t.

~~~
thu2111
Because I didn't use the word bed?

Look, the key point here is neither you nor the author actually know to what
extent "aggressively and ruthlessly implementing social distancing right now"
will impact the need for beds, that concept isn't well defined. And you are
still ignoring that such measures can't last indefinitely.

OK, so everyone is put under total curfew right now and shot if they're found
on the street. The spread slows then stops. After a month life starts getting
back to normal, and then case numbers start shooting up again. What then?

The optimal position is for every bed to be taken all the time, as that way
the curve is flat at exactly the right point to get everything back to normal
as soon as possible by having people build up immunity. We all have no idea
when the right time to start asking people to hide in their homes is, or even
if asking everyone to do that is a good idea. But we can be pretty sure it
can't last forever and the right time for people to be isolating themselves is
when most people have it, as that way they're getting sick and recovering at
home. It's not at a time when most people don't have it and the home stay does
nothing but put off the inevitable for a few more weeks.

------
m0zg
I think the UK plan is based on some sobering truths that others are just not
prepared to acknowledge (yet):

1\. You can't shut down the economy indefinitely. At least not if your goal is
to minimize fatalities. And if you don't do that, your "quarantine" is not
going to be effective

2\. You can't maintain quarantine for more than a month or two, after which
your epidemic simply re-starts, and you don't get to re-impose the quarantine
then because the first quarantine "failed".

3\. Vaccine is over a year out in the best case, assuming it works at all. If
it's anything like the flu vaccine, chances of it working reliably on mutated
strains are approximately nil.

4\. Younger people tolerate the disease much better, and if they build up
immunity to it while the senior population self-isolates, the overall number
of deaths could be minimized.

5\. Due to how widespread and virulent this is, it will just become the "new
flu", and it will come back with mutations every year. We can't do what we're
doing now every year, at least not if the goal is to minimize deaths.

~~~
threeseed
1\. China didn't need to.

2\. China did.

3\. So then there isn't any point to herd immunity.

4\. Only younger people who are in good health. There are many disabled and
sick young people.

5\. It could be the new flu. Or it could be like SARS/MERS.

~~~
m0zg
#2: we'll see about that; the UK is betting that China's strategy, even if it
could be applied in the West (which it can't be) will be ineffective in the
medium to long term

#3: there is: if 60-70 percent of people are equipped to kill the virus, it's
the best "quarantine" imaginable for people who are at risk

#4: those who have comorbidities could also self-isolate; it's still much
better than telling _everyone_ to self-isolate - that's simply not going to
happen unless you weld people's doors shut

~~~
threeseed
China's strategy is largely what is being adopted in Europe and Australia/NZ.

And as we've seen in Italy it's absolutely possible to have everyone self-
isolate. You just police it.

~~~
m0zg
Italy is _way_ not out of the woods yet. Their case growth remains
exponential. It's too early to tell if their strategy is working at all.
Germany is already planning for herd immunity scenario (as per Merkel - she
expects 60-70% of Germany's population will be infected, and hundreds of
thousands will die). In fact I don't see any difference in the rate of
doubling between Italy (which is imposing hardcore containment measures) and
the UK where the measures are much less severe. Although I'm sure Italians
feel like they're "doing something" and "in control" of the situation, so it
should be psychologically easier. But that's not the reality I see in the
graphs.

------
ce4
This will cause a hard Brexit and isolate the island if they don't turn around
quickly...

------
globular-toast
But "herd immunity" is not the plan, that's just what people on social media
are saying.

~~~
mytailorisrich
Quote:

In another interview with the BBC, Sir Patrick said: “If you suppress
something very, very hard, when you release those measures it bounces back and
it bounces back at the wrong time.”

He added: “Our aim is to try to reduce the peak, broaden the peak, not
suppress it completely; also, because the vast majority of people get a mild
illness, to build up some kind of herd immunity so more people are immune to
this disease and we reduce the transmission, at the same time we protect those
who are most vulnerable to it.”

Source:
[https://www.ft.com/content/38a81588-6508-11ea-b3f3-fe4680ea6...](https://www.ft.com/content/38a81588-6508-11ea-b3f3-fe4680ea68b5)

~~~
hilbertseries
So, the U.K. plan is survival of the fittest. I’ve been reading reports that
high severity cases cause lung scarring even in young people who survive.
Given that high severity cases seem to have the same incident rate in young
people, this seems insane.

~~~
CraigJPerry
It is expressly not survival of the fittest.

It is fine to state this is risky, it is. It’s unproven, also true. However
the methodology is not survival of the fittest (do nothing). Don’t miss label.

------
throw7337
Hospitals are already stretched, it takes hours of waiting to treat normal
injuries such as broken legs. Waiting list for some operations is years long.

How many people are going to die from other causes, if we shutdown entire
country for 6 months? How many of those will be children and young people?

It may sound harsh, but as a younger person I prefer this plan.

~~~
Zenst
Indeed, you realy want the bulk of those who will not have complications to
catch it early and leaving schools open, enables that. Over making every
parent stay at home to look after their child!

Coz you need to balance out infections and with that manage them, so you will
see periodic lockdowns in some parts to throttle back infection and also those
most at risk will see themselves issolating for months and however you do
things, you want to be doing that anyhow.

So infect, isolating those who high risk and letting others carry on and
manage infection rate with hospital numbers as you will get risk people
getting infected anyhow, so focusing on managing infection in those you can
and getting it out the way, has logic behind it. yes people will die, they are
not flowing that up, but equally, they are planning for those longterm to be
lower than falling victim to the seasonal waves ala spanish flu and how that
went.

Yes it does seem harsh, but as an older person it is the best plan for the
whole and I'm high risk.

~~~
baq
you seem to believe that the government can control a function exponential in
time but with incomplete and delayed information. what could possibly go
wrong? you only have to miss one super spreader event and you're left with a
runaway transmission that you only get to know about 5-10 days after it
happened.

also, if bojo wants to ask old people to stay home for 4 months in a couple
weeks, why not ask them now to stay home for 4 and a half months? not enough
dead in the calculation or what?

~~~
Zenst
I believe people are going to die, and looking at the long term counts over a
short-term mentality and with that, having less deaths overall is a better
plan than not.

But if you have a solution to how an entire country can completely isolate and
operate in today's times for any European sized country then I'm all ears to
hear it as we are talking a year at least until any sort of vaccine is
available.

As for `super spreaders` that's a given, just the same way Europe has easy
access to heroin and cocaine that are all imported - you can't stop things
spreading even with best intentions and efforts and viruses are much smaller
than smuggled drugs. So given that, people who spread this will happen and how
would you ever stop that? Sure isolate from the vulnerable and at risk and
those groups are already on the case, heck the amount of old people I know and
saw 2 weeks ago buying a years worth of toilet roll - well, they are already
self isolating and no need to be told by some PM they may or may not respect
when they have a lifetime of common sense and experience to draw upon and
effectively kick into war-mode mentality lockdown. Though many will learn that
over the comming year as this is a world war, only it's the entire world this
time fighting a virus. Looking at how the spanish flu went, the real fear is
not the hear and now, but the winter to come.

~~~
baq
my plan would be pretty much what my country is trying to do (I hope) and what
South Korea has successfully done already: tell everyone to sit on their asses
while massively scaling up testing capabilities so that everyone can test
every few days. follow up on every positive case, quarantine carrier and all
contacts. test everyone (literally) crossing the border, quarantine as above.
this allows to open the country back up while waiting for a vaccine in 12-18
months... or however long it takes.

~~~
makomk
South Korea can test about 10,000 patients a day. Their total population is
about 50 million. They've primarily been relying on contact tracing to target
their testing, I think.

~~~
baq
15k but you're right otherwise. they've done many other things for this to
work.
[https://www.npr.org/sections/goatsandsoda/2020/03/13/8154410...](https://www.npr.org/sections/goatsandsoda/2020/03/13/815441078/south-
koreas-drive-through-testing-for-coronavirus-is-fast-and-free)

------
eanzenberg
The disparity of death rates among countries has more to do with
infrastructure than the virus. Germany and Switzerland are proving this is
just a flu, albeit a pretty bad one (0.1-0.5% death rate). More testing will
prove this out by increasing the denominator by 10x.

~~~
nostromo
Testing is the biggest variable.

More testing = lower mortality rate.

The alarming mortality statistics from Wuhan and Italy turned out to be
extremely high due to lack of available testing and mild cases that were never
reported.

Statistically there are likely already thousands of unreported cases in
Seattle, but nobody can get tested. If you have a fever, people are being
asked to stay home and not go to the hospital at all. So they’re not even
counted in the official numbers.

~~~
photon-torpedo
This is also showing in UK already, where mortality rate seems to be ~3% now.
And it is already announced that people who don't need hospitaliztion won't be
tested. So number of confirmed cases will appear relatively low but death rate
will go up.

------
leonixyz
UK will survive, UK's economy will survive, they are consciously sacrificing
many of their elders and weaker people - who are in most part a mere cost for
the society - in favour of young and productive individuals. They are
rationally addressing the consequencies of Brexit by doing so, taking an
advantage over EU, who is likely to fall into recession. UK traded their moral
for their economy.

~~~
enitihas
But aren't their elder people highly likely to be conservative voters, and
also voting in large percentages. If those people do not vote in the next
elections, won't the tories lose by a large margin?

Source: [https://yougov.co.uk/topics/politics/articles-
reports/2019/1...](https://yougov.co.uk/topics/politics/articles-
reports/2019/12/17/how-britain-voted-2019-general-election) (And anything else
I could find by googling gives similar stats)

The government may not be moral, but I don't know if any government makes
plans for losing election in a landslide. Is there something I am missing
here?

~~~
tigershark
The next national election is in 5 years time...

