
New research shows social distancing a must to beat Covid-19 - rkolberg
https://directorsblog.nih.gov/2020/03/19/to-beat-covid-19-social-distancing-is-a-must/
======
sojournerc
> For every confirmed case of COVID-19, there are likely another five to 10
> people with undetected infections.

I wish this was reflected more in the numbers being presented by various
authorities. There is just too much confidence that confirmed cases are
representative of the spread of the virus.

This unknown denominator can change mortality rate, and severe case rate by
orders of magnitude.

Because of the dearth of testing in the US, it seems highly likely that far
more people are infected, and maybe even recovered.

I'm fairly certain I've just recovered from COVID-19 given my symptoms, but
can't get tested here in Colorado. By the time I am able to get tested it
seems likely that I won't be shedding the virus any longer, and will test
negative.

This article captures my feelings on this very well:
[https://blog.longnow.org/02020/03/14/an-epidemic-of-false-
co...](https://blog.longnow.org/02020/03/14/an-epidemic-of-false-confidence-
related-to-covid-19/)

~~~
scott_s
A comment by Bradley Kuszmaul on that blog post gives a good reason why the
scenario presented is not likely:

> Given the amount of testing being done in South Korea, we can rule out that
> there are a lot more people currently infected than we know about. And if
> there were a lot more people recovered than we know about, we would have
> seen deaths earlier in South Korea, since South Korea started their testing
> earlier. I suspect there's a lot more evidence that rules out the "fast and
> stealthy" hypothesis.

~~~
thu2111
_Given the amount of testing being done in South Korea, we can rule out that
there are a lot more people currently infected than we know about_

That's a very strong claim. SK has done a lot of testing relative to most
places but it's still:

a) A tiny amount relative to the population

b) Not a random sample of the population

Their tests were done at testing clinics that people had to take themselves
to, which in many cases had large queues and generally you'd only go there if
you actually felt really sick because otherwise why would you expose yourself
to lots of probably really sick and infectious people?

So far there's overwhelming evidence that either a lot of people have the
disease without symptoms, or the tests have a very high FP rate. There's also
a lot of people writing like the person above, who are sure they've had the
disease based on symptoms but were never tested. South Korea wasn't deploying
their tests on people who were asymptomatic, they are doing the same as
everyone else: testing people who present for testing or who otherwise seem to
need it.

~~~
scott_s
China tested hundreds of thousands of people in provinces with known cases,
and found very little evidence of asymptomatic circulation. See my comment
from a week ago,
[https://news.ycombinator.com/item?id=22475853](https://news.ycombinator.com/item?id=22475853),
which quotes Bruce Aylward, an assistance director general and epidemiologist
for the WHO.

Our current evidence points to there _not_ being millions of asymptomatic
people.

~~~
btilly
I see your HN comment from 2 weeks ago and raise you with a point in this
article lifted from a recent _Science_ paper. Namely, _...individuals with
undetected infections were so prevalent in China that they apparently were the
infection source for 86 percent of confirmed cases._

This is strong evidence of asymptomatic circulation.

This conclusion is not in contradiction to the evidence behind your previous
comment. In mid-February with ~60k confirmed cases that would be 300-600k
asymptomatic ones. Which means that China did not have millions of
asymptomatic people at the time. And so it is no surprise that a broad testing
regime failed to find what did not exist at that time.

However what it also means is that as the number of confirmed cases
skyrockets, it WILL be true (and possibly already is) that the number of
asymptomatic cases will be in the millions.

~~~
gbacon
“I’ll see … and raise” is known as a _string raise_ and is seen as bad form or
even cheating. Actions in poker must be atomic.

[https://upswingpoker.com/angle-shooting-string-bet-
raise/](https://upswingpoker.com/angle-shooting-string-bet-raise/)

~~~
magduf
Sorry, I don't know anything about poker, but didn't Riker do this all the
time on TNG?

~~~
milesvp
He did, and the poker on the show was generally abysmal. But partly for the
‘I’ll see you... and raise you’ prevalence in drama is that it creates a more
dramatic situation. The dramatic effect is the very thing that can be taken
advantage of in poker, and is why there’s a rule at most professionally run
tables that what you claim, on your turn, is what you must do. Once you call,
you can no longer raise no matter how much you want to.

Though the bigger reason for not allowing it, is that it can really add
confusion and slow down the game when a person says call and the next person
now has to wait until they’re sure the current asshole isn’t going to say ‘and
raise’ before they can act.

Oh, and keep in mind that poker is full of assholes who will do all kinds of
anti social behavior to gain an edge. So the fact that this is a standard rule
really gives some idea as to just how annoying it is to the poker community.

------
graton
Am I the only one who would prefer the term "physical distancing". Social
distancing seems open for confusion by people.

Since when they say "social distancing" it seems to mean stay physically
distant from each other.

~~~
chrisa
One of the doctors on one of the press conferences (sorry, can't remember
which one), said that she would prefer the term "physical distancing" as well
for the same reason.

She said that "social distancing" is a medical technical term that doesn't
translate super well to the public.

~~~
PappaPatat
> She said that "social distancing" is a medical technical term that doesn't
> translate super well to the public.

Which is 100% the opposite of what I in my daily life observe: everyone, young
& old, private & work, calls it social distancing.

It addresses the issue better too, then the "proposed" physical distancing.
When you pass people physically the (need and) possibility to keep that 2
meters is often impossible where as while socialising it very much is.

~~~
Thriptic
Yeah but that's the point. The use of this term makes people think that this
is simply about socializing when it is not. The fact that it's hard to stay 6
feet away from someone else in a city while outside is why people should stop
going outside unless they absolutely have to. It's not enough to simply stop
hanging out with people, and this idea can't be communicated well with this
term. Many people I see outside make no attempt at distancing themselves from
strangers they are passing or while shopping.

------
AntonStratiev
Introducing social distancing for the entire population comes at huge economic
and social cost.

It is more effective to follow these three simple measures:

1\. Symptomatic cases stay at home for 7 days

2\. All household members of symptomatic cases stay at home for 14 days

3\. Social distancing for the over 70 population only

[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)

Social distancing of the entire population also slows the acquisition of
immunity with zero and low risk age groups, which drags the whole situation
out months longer.

It might even be logical with the above 3 steps in place for zero/low risk
group to deliberately seek out the virus. This grants immunity quicker, and if
they become sick, they can receive treatment whilst hospitals are still
underwhelmed.

Speaking personally I would happily accept a strain of the virus considered to
be low risk, then go into 14 day quarantine, if it meant I could afterwards
work and socialise without any lockdown or restriction.

~~~
Darkphibre
Italy is proof that we _need_ to slow this down for months longer. Our medical
system was projected to only have enough N95 masks and related supplies for
two weeks of a pandemic... sure enough, we're having to cobble together
makeshift supplies MacGyver style here in Washington.

In a couple weeks, more of our front-line medical staff will start getting
sick (the first case just occurred here), and requiring their 14-day
quarantine... taking them out of rotation and adding even more strain.

It's going to get bad. We __have __to slow this down, to reduce the mortality
rate. Or that 1% number people are throwing around is going to look like
roses.

~~~
DoofusOfDeath
I wonder if mildly symptomatic healthcare providers should treat patients
known to have the same strain. As opposed to fully benching those providers, I
mean.

------
sailfast
> Although they are thought to be only about half as infectious as individuals
> with confirmed COVID-19, individuals with undetected infections were so
> prevalent in China that they apparently were the infection source for 86
> percent of confirmed cases.

Figuring out how to manage this risk so we can return to society / open venues
at a much lower risk of infection (while not giving all of our data to the
government) is a challenge with which maybe some of this site's audience could
assist.

~~~
raducu
I've read(but can't seem to find the article) that it's estimated that 95% of
wuhan population is not immune to the virus.

So I really doubt there are that many i dividual with undetected virus.

------
alexandercrohde
I'm sorry but what does this title even mean?

Define "beat Covid-19."

Not to be a hardass, but I'd prefer real information not babyfood. Something
akin to "Currently predicted US deaths without social distancing: X. With
social distancing: Y. Potentially recurring each year"

~~~
gdubs
Humans still have to read these things. Getting policy makers to pay attention
is an actual problem, so using 'plain talk' can be effective.

------
SubiculumCode
I really wish we had widespread testing, or even a test to see if you had
COVID-19 in the past. Before we had all been so focused on this thing, my
child's friend came back from China in December, and she had a upper
respiratory illness with a fever. Then my whole family and I suffered under a
low-grade fever and upper respiratory illness for a week or so in early
January. I have no idea if it was COVID-19, but it is hard not to wonder.

~~~
microdrum
That's fear talking. Why would you want to be tested? What would you do
differently? You had a virus, now you aren't sick any longer. You aren't
making other people sick, either.

~~~
josephorjoe
Well, for one thing, if people can be tested to confirm they had and recovered
from the virus and therefore have some immunity to it, those people can more
safely assist people who are currently ill and move about more freely in
society (unless they are still at risk to transmit the virus to others, of
course).

~~~
filleduchaos
You cannot assume that recovering from the virus confers immunity, especially
when "the virus" is already "two strains of virus" (and will almost definitely
end up mutating more before this is over).

~~~
abhorrence
It certainly confers immunity for a short period of time. How long that
immunity lasts for is unknown, but it’s not unreasonable to start with an
assumption of “at least a few months”.

There’s also not strong evidence that there are two sufficiently different
strains. Viruses experience small, mostly meaningless, mutations with great
frequency. The research talking about S and L types are actually just an
arbitrary categorization of many different mutations of the virus.

------
vsareto
They really are changing the language for this event.

[https://www.cnbc.com/2020/03/19/new-york-gov-cuomo-
orders-75...](https://www.cnbc.com/2020/03/19/new-york-gov-cuomo-
orders-75percent-of-non-essential-workforce-to-stay-home-as-cases-surge-
to-4152.html)

This is pretty damn close to quarantine, without actually saying quarantine in
the headlines.

~~~
josephorjoe
I think the motivation for this change is to prevent employers from trying to
maintain "business as usual" operating conditions.

Anecdotally I've heard of places where the company has made no policy changes
about sick leave or what employees who are feeling ill should do and,
therefore, hourly workers keep coming in to work with "flu-like symptoms" or
days after having had symtpoms because otherwise they don't get paid and could
get fired.

------
anon102010
Fascinating that they recommend you take OFF masks while on things like
crowded BART trains and airports (I had lots leftover from forest fires) if
you are "healthy", even though that might mean you are asymptomatic, or not
yet diagnosed etc.

Despite claims masks (with good adherence to wearing) are highly effective -
primarily by reducing hand to mouth/nose contact, secondarily as a direct
barrier. And surgical masks are dirt cheap.

It looks like other countries went big on mask production and wearing - be
very interesting if the claims that you should NOT wear masks if "healthy"
even on crowded BART cars etc checks out in the end.

~~~
gpanders
My understanding is that the urging to not wear masks when healthy is solely
due to preserving masks for people who actually need them (sick people and
doctors) given a limited supply, not because they're ineffective when healthy.

It's just a form of triage.

~~~
SketchySeaBeast
And asking you to save them is very much different than asking you to
deliberately take them off while on a crowded subway car.

------
psychlops
Given the ongoing statistics coming out of South Korea (which I'd suggest are
the most accurate) where only one person under 50 has died. It seems that
these safeguards would be best spent around those aged 60+ and perhaps those
50+ with other health issues.

Those who are younger seem to be mildly affected for the most part and could
go on with their lives as long as they didn't interact with the older
population.

~~~
SketchySeaBeast
Deaths are all fine and good, but do you know statistics on hospitalizations
for the under 50 crowd? Those are the resources that are important - even if
the under 50 doesn't die from it but requires hospitalization that's both a
resource that can't be used by the above 50's, as well as a possible death if
there isn't a bed for them.

~~~
psychlops
I use their daily updated website* for statistics which don't break down
age/hospitalization.

Deaths will come either by the coronavirus and/or by the poverty created by
the extreme social measures suggested by the ongoing mania. I tend to believe
the latter will kill more and be longer lasting.

* [https://www.cdc.go.kr/board/board.es?mid=a30402000000&bid=00...](https://www.cdc.go.kr/board/board.es?mid=a30402000000&bid=0030)

~~~
SketchySeaBeast
A lot of people have responded here - the ICU rates seem very very high for
even the young and healthy - which tells me people are going to die as the
beds get swamped.

There's already a softening to people's needs in regards to healthcare and the
economy - can you imagine the US seriously discussing any form of UBI 3 weeks
ago?

While I understand it's going to be a tough hole to get out of, the economic
levers seem like they'll be easier to adjust, and are adjustable on a longer
timeline, than the acute condition of "not enough beds".

~~~
psychlops
The United States is not necessarily headed down the direction of "not enough
beds"* that seems to be fashionable thinking today. There is advance warning
and precedent far more information already at hand.

* [https://www.niskanencenter.org/is-u-s-health-care-well-equip...](https://www.niskanencenter.org/is-u-s-health-care-well-equipped-for-the-coronavirus/)

------
onetimemanytime
This is just trying to avoid too many deaths until the vaccine is out,
correct? I doubt we can all be quarantined until the virus dies out.

dumb question: what happens to the virus a month after John was infected, does
it die out?

