
Ask HN: What happens next after a successful lockdown? - martokus
Optimistic scenario - lockdown everywhere is a success and after a month there&#x27;re single cases here and there, maybe even 0 cases. Would countries resume travel and ease gathering restriction before a vaccine has been invented? Or we can expect to be in a lockdown for 12-14 months until a vaccine comes to market, if it comes to market?
======
adaisadais
I remember all of the statistical problems centered around virality that we
would have to do in college. The problems always seemed so make-believe and
dystopian.

Now my company is close to going out of business and I have just been laid
off. Partly due to high-ranking officials not believing in the virality of
nCov-19.

I can't get W.B. Yeats "The Second Coming" from 1919 out of my head:

"Turning and turning in the widening gyre The falcon cannot hear the falconer;
Things fall apart; the centre cannot hold; Mere anarchy is loosed upon the
world, The blood-dimmed tide is loosed, and everywhere The ceremony of
innocence is drowned; The best lack all conviction, while the worst Are full
of passionate intensity.

Surely some revelation is at hand; Surely the Second Coming is at hand. The
Second Coming! Hardly are those words out When a vast image out of Spiritus
Mundi Troubles my sight: a waste of desert sand; A shape with lion body and
the head of a man, A gaze blank and pitiless as the sun, Is moving its slow
thighs, while all about it Wind shadows of the indignant desert birds.

The darkness drops again but now I know That twenty centuries of stony sleep
Were vexed to nightmare by a rocking cradle, And what rough beast, its hour
come round at last, Slouches towards Bethlehem to be born?"

~~~
8bitsrule
Yeats, hunh? No; give me Omar

 _The Moving Finger writes; and, having writ,

Moves on: nor all your Piety nor Wit

Shall lure it back to cancel half a Line,

Nor all your Tears wash out a Word of it_

------
aqme28
I thought this interview was illuminating for post-lockdown life in China
[https://twitter.com/MikeIsaac/status/1238604080571772928?s=2...](https://twitter.com/MikeIsaac/status/1238604080571772928?s=20)

It shows just how far behind we are.

TLDW: Temperature checks everywhere. Fever clinics optimized for quarantining
the potentially infected.

China is trying to actually contain the virus. The only way out for us unless
we significantly ramp up testing and lockdown is to admit defeat and simply
optimize for slowing down the onslaught.

~~~
smacktoward
_> The only way out for us unless we significantly ramp up testing and
lockdown is to admit defeat and simply optimize for slowing down the
onslaught._

This has already happened. “Flatten the curve” takes it as written that most
people will be exposed to the virus, and thus aims instead to just spread
those exposures over a long enough period to avoid overwhelming the health
care system.

~~~
smoyer
I saw a statistical analysis of the flatten the curve idea but assuming we
couldn't ramp up the number of intensive care beds, it took 3600 days to fit
everyone in under the "available health care" line.

It's still a good strategy for right now because it gives us some extra time
to ramp testing and healthcare up.

~~~
dharmab
Presumably not everyone needs a hospital bed. Most are fine to take a few days
of bed rest, many who would normally be hospitalized out of caution can be
cared for by family at home with teledoc guidance, it's a small percentage at
high risk who need hospital care.

~~~
bosie
a small percentage of a large number is still a large number. 80% infected
within 1 year and ~10% of those require hospitalization. usa: 350m => 80% is
280M => ~30 million hospital/ICU beds for 2-4 weeks. this is on top of
regular/ongoing hospitalisation. hence it hitting any african country or india
with the same force would be devastating.

~~~
markhahn
much less than 10% require hospitalization, though.

~~~
bosie
the beauty of the equation is that you can fiddle with the numbers as much as
you want, it will always lead to a collapse of the health care system

------
kstenerud
It's your typical pandemic response:

\- denial

\- placating measures

\- minor lockdowns

\- major lockdowns and panic (running to the store to stockpile toilet paper,
for some reason)

\- total quarantine

\- life slowly returns to normal

China is now on the final stage (restaurants and stores reopening, etc), with
the rest of the world between 2 and 3 months behind.

Most people are unable to comprehend exponential growth, so this is the
pattern that gets followed.

~~~
drstewart
Total quarantine isn't happening in any western country

~~~
kstenerud
... except Italy

~~~
friede
and spain

~~~
DanielleMolloy
Germany is close, they just announce new measures bit by bit every day. Next
step not unlikely to be total quarantine.

~~~
mirekrusin
Switzerland is in state of emergency since today, it's great because they can
deploy military to help.

~~~
vinay427
It's not even close to the intense measures in Italy or Spain (for example),
however. There's a good bit of discontent about that among people I talk to in
Switzerland, but there's no good option so that's expected whatever they
decide.

------
zamfi
I’m surprised that no one here is mentioning the example of South Korea. [1]

They are not in total lockdown, but they are doing extensive testing and
contact tracing, and substantial isolation of anyone who might be contagious.

Once we get testing infrastructure ramped up, this is not an unreasonable plan
in the United States.

[1]: [https://www.bbc.com/news/world-
asia-51836898](https://www.bbc.com/news/world-asia-51836898)

~~~
bcrosby95
Because it's too late. The time for that in the US was at least two weeks ago.
This is why the US response to this has been driving so many of us crazy. The
later you respond the fewer options you have.

~~~
zamfi
The original question was what to do post-lockdown.

To be clear, lockdown is the only option for the US right now. But then what?

~~~
seunosewa
Wait until the rest of the world catches up with you, else they'll reinfect
you as soon as lockdown ends.

------
cperciva
If social distancing can bring the number of cases down to a manageable level,
you can switch to a traditional public health approach: Test anyone showing
symptoms, and aggressively trace and test any contacts of known cases.

~~~
martokus
Wouldn't they be afraid that if the rules are relaxed the single cases would
spiral up and start it all over again?

~~~
cperciva
If you can identify the remaining cases and isolate them, you're fine. The
danger is that some cases slip through the contact tracing procedure (e.g. the
identified patient forgot about someone they were in contact with) which is
why you also want to aggressively test anyone presenting with symptoms.

------
fspeech
The South Korean model:

1\. Build up testing and contact tracing capabilities.

2\. Massive mask making, everyone required to wear a mask in public.

3\. Hospitals reconfigured to deal with covid patients.

People can then go outside and mingle again.

~~~
superpermutat0r
What kind of masks are effective? The one I have seems weird, I just feel the
water vapour touching my eyes when I exhale. I guess the mask would block the
sneeze/cough projectiles and small spits while talking but if I were sitting
in the public transit the water vapour would float around.

~~~
fspeech
Wearing a mask is to protect others from your own droplets. This is CDC
protocol: if a doctor suspects covid, the patient is given a mask to put on.
If that is enough to protect the doctor in close proximity, it is good enough
to protect the general public. Like herd immunity if we all wear masks in
public, the chance of droplet exchange is greatly reduced. The quality of mask
and the manner of mask wearing become irrelevant. This is why we need
universal mask wearing. It is the fastest and cheapest way to get the economy
back on its foot again.

~~~
matt_the_bass
I don’t understand why this is not mandated now everywhere. Yes I know
supplies are limited but factories could start making these quickly if govt
mandated them.

------
hackermailman
There's vids all over YouTube from WuHan what to expect. First the jubilant
singing and party slogans, then screaming for help all night
[https://m.youtube.com/watch?v=Zp3jH6iYrnw](https://m.youtube.com/watch?v=Zp3jH6iYrnw)

Then each block is allowed movement after 2 months with community punishment
if they hide cases and monetary incentive to follow rules, such as keeping
contaminated clothing outside. Workers in critical industry will live at work
and not allowed home to prevent contamination
[https://m.youtube.com/watch?v=yyucJekT87E](https://m.youtube.com/watch?v=yyucJekT87E)

------
RickJWagner
Is anybody else wondering about authoritarian power grabs?

It's all so surreal, I can just imagine it. (In the US, I think some primary
elections are under discussion for delays.)

I'm not worried, just wondering how to best disarm it from a distance.

------
zaptheimpaler
I would hope the lockdown gives us enough time to do thorough testing &
tracing of the virus. Also a lockdown + messaging should convince people to
take this thing seriously and follow the precautions.

If we know who has it well enough then we can focus care on them, wait until
they can fight off the virus and go back to normal after. That is assuming
people don't transmit the virus after recovering from it.

------
shartshooter
The primary goal right now is to flatten the curve so the growth doesn't stay
exponential for any longer than it has to.

Once that flattens out and the growth rate slows or decreases a concerns is
that folks will head back out, assuming the coast is clear.

That could cause a second wave of infections that restarts this whole thing.

Folks not taking this seriously is a problem, imagine what happens when folks
who don't take this seriously think that it's finally over, when it really
isn't.

~~~
danenania
Subsequent waves should be a lot easier to contain if we’re prepared for them
and act immediately at the first signs of renewed spread. Apart from contact
tracing, judicious use of targeted, local lockdowns in areas where community
spread pops up again can prevent the need for country-wide lockdowns.

~~~
gbersac
Health worker will be exhausted, so it will be harder

------
Leary
Resume work after countries have the capacity to test everyone who has a
fever. Maintain strong hygiene and social distance if possible. Firefight
clusters of outbreaks where they occur. Wait for treatment and vaccine.

~~~
notyourday
> Wait for treatment and vaccine.

Isn't this a virus? There's not a single virus that we have a treatment for -
we know how to deal with bacteria but not viruses.

~~~
Leary
Treatment won't be completely effective but can reduce death rate. There are
hundreds of trials ongoing, 1 or 2 or 3 may work well enough to give to
people.

~~~
notyourday
So this is 1-2 years out.

------
Zaskoda
If tensions ease too quickly and we release everyone into the wild, it could
cause another outbreak. I don't personally know the parameters of that risk, I
just know it is a risk.

But on the bold assumption that we somehow contain the virus, we have a global
economic collapse to tend to.

------
ChuckMcM
It's a good question. I've been thinking of it this way;

If we have an "unlimited" (by which I mean we manufacture them faster than we
consume them) number of test kits with a turnaround time of < 24 hrs, then
everyone on lock down for 14 days. Medical/Drive through facilities set up to
process everyone for a test. Get a test, and then within 24 hours get a text
on what their status is (infected, uninfected, immune (post infection)).

People who test positive go into quarantine to be re-tested weekly until they
are immune.

People who test immune are allowed to resume work movement while keeping good
practice (washing hands, coughing into elbow, Etc.)

People who test as non-infected are required to come back for re-testing every
week, can move around with social distancing.

I don't know if it would work (I'm not a public health professional) but from
a systems perspective surveillance of the infection seems to be the best
strategy for staying on top of outbreaks.

Once a vaccine is available it becomes one of the things you get every year
like a flu shot.

~~~
pmoriarty
Regarding immunity, there is evidence that such immunity (if it exists) is
short-lived, and after a little while recovered individuals are susceptible to
being infected again.

~~~
tonyedgecombe
Do you have a reference for that as I keep hearing it repeated but I'm yet to
see any real evidence for it.

~~~
pmoriarty
Here's what Ralph Baric, an epidemiologist from the University of North
Carolina Chapel Hill, had this to say on episode 591 of This Week in
Virology[1] a couple of days ago:

Ralph Baric: _" I saw some very interesting data from Stan Perlman the other
day, who has been looking at serum neutralization titers of MERS patients from
the Middle East kingdom of Saudi Arabia area and it's quite intersting that
people peak fairly quickly with high neutralization titers but then they wane
over the next year to almost background levels or just slightly above
background levels by the second year, and with MERS there have been several
reports of people who have seroconverted. They were rtPCR positive and their
serum neutralizing titers and even ELISA titers went to almost zero within a
few months."_

Baric: _" And it has not been studied and it should be studied, and this is
the contemporary human Coronaviruses -- nobody knows how they maintain
themselves in human populations. They don't undergo rapid antigenic variation
like influenza. There's not 115 common cold or corona virus type genotypes or
whatever they're called, serotypes. Sorry Vincent, I just butchered the
coronaviruses."_

Vincent Racaniello: _" That's ok."_ <laughter>

Baric: _" So one hypothesis is that they cause a transient protective immune
response that wanes quickly and then they can reinfect and cause mild upper-
respiratory tract infections and that's how they maintain themselves. So it is
quite possible.. there's been a number now of reported cases in China of SARS2
infections where people were documented to be infected and recovered. They
were rtPCR negative. They went home and they became reinfected a month later
or so."_

Baric: _" In this case the United States has sufficient cases that we can
actually track the serologic responses of the individuals and their general
immune.. both B- and T-cell responses after infection and we can get a handle
on the long term immunity that may be elicited after infection."_

[1] -
[http://www.microbe.tv/twiv/twiv-591/](http://www.microbe.tv/twiv/twiv-591/)

[2] - about 15 minutes and 50 seconds in to the program

~~~
gomox
Could you clarify this for laymen?

~~~
dijit
"The Immune response for MERS tapers off over a year; but we don't know what
the immune response is of SARS2, it looks very different, it might be very
short lived, we need more evidence"

------
jredwards
I anticipate that sooner or later the economic costs of staying on lockdown
will overwhelm the benefits. We will probably begin to loosen restrictions and
we will probably see periodic outbreaks in various places.

I don't know if that simply continues until a vaccine is viable or some other
factor intervenes.

But this new reality won't be short-lived.

~~~
hfufigivknog
No actually it will be. It will be gone from the planet more or less within
months. Corona viruses don’t mutate in a way that invalidates immunity gained
from exposure to its ancestors. The flu does that but corona viruses do not.
And there is no evidence that this one is an exception. Herd immunity will be
achieved and it will stop spreading.

------
zw123456
I don't know if anyone is still following this post but does anyone know if
there are studies around the cost in lives of the shutdown itself? I recall
reading somewhere that every 1% of unemployment equaled some number of
additional deaths per year. Does anyone know of a study of the human cost of a
shutdown vs. the virus itself ?

------
SpinyNormal61
The commonly stated goal of lockdowns is to slow the spread, flatten the (new
cases vs time) curve, and thereby try to manage the rate of new cases so
hospital resources (ICU beds, respirators, nursing staff) arn't overwhelmed.

Once (whenever that may be) the curve is shown to be flattening and hostpitals
are in control, it'd be logical to see some gradual loosening of the
restrictions that are currently being ramped up.

I personally doubt that loosening of restrictions, once above conditions are
met, will be contingent on a proven and widely available vaccine having been
developed (not least because there's no guarantee that one ever will be).

At this point it's anyone's guess how long it'll be in any given country until
things appear to be more under control... Even in South Korea, who seem to
have done best job in containing this, I've yet to see any estimates of how
long it'll take at current rates on infection for the majority of the
population to get it and/or get to "herd immunity" point.

In the US all bets are off.. it seems we were (and still are) extraordinarily
slow to recognize the severity of this and take appropriate actions (severe
lockdowns, widespread testing and resulting case tracking), so a reasonable
expectation is that we may be following the case trajectories of the harder
hit countries, with similar measures as they have in place coming to the US.

------
jamesdmiller
The endgame is to figure out the least cost sustainable measures of getting
R0<1 until we have a vaccine or treatment safe enough for people in high risk
groups to take.

~~~
pdonis
_> The endgame is to figure out the least cost sustainable measures of getting
R0<1_

The question assumes this has already been done: "single cases here and there,
maybe even 0 cases".

It seems to me that the key question at that point is, if there are no active
cases--everyone exposed to the virus who is still alive has either never
developed symptoms in the first place, or has recovered from whatever symptoms
they had and is now asymptomatic--is there still a risk of spreading the virus
further?

~~~
PeterisP
It does not assume that - Wuhan currently has R0<1 and it did not and still
does not have "single cases here and there, maybe even 0 cases"; R0<1 through
a lockdown is a tested (in Wuhan) way to get from tens of thousands of cases
to just tens of new cases per day and probably eventually to single isolated
cases here and there. But we'd really like to find a less invasive, more
sustainable set measures than what was done in Wuhan.

~~~
pdonis
_> Wuhan currently has R0<1 and it did not and still does not have "single
cases here and there, maybe even 0 cases"_

You're missing my point. I'm not saying that R0<1 implies "single cases here
and there, maybe even 0 cases". I'm saying the converse: that "single cases
here and there, maybe 0 cases" implies R0<1\. Which is obviously true. And the
scenario posed in this "Ask HN" question assumed "single cases here and there,
maybe 0 cases", so if that implies R0<1, and it does, then the OP's scenario
does assume R0<1, even though it doesn't say so explicitly.

------
olliej
The purpose of the lockdown is solely to prevent emergency services from being
completely overwhelmed. Not make it go away.

------
projektfu
A country like Colombia could implement a lockdown and stop transmission
entirely. The virus would naturally die out there in a few weeks. All foreign
travel would have to be quarantined but life could go on after that internally
without disruption. Eventually vaccination could bring herd immunity.

------
pmoriarty
I've heard an epidemiologist say that if a vaccine becomes available in 18
months it'll be a record.

Experimental treatments are being researched, but with only very small numbers
of patients. It'll take quite some time for those treatments to become widely
available.

It's unlikely that we're going to even begin to see things return to normal in
a month or even three of isolation, especially if that isolation isn't as
effectively and universally enforced as in China.

Afterwards there has to be extremely aggressive testing, tracking, and
monitoring, or the outbreak has a very good chance of starting all over again.

In addition, the health care system itself has to have time to recover and
replenish its equipment, ICU capacity, and healthy and able medical personnel.

~~~
scottlocklin
> I've heard an epidemiologist say that if a vaccine becomes available in 18
> months it'll be a record.

Your epidemiologist should talk to a chemist or look at a wikipedia entry. In
1957, the H2N2 pandemic vaccine was available in 3 months. Still managed to
kill a few million people.

[https://www.globalsecurity.org/security/ops/hsc-
scen-3_pande...](https://www.globalsecurity.org/security/ops/hsc-
scen-3_pandemic-1957.htm)

[https://www.city-journal.org/1957-asian-flu-pandemic](https://www.city-
journal.org/1957-asian-flu-pandemic)

~~~
etrabroline
I think you are nitpicking this doctor's words instead of listening to what
he's saying. 18 years and no SARS vaccine. 18 months for SARS 2 would be
miraculous.

~~~
scottlocklin
He's an epidemiologist, and I think people aren't listening to what history is
saying about the possibility of things. People accept 18 years or 18 months
because they're trained to live in a sclerotic bureaucratic hellscape not
because those are actual limitations involving long periods of time.

There was a thread last night about people worrying that improvised
ventilators aren't FDA tested or whatever. That's a great thing to worry about
in soft times. If I (or a member of my family) am facing death while waiting
for a ventilator to save my life, I'll take my chances on the doodad cobbled
together from a CPAP machine without FDA approval. Same story with
vaccinations.

------
scotty79
I think you just gradually make lockdown less strict to throttle number of
cases so that it's on the level your healthcare can handle and do that till
most of your population already had the virus. And hope for new treatments,
vaccines and that immunity from already having the virus lasts at least a year
or two.

------
forkexec
A rational move would be to lock everyone down until a vaccine is proven safe
and efficacious can be delivered to enough people. Since no one other than
indigenous people living near bats have any immunity to beta-coronaviruses, it
doesn't make sense to expose billions of people to unnecessary risks when we
can pause nearly all social- economic activity until immune defense is
possible or supplies run low.

The vaccine, once developed, should be free for everyone to encourage high
uptake herd immunity.

~~~
kelseydh
Do you think the world could handle two years of two supply chains being
disrupted and shut down?

------
aaron695
How long did the HIV vaccine take?

Use that as a yard stuck.

A lockdown isn't 'successful' it does little, except drag society into the
dirt while a little time is bought to work things out.

Time China bought us but we squandered.

If you're lucky it's a winter desease so it'll become summer and it'll die
off. But that's coin flipping a little.

Treatments might be found but it's hard to know how fast, especially while
everyone is on lockdown.

~~~
dgb23
> A lockdown isn't 'successful' it does little, except drag society into the
> dirt while a little time is bought to work things out.

Slowing down the spread is useful to soften the blow on medicinal
infrastructure.

~~~
aaron695
The flatten the curve meme has become toxic. Maybe it always was.

Have a look at a flatten the curve with actual numbers not cartoons.

Make sure the hospital capacity is seasonal and accounts for the fact nurses
and doctors will wear out and supply's will dwindle.

Then say it softens the blow.

------
totaldude87
One word...

Summer..

once the summer starts and we see 30c or above , i think the spread will be
limited and the quarantine might end.

But, worrying part is what comes next, without a Vaccine, coming Winter might
be lethal, and we may end up with same cycle..

[https://www.scmp.com/news/china/science/article/3074131/coro...](https://www.scmp.com/news/china/science/article/3074131/coronavirus-
highly-sensitive-high-temperatures-dont-bank-summer)

~~~
dhosek
It's summer in Australia and South Africa. They're still seeing spread. I
wouldn't count on that.

~~~
adventured
Is there any information on how many of the ~377 Australian cases originated
outside versus inside their borders? I can't find much on that figure.

South Africa only has 62 cases and New Zealand only has 8 cases. Not much
there yet.

~~~
dhosek
I haven't seen any statistics, but it appears that Rita Wilson and her husband
contracted it in Australia from what I've read. That was the more worrying
thing to me about that news than the celebrity connection.

~~~
kevin_thibedeau
Two global travelers with frequent contact to other global travelers doesn't
prove much.

~~~
dhosek
It's anecdata for sure. Apparently though, at least one TV reporter contracted
the virus after being in contact with Rita Wilson. Again, anecdata, but it
points towards the idea that there is local transmission.

------
hfufigivknog
The virus isn’t serious enough to warrant or motivate total quarantine so a
ton of people are going to get it. Then we’ll have collective immunity and
things will go back to normal. 3 to 6 months from now.

~~~
ztjio
It's not that simple. First of all, most people do not develop permanent
immunity to the cold which is usually one of the first 4 known human
transmissible corona viruses. So there is no reason to think we'll develop
long term immunity to this one either.

Second, our reaction has be abysmal which, similar to the 1918 Spanish Flu
pandemic, massively increases the chance of a second or even third wave of
massive infection spread. That will be on many peoples's minds.

And one more thing I want to touch on so people here can get it through their
thick heads: just because the death rate is supposedly "low" and "only"
impacts old people mostly, that doesn't mean it doesn't impact YOU. If YOU
have an emergency and the hospital is packed with COVID-19 patients, it
doesn't really matter what you have, you are affected.

Even ignoring the ethical implications of just letting people die from this, I
think most people who would do that are unlikely to ignore implications to
themselves so figure out where you land or not, it doesn't matter, the goal of
keeping hospitals from being overloaded affects everyone.

~~~
hfufigivknog
Corona viruses are not “the cold.” Rhinovirus causes the common cold and
corona viruses cause 10% of cold cases. Just like other corona viruses, they
make a recurring appearance. But this is not because they mutate in the way
the flu does. No corona viruses mutate in the way that the flu does. If you
have some evidence to prove me wrong then produce it.

You definitely develop immunity to viruses that sicken you. For the average
person who is healthy.

If there is a second wave it will only be because of overly aggressive
quarantining. This is why I said it won’t happen. For it to work, it would
have to be air tight. All these young kids staying home are just saving fuel
for a second wave. Old people ought to stay home and let younger people gain
herd immunity as quickly as possible.

~~~
scotty79
> If there is a second wave it will only be because of overly aggressive
> quarantining.

Common cold causing coronaviruses have recurring waves every 2-4 years. If
they don't mutate like flu it means that immunity is not that long lasting.

~~~
hfufigivknog
No, it doesn’t necessarily mean that. If you find a paper or expert testimony
that totally unambiguously shows that I’m wrong, I will totally retract what
I’ve said.

------
tuna-piano
The economic loss of a lockdown is just extraordinary. Just think about how
many people and resources are idle... Literally trillions of dollars in lost
economic potential (let alone the harder to quantify human+health
consequences).

So it's crazy to me how little, relative to the hard economic costs of the
virus, is being spent on mitigation.

I'm a totally uninformed lay-person, but the below seems reasonable:

Huge testing effort, something like 5% of the country's population gets tested
every day (once every 20 days per person). Manage electronically. If positive,
quarantine that person and known contacts.

Huge contact tracing and small lockdown strategy (found 10 cases in Omaha,
Omaha lockdown for 2 weeks).

Seems that would be doable, cost billions and billions, but enable economic
activity and minimize health+human consequences. Would be a great RoI.

