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Here is a rule of thumb that will be familiar to many who manage risk in a professional capacity:

The time to get creative is when you face a capped downside on the one hand, and an uncapped upside on the other. The time to get conservative is when you face the opposite condition.

The reason for this rule is that creative policies almost never work; but when they work, they have a much higher chance of working extraordinarily well than conservative policies do.

The UK is facing a capped upside and a huge potential downside. The UK is choosing to handle this situation with a creative experiment. This experiment will, in all likelihood, not succeed. And unfortunately most values of "not succeed", in this context, map to catastrophic outcomes.

Time, as always, will tell.

It’s already too late. They’re on the Italy path.

This “herd immunity” thing is nonsense. So much so that doctors and scientists are warning against it:


Some are against it, others (such as presumably a majority of those advising the government) are for it. That's just good debate.

> It’s already too late. They’re on the Italy path.

Well, that's pretty much the point of the policy. 'Already screwed this year, let's try to cope, and be less screwed next year'.

I was very critical at first, but I'm more interested/satisfied with the response now, it does seem to be well thought through, even if there are also arguments against (of course there are).

It's basically:

Throw 2 or 3 hounded thousand lives away to have less economical impact next year.

I.e. pure evil IMHO.

especially because there is a non small chance that it will be more like 1-1.5 Million more death then necessary.

That’s a misconception though. Economic depression and deprivation also causes death, and staggering amounts of human misery.

Evil is reserved as a description for gross failures of moral duty. Choosing pragmatically between several terrible options with highly unpredictable outcomes does not meet that standard.

> Economic depression and deprivation also causes death, and staggering amounts of human misery.

Let's quantify things here, for a first world country with a social net.

On the one hand, we have people getting evicted from their homes and having to visit soup kitchens.

On the other hand, we have dead people (more likely, dead poor people).

Evil seems pretty fair.

> On the one hand, we have people getting evicted from their homes and having to visit soup kitchens.

Which translates directly into many years of reduced life expectancy, no?

I have trouble seeing a worse economy for a few months vs a highly optimistic 100,000+ dead having similar numbers of lost lives.

It's not just a few months though; a 0.2% recession (say) quite possibly translates to everyone in the future being 0.2% worse off, forever.

That would be true if annual returns were independent of each other which is definitely not the case.

I understand the point you and GP are trying to make.

I'm saying that the two miseries feel like apples vs oranges, given the context.

You'd have to go pretty far to convince me that (even mass) economic depression is more harmful than widespread, near-term fatalities.

That is part of the problem. It is very hard to quantify the consequences of economic depression because it affects everyone at least a little bit, and some more than others. It might cause so and so many more people to have to go through therapy, so and so many families break up over financial hardships, and the children are ever so slightly worse off and the second-order consequences aren't fully realised until 30 years down the line. It's individually (possibly) very small effects, but it hits the entire population.

That's hard to weigh against a concrete number of very concrete deaths and serious recuperation periods.

mass economic depression affects certain groups more than others.

Near-term fatalities affect certain groups more than others. Those with access to medical services (or can pay for more of it) will be less affected.

Which side being worse is a determination you have to make for yourself.

Funnily enough recessions are associated with lower overall mortality rates.

Something to remember the next time people harp on about GDP being the most important metric for a country's advancement.


There was an op ed recently from a former member of the Johnson government that stated "It is time the economists took over from the doctors, before the real pandemic [economic recession] spreads."

So that, told me all I need to know about the cruelty and stupidity of the UK government at this time.

Just to correct this, the statement was made by Omar Hassan, who was head of inward Middle Eastern investment while Boris Johnson was Mayor of London, and was never part of the Johnson government. Here's the article the quote comes from:


Thanks, I didn't realize that.

It is basically nothing like that in any way. If it works, it will not be at the expense of extra "sacrificed" lives, that's nonsense. The basic idea is to isolate the vulnerable and eventually protect them with herd immunity. You are allowed to opine that this will fail dismally, but you're not allowed to just make shit up and accuse people of sacrificing lives. Have an ounce of shame.

How are going to isolate the vulnerable population? They also neglect that the vulnerable population clusters. Old people socialize with other old people. A bunch of immune school kids don’t provide much herd immunity to a nursing home.

They might if they were the kids of people working at the nursing home. I am not sure if this strategy will work either but I get it -- every infected and recovered individual is another control rod pushed into the out-of-control atomic pile.

The problem is that most of the people in the nursing home are the residents. If none of them get the disease, The R0 in the nursing home is still going to be well above one. The minute one person who is infected shows up at the nursing home, it races through the whole place.

Meanwhile, in the schools, the intention is to get the rate of kids that are immune as close to 100% as possible. That will be difficult without deliberately inoculating them, because they will develop herd immunity at about 66% in their population and it won't spread in that population anymore.

In the nuclear reactor analogy, it's as if you put in half the control rods, but only the ones on the left side of the reactor. That might make the left side strongly subcritical, but the right side might still be critical, even if with an even distribution of the same number of rods, the whole reactor would be subcritical.

This plan is not going to work and it will kill millions of people in Britain unless Chloroquine or something else ends up being a silver bullet for treatment.

> The basic idea is to isolate the vulnerable and eventually protect them with herd immunity.

so what about those who had to suffer to give this herd immunity? If i were a UK citizen, and i got infected, there's a non-zero chance that i will also need a ventilator. Any, even a tiny misstep will cause the numbers to grow beyond the amount of beds available. That i am asked to take this risk is absurd.

Full isolation and quarantine is a more conservative way - for myself at least. Even if the economic damage is severe.

> such as presumably a majority of those advising the government

Why? Politicians have shown several times that they prefer to listen to a minority of scientists that tell them what they want to hear, rather than a majority that doesn't.

if that is the case, it seems reasonable that it is indeed the majority. under your hypothesis the "majority that doesn't" isn't advising the government in the first place.

Worse, politicians (particularly Health ministers) have disporportionately high infection rates.

Not sure why Health ministers are getting shade for testing positive?

I'd rather my top health officials actually have contact with those under them, than sit in a glass bubble.

They don't follow basic advice (e.g. don't shake hands, touch your face, etc), they don't close down mass events, they don't close schools "because we're not at that stage yet". The time to close them is before we reach "that stage".

Number of cases is a trailing indicator, which also only covers those tested.

"I was very critical at first, but I'm more interested/satisfied with the response now"

It sounds more like you're at the bargaining stage now, rationalizing why it might be a good approach because it's happening and you hope for the best.

It sounds insane. Italy quite literally did the same model. Now they're in the worst of both -- mass quarantine / enormous economic damage AND the brutal human toll.

Well it's not how I'm behaving on an individual level for sure, I'm concerned about unknown long-term effect and don't want it.

But I can see how it might make sense on a wider societal level, assuming everyone doesn't behave like me. (Which they don't, I've observed plenty of people complaining about how it's just 'media scaremongering' and 'just like Brexit'.)

I definitely think we're (almost every country is, save maybe Singapore) past containing it; so I can see how a relatively controlled exposure might actually be a good policy as far as managing resources, economy, and next season...

Nobody thinks it’s a good idea. It’s just nonsense. There is no debate.


One point neglected in discussions is the effect of spreading it to other territories that are not adopting a similar strategy. The majority of cases in the English-speaking Caribbean to date have been from persons who traveled to the UK recently.

If the UK government's policy is to deliberately allow widespread infection of the population, the logical response from other countries will be to ban entry to people traveling from the UK.

I can see the idea behind that gamble. You take short term pain for long term gain.

Except... A vaccine is expected to be ready in 12 months!

So the long term should be pain free either way!

It's not "nonsense". It's real. It works for almost every other virus out there (even colds and flu, even though it's imperfect: new seasonal cold and flu strains don't become pandemics, because many people have some immunity from previous infections). If you let a large enough fraction of the UK contract and recover from COVID-19, we have every reason to suspect that the society will develop good enough herd immunity to make further pandemic-scale propagation impossible. This part is good science, and reasonably well understood.

The question is on the impact side. The reason this theory seems to work is that the seeming danger from COVID-19 is all on the elderly and immunocompromised. If you can prevent them from getting the same disease everyone else is, then they'll be protected by the herd -- new clusters won't form and infect them.

So this all comes down to those assumptions:

1. The virus is genuinely of low danger to the young and healthy

2. The vulnerable can be adequately protected during a pandemic of the general population

If either is wrong, we're looking at a staggering disaster. Are they wrong? We have no fucking idea. I'm not even on the continent and I'm terrified.

> It's not "nonsense". It's real. It works for almost every other virus out there (e

You're failing to take in consideration that the virus incubation period is on average 1 to 2 weeks, and those who manage to recover from the disease take about 2 weeks from diagnosis to confirmed cure.

This means that you're comparing 4 weeks of exponential growth with 2 weeks of constant recovery.

Sure, those who survived the disease will be immune afterwards. That's great for herd imunity. But the thing you fail to understand is that as the disease increases exponentially, when that time arrives the whole nation has already become infected, and it's too late by then because health services will be unable to cope with the demand and a lot of people will die due to lack of basic medical care.

> But the thing you fail to understand

No no, I understand that. But the thinking is, and it seems to be backed by data, that the health system will be able to cope with a full-population maximal pandemic, as long as it is limited to the much less vulnerable segments of the population. The ICUs in Italy and Hubei were filled, for the most part, with elderly patients. The math, such as it is, checks out.

The risk management analysis, again, is IMHO batshit crazy. But the theory seems about as sound as it could be given the data we have.

> No no, I understand that. But the thinking is, and it seems to be backed by data, that the health system will be able to cope with a full-population maximal pandemic, as long as it is limited to the much less vulnerable segments of the population.

It really doesn't seem that you're getting it, because the whole point of this exercise is that it's quite patently obvious that no health care service in the world is able to keep 10 to 15% of their population in intensive care, which so far is the expected incidence of cases that require medical care.

If that was the case then no one would be bothered with yet another flu-like viral infection.

> the expected incidence of cases that require medical care.

Among the general population!

Among people under 50, the best data we have is that the fraction needing ICU care is something like 0.2% (I think, I'd have to look it up again).

The intent is to quarantine the at-risk and let it propagate in the "safe". I genuinely think it's you who's failed to understand the plan. You're arguing against something that is not the stated UK policy.

Thanks for being devil's advocate.

I too think it's too risky, FWIW. I read a while ago there might be permanent damage as well, but maybe that was hocus.

Edit: Business Insider reported HK doctors found some people have 20-30% reduced lung capacity after recovery: https://www.businessinsider.com/coronavirus-recovery-damage-... (n=12)

> Among people under 50, the best data we have is that the fraction needing ICU care is something like 0.2%

Any chance you remember where you found this statistic? I have been looking for any details on hospitalization rates by age range, but haven't had luck so far.

Do we actually have evidence that this quarantining is possible or working?

> 10 to 15% of their population in intensive care

Estimates are closer to 10% of the infected getting severe cases, and some small-ish fraction of those requiring intensive care. (The higher percentage numbers are usually an artifact of low testing rates of infected people.)

Also, epidemiology suggests that 20-70% will get it. So, we’re looking at ~1% of the population in the hospital at once.

The rest of your points stand; we don’t have nearly enough hospital capacity for 1% of the population.

Note that with a two week active phase, the pandemic would have to drag on for 20 weeks to get that number to 0.1%. I doubt there is capacity for that either.

What is the age distribution of the ICU requirement? Is it really in the ballpark of 10% for all age groups?

The plan also relies on flattening the curve like other countries' plans. They're just calculating that people won't stay in lockdown for months, and that if they put one in place now people will start emerging just in time to hit the peak of the infections.

Recovery is exponential too - it just lags behind the new cases.

There are 200 Viruses, vaccines only exist for 20 or so. For some you can hardly build immunity (e.g. Dengue fever).

"Sure, those who survived the disease will be immune afterwards." There have been reports of re-infections in China and Japan. This may be mistakes - the never were cured - but this could also point to something more severe. Proceed with caution.

3. the immunity gained through an infection holds for a long enough time (how long would need to be checked with the infection rate), which we do not know yet

Additionally, we know nothing of the long term effects even for the "young and healthy". Mortality rates for people 10-39 is 0.2%, 40-49 it's at 0.4%, 50-59 1.3%, 60-69 at 3.6%. Serious conditions develop in a bigger proportion of cases, so you are looking at 4-10% of under 60 population in ICU with unknown long term effects.

Translation: good luck!

Yes, the idea that only those 70+ are "at risk" is weird. But they probably can't afford to isolate everyone 50+ - both from an economic and herd immunity viewpoint - so they will risk losing 3.6% of people aged 60-69 and 1.3% of people aged 50-59.

According to https://www.statista.com/statistics/281174/uk-population-by-...

8.96 million aged 50-59, 7.07 million aged 60-69.

> unknown long term effects

Ultimately, it’s a just a really inconsistent cold. The vast majority of cases are mild. However, if it spreads to the lungs, it’s worse than the flu.

As far as I know, there’s no evidence that it’s any more exotic than that.

There are reports from China of significant lung scarring among patients who had to be hospitalised.

This is the concerning thing for me, as an asthmatic if I stop taking meds I'm already 30% down on lung capacity, adding another 20% on top of that is scary. That 20% can't be mitigated by meds either.

This ignores the risk of spreading the virus to other populations.

And if the worst case occurs, with millions of elderly and immunocompromised dying, there are billions in potential savings in pensions and old-age healthcare, as well as improvements in housing affordability and overall reductions in national CO2 emissions.

Herd immunity works because:

1. Vaccines, immunitized people don't get sick in the process of imunization, don't need hospitalization, don't die

2. Slow and gradual imunization over multiple years.

Neither of this is uphold all other cases of herd imunization in history I'm aware of always had a massive price in human lives.

Also it only works if the virus doesn't mutate to much, party of the reason the flu is still around even through you would believe we got herd imunization in last many decades since the flu is a think.

> 1. The virus is genuinely of low danger to the young and healthy

Except it's not really that low it's only compared to old people low.

And it's close to practically impossible to only affect young people without having idk concentration camps for young people with strict separation from the older people (like over 20?,30?) for a duration of over a month and still 2 in 1000 or so dying. AND it's anyway to late for that measurements as it's already to widely spread in the UK eitherway.

That is... not a good description of herd immunity at all. It has nothing to do with vaccinations or time scales. Wikipedia's is quite clear: https://en.wikipedia.org/wiki/Herd_immunity

The idea is that once a significant fraction of the population has some immunity to an infection, the ability of an infected person to spread the virus (a term called "R0" in the jargon) is fundamentally impeded by its ability to find infectable targets. So the R0 drops, and so does the exponent to the growth. Once that exponent goes below 1, the number of cases drops over time instead of growing, and new infection clusters can't start.

This works. It's why we don't have things like measles outbreaks (or didn't, until the anti-vax crowd messed things up) and why newly mutated flu strains can't find purchase and become pandemics.

Newly mutated flu strains don't become pandemics because they aren't severe enough for people to care, they certainly proliferate.

You seems to think that people who is against the idea either doesn't understand what herd immunity is, or doesn't understand the plan. We understand both, we just think that the risk analysis is wrong.

Specifically with the GP, his argument is that herd immunity gaining through large percentage of the population being infected in a short amount of time is a bad idea. Normally we got herd immunity via vaccination of the population, since it is much safer than being infected. That's why vaccination was mentioned.



Imagine going ahead with this instead of... doing something.

And no, the NHS doesn’t have the capacity to handle this. So...


Here, we can stop “debating” dumb st:


Yeah, like, the parents of all the kids will get it and many will die. Others will infect everyone at work.

This seems like a obviously bad idea.

Most parents that have young children aren't in their 70s

But they have parents who are. Maybe in UK this works, different cultures have different degrees of socialization between adult children and their parents.

I'm not sure what your point is here, the comment I replied to said that many of the parents of kids will get infected and die.

This is a smart observation. The UK is now taking the conservative view because it's the long term view, that this will likely become a recurring seasonal virus (or a one-time virus that keeps knocking on your door until you get it), and therefore there's not much point in a national "lockdown" to "stop" the virus, because as soon as a nation relaxes its lockdown the virus will simply pick up right where it left off.

Herd immunity is the goal for the UK government; they are explicitly saying they want ~60% of the population to get the virus. The only concern for the UK government is to space out the rate of infection so as to avoid overloading hospitals. So they are banning large gatherings, but not doing a lockdown per se, if that makes sense. Slow the pace, but let it continue. (They may do a strategic lockdown later if necessary to flatten the curve, but right now is certainly NOT the time to do a lockdown, according to their strategy, because at this stage it would be motivated by an attempt to "stop" the virus rather than an attempt to flatten the curve.)

This approach is definitely negligent to the point of criminality. There's no practical way to keep younger and healthy people away from older or less-healthy people and once the virus spreads to the less healthy people it will likely spread further.

(I've been doing the arithmetic for this stuff all day but here goes).

The UK's population is about 66 million. Sixty percent infected is 39,600,000. A 1% death rate (which, per above, you can't escape by "just infect young people" or something, jeesh) implies 396,000 dying. That many people dying, spread out evenly over a year is 1084 people dying per day but 10,840 people arrive sick at hospitals. Which is something the UK surely can't deal with. So with the health care system overwhelmed, the death goes to 5% or more and you have 2 millions deaths, much the WWII casualties etc.

Also, the "herd immunity" reasoning is wrong in the sense that we don't cultivate herd immunity to black plague, Ebola or small pox because they are deadly enough that we containment. Covids is in this special deadly "sweet spot" where it doesn't seem deadly enough to isolate in small area but too deadly to allow to run rampant across a city or nation. The answer that's forced on nation is mass city-by-city quarantine. Harsh but China's Wuhan experience was nowhere near the horrors that this "herd immunity" plan promises.

Herd immunity doesn't happen for Ebola because it's not that infectious compared to covid19. Ebola spreads when an infected person coughs up infected blood over someone. That's pretty easy to contain - people don't walk around spreading Ebola with no symptoms.

Herd immunity in this case isn't something you choose to cultivate or not. With such an infectious disease you're going to get it sooner or later; that's the UK's point. Trying to wipe it out through self isolation won't be globally 100% effective and if it's not it'll just come back. Ultimately only the population carrying lots of antibodies will end transmission for good.

With such an infectious disease you're going to get it sooner or later; that's the UK's point.

I believe it's mistake to claim that the disease will inevitably become endemic in the fashion of the flu. It certainly reach that level but costs would be massively catastrophic in a multitude of fashions. Oppositely, that of the different nations who've contained the infection show that is possible to eliminate it from a region and so a world-wide effort could eliminate it world wide as well.

One factor is that the disease is much more deadly than the early commentators (notably in the Atlantic) believed and aside from making "everyone get infected, OK?" horrific, this gives a strong marker for the disease and a strong incentive to act.

So far nobody has shown it can be eliminated from a region. To show that would require that transitional controls on movement of people end and yet the disease doesn't come back.

This is a disease in which people can be infectious yet show no symptoms. How do you stop infected people moving between regions? Do you think a "world wide effort" is going to successfully encompass places like Africa, central Asia, even Latin America? It's out now, it'll be circulating for a long time.

Except if it became seasonal there's going to be vaccines (with my faith in the medical research). And if the death rate is as high, everyone is going to get it. Making the sacrifice that british public is going through now senseless.

Also, it becoming seasonal could also be a self fulfilling prophecy due to its policy.

Yeah this basically reads to me as UK doesn’t give a shit about it’s seniors since death is inevitable.

Once a vaccine that works is out I’m sure most of the world will get it. The lockdown is all about preventing (early) deaths.

A vaccine is 1-2 years away. It's likely the majority will be infected before then.

It is unclear if you can continue playing whack-a-mole with quarantine measures for the next 1-2 years. It's possible but unlikely, at least in the West.

The UK's gambit is that by timing stricter quarantine measures they can cut the head off the peak, while slowing down spread due to some immunity in the population. This may work if the risk groups can indeed self-isolate for 4 months, and if more ventilators can be manufactured at speed.

It will still be devastating.

It will be interesting to see what happens in China after people return to work.

Either way, I think we are looking at bans on international travel to continue for many months to come.

That is a complete misreading of what they are trying to do, which is flattening the curve and making sure more people can be treated with the medical resources they can measure and substantiate.

> which is flattening the curve

You are NOT flattening jack shit by having all your young population become infected!! [0]

They are NOT gonna mass transport ALL the elderly population to a far away island and isolate them there, they all are gonna get infected and the NHS is going to collapse because of it

There already have been cases documented of people getting infected because of unsealed bathroom toilet pipes on apartment buildings... [1]

[0] https://youtu.be/C98FmoZVbjs?t=693

[1] https://www.scmp.com/news/hong-kong/health-environment/artic...

> therefore there's not much point in a national "lockdown" to "stop" the virus, because as soon as a nation relaxes its lockdown the virus will simply pick up right where it left off.

I haven't seen anyone address this concern among the people who think the UK's strategy is insane.

Yes, if you lock down society, you will halt the spread of the virus dramatically.

But for how long? When do you lift the lock down? When it's died out in your country? How long will that take? What if it hasn't died out elsewhere? Are you going into another lock down right on the heels of the first one?

And how do you get people to comply with it? Hell, there's plenty of people in the US who are completely convinced that the coronavirus is a hoax or a conspiracy or something something Trump Democrats Obama Liberal But Her Emails. Less than two weeks ago President Trump called the thing a hoax!

The UK strategy takes this into account and rolls with it. They know it's going to infect a majority of the population eventually, so let's just get it over with as quickly as possible, while protecting the vulnerable in society, and then herd immunity kicks in and after that your country is protected no matter what other countries do.

But no lock down strategy is about halting the virus!

They are about slowing it, so that the load on the health care system isn't too grade.

Current data show that dath ratio in case of slow spread can be reduced to 1%, potential even less. While with overload it's more like 5% and with collapsing overload even potentially more.

Also work slowing the number of total infected people without usable medicine against it can potentially be drastically reduced. Especially if we find some usable but imperfect medicine in the near time which reduces ICU cases.

Also let's remember 1918:

The first wave killed the old, the second wave killed the young, the third wave killed without discrimination.

I.e. we are still in the first wave, it's not impossible that a mutation occurred which makes it especially deadly against the young (through maybe quite unlike). Just consider what happens if that overlaps with the UK plans and they notice it to late. It would be a lost generation.

> They are about slowing it, so that the load on the health care system isn't too grade.

Again, the load on the health care system depends completely on the demographics of the people who get infected.

By isolating and quarantining people in risk groups, the load on the health care system will be much lower.

The gamble is this: By letting the virus spread indiscriminately through the part of the population that is not at risk, the load on the health care system will be manageable, the death rate will be nowhere near the current measured ones, and once the virus has passed, you have herd immunity in your population.

But if you argue for harsh lock down of everything now, you are also gambling. You are gambling that you can delay the spread until there is a vaccine, without knowing how far away a vaccine is. You are gambling that all the other countries get a handle on the virus, without knowing if they will.

Uh huh... is the UK isolating and protecting people in risk groups? Because the last time you could safely get infected, and be guaranteed medical attention, was two weeks ago. The NHS is already at capacity right now. There's certainly no danger of accidentally containing it too much.

> There's certainly no danger of accidentally containing it too much.

Actually, there is. The UK strategy explicitly aims to avoid a peak come autumn/winter, you want it to go through enough of the population before summer ends. Too fast and it overwhelms the NHS right now, too slow and it will overwhelm the NHS in November.

I completely agree that it is a risky strategy, but unlike the general sentiment in this thread, I don't think it's an obviously bad strategy, and I absolutely think that everyone arguing against it are also engaging in a lot of wishful thinking regarding people's willingness to self-quarantine and obey government recommendations aimed at containing it.

Try harsh containment measures in the US, and 20% of the population is going to go "fuck you it's a Democratic hoax/Chinese conspiracy/Deep State population control scheme, nothing's gonna stop me!"

At least the UK strategy takes the unwillingness of the population into accord, locking down all retirement homes is much more doable than locking down everything.

>Too fast and it overwhelms the NHS right now

The NHS is already overwhelmed. Right now. We are firmly in "too fast" territory. There is no amount containment, starting from now, that will be too much - the exponential growth is already getting away.

Are there any examples of countries isolating vulnerable people (elderly, obese, breathing problems, smokers)? It doesn't seem like that is actually viable at all.

It's an explicit part of the UK's strategy, it's been pointed out throughout this thread.

Also, why would that be less viable than locking down all of society the way for example Italy has done?

Yeah, I know that's the UK strategy, that's why I asked if there are any examples of it being done, because it doesn't seem plausible to me. For starters if everyone is out getting infected rapidly, who will be taking care of the vulnerable people?

>They are about slowing it, so that the load on the health care system isn't too grade.

This isn't really a plan, it's mostly wishful thinking. We expect herd immunity to kick in at around 60% prevalence, which in the UK would be ~38 million cases. ~10% of cases require hospitalisation, so that's ~3.8 million hospital admissions. At the last count, NHS England had a grand total of 4123 critical care beds. Unless we remain in isolation for the best part of a decade, the healthcare system is going to be substantially overwhelmed and care will have to be rationed.

We may get a vaccine, but that'll take at least 12 months and we don't know how well it'll work; until we know how rapidly SARS-CoV-2 mutates, we can't assume that a vaccine would end the epidemic. It is a strong possibility that COVID-19 will become a regular seasonal affliction like influenza.

There are no good options and we're not even sure which are the least bad options. Strict isolation measures will kick the problem down the road for a while, but at the risk of a whole bunch of other problems. How long will people tolerate being confined to their homes? How long can the economy withstand a huge reduction in productivity and spending? What happens if the lockdown fails and social unrest occurs just in time for the next winter flu season?

We need a lockdown to buy us some time, but we also need to face up to the reality that a lockdown isn't a solution but merely a stopgap.

> ~10% of cases require hospitalisation

That depends on the demographics that get infected! Stop pulling these numbers out of your asses as if they're universally true!

That number is based on the virus hitting everyone equally, and central to the UK strategy is that you avoid that, that you instead quarantine and isolate the at-risk people, and build herd immunity among the remainder, not among the entire general population.

This entire post and all the comments is one giant "holy crap the UK strategy is bananas!", but it seems no-one understands the rationale behind it!

Come on! There are legit arguments against it, but your argument isn't it!

> We need a lockdown to buy us some time, but we also need to face up to the reality that a lockdown isn't a solution but merely a stopgap.

The whole mad point of the UK strategy is that you'll reach herd immunity without massive hospitalisation and death, and that once you're through it, you're done, the virus will die out in the UK, no matter what the state the rest of the world is in, no matter when a vaccine is finished, no matter if other countries fight intermittent outbreaks or not.

But how can anybody be sure that conservative policy (lockdown, I assume) would work for UK (or any other nation beside China)? They probably have to factor in the chance of success. They can fail in implementing conservative option (which might not be so conservative after all), and ruin the economy as a side effect. I imagine this as a choice between these: - long struggle with uncertain outcome in terms of life lost but with certain economic ruin - short struggle with uncertain outcome in terms of life lost, with small economic ruin

I’m neither epidemiologist nor politician in power, so I can entertain myself with these thought experiments. In the end, I have little choice (and knowledge or firepower), but to do as instructed by local authorities.

The economy is a tool to get people goods and services. It is less important than life & death on a mass scale. 0.1% to 1% of the population unexpectedly dying is huge.

If the government was implementing a plan that they had considered and prepared over a number of years, carefully assessed the evidence and weighed the options? Costs and benefits have been weighed and it is hard to ask for more.

Government has no idea what is happening and it decides to go in and see how bad it is? Not a great time to prioritise the non-essential parts of the economy.

> 0.1% to 1% of the population unexpectedly dying is huge.

A lot of people seem to be focusing on mortality rate, but data from China and Italy show that people who get severe symptoms, but survive COVID-19 will live with lifelong scares, that make them vulnerable for say the next flu season.

So while 0.1-1% may die, we are talking about upwards of 10% of people being put out of commission. It's also wrong to say that younger people aren't hurt by this, there are plenty of young people with chronic illnesses, and limited immune systems. And even if they do survive, it may not be worth living.

This is pretty scary. Not only do SARS cause scarring which decrease quality of life, we are on our 3rd ARDS-causing outbreak in the past 2 decades. So potentially tens of millions worldwide with lifelong lung damage and huge risk of getting taken out in the next round.

do you mind sharing some sources regarding the long term effect of covid-19? i am worried about it, especially since i haven't heard much about it so far (might be too early to tell). thanks.

Not OP, but I remember reading about this. The summary was it's too early to establish long term damage. The scarring is present, but its bound to be on patient who recovered a mere few weeks ago.

> The economy is a tool to get people goods and services. It is less important than life & death on a mass scale.

It's not as simple. GDP per capita is strongly correlated with life expectancy. In other words, people die sooner with worse economy.

or die _even sooner_ with this herd immunity strat.

On an individual level, i would not want this, even if it's "better" for the UK in the long run. As an individual, it's unacceptable for me to take this sort of risk, and i would not agree to it if i had a choice.

I agree with what you just wrote. But, the premise is wrong, I think; We don’t know if lockdown now vs lockdown later (in UK’s case) will result with 0.1% vs 1% of life lost, respectively.

Let's do math!

I'll use US numbers, because I know them.

The current worst case scenarios on the table are between 1% and 5% of the individuals catching the disease dying (there are better numbers, but we're worst casing it). For achieving herd immunity, numbers like 40-70% of the population infected and recovered are bandied about.

So worst case, you're looking at 1.3-11.6 million deaths in the US.

Now, the US government values the lives of its citizens at $7-9 million dollars a piece.

That puts the economic cost of this strategy, in the US, at $9.1-104 trillion dollars.

That dwarfs what is happening in the stock market right now; shutting down the entire US economy for a year makes sense when faced with that magnitude of potential loss.

I assume the math is similar elsewhere.

> The current worst case scenarios on the table are between 1% and 5% of the individuals catching the disease dying (there are better numbers, but we're worst casing it). For achieving herd immunity, numbers like 40-70% of the population infected and recovered are bandied about.

Yes, those numbers apply if it spreads indiscriminately throughout your entire population.

But we know the virus is here, we know who is in the risk group, which means that if you isolate and self-quarantine people in the risk group, and let the virus slowly roll through the rest of the population, you will get a much lower death rate.

There's a ton of variables that determine the death rate, and yet everyone is just staring themselves blind at the first best numbers we have. No. Come on. It depends on the quality of the care available, it depends on the knowledge of doctors who have experience with it, but most importantly it depends on the demographics of the people who get infected.

> shutting down the entire US economy for a year makes sense

Except "the economy" is made up of millions of individuals. Some will still have an ok quality of life, but many people won't. They'll be fired, or their companies will have gone bankrupt, they'll have no money, no food.. Then what? Do you think hungry people won't food riot just because there's a quarantine? Or go stir crazy? Or ignore it? Or spread propaganda that the entire thing is a hoax so that the New World Order can take over?

> Some will still have an ok quality of life, but many people won't. They'll be fired, or their companies will have gone bankrupt, they'll have no money, no food.. Then what?

The point isn't to actually shut down the entire economy.

The point is that when you are talking loss numbers in the trillions, interventions that cost hundreds of billions or even "smaller numbers of trillions" to avert the big losses make economic sense; helicopter dropping a trillion dollars to allow people besides tech workers to self-isolate and socially distance themselves for a few months could be cheap, in the long run.

> The point is that when you are talking loss numbers in the trillions

The main part of my argument above is that you pulled that number out of your ass, you didn't address any of my points against why that number is baseless, yet you continue using the number.

Your number is a worst-case "cost" of doing absolutely nothing and just letting people die, and then you say that your suggested strategy of dumping cash on the population is much cheaper. While true in itself, the error is that you're equating the UK strategy with the worst-case doing-nothing strategy, and that therefore your strategy is better.

The case for the UK strategy is that by letting the virus spread uncontrolled through the not at risk population, health care systems won't ever be overwhelmed, death rates will be much, much lower than current measured ones, and you'll emerge on the other side with a herd immune population, without doing too much damage to your economy, and the at-risk population won't ever get infected in the first place. And by doing that, the total death toll will be lower, than having the virus slowly go through the entire population, at-risk or not.

>letting the virus spread uncontrolled through the not at risk population

Sounds excellent. Did we remember to tell the virus?

Or at the very least, to divide the UK into two non-interacting populations of at-risk and not-at-risk individuals?

I don’t understand how we can have reliable mortality/morbidity statistics when it’s only been out for a few months, and many people that get it don’t even get diagnosed with it and so aren’t counted in the survivors. How can there be a representative sample of data available yet?

We work with what we have, and update as more information becomes known.

At the very least, we have a current floor that 0.002% of the total Italian population has died from the disease so far; conversely, we know a minimum of 21,157 have contracted it in the same population, and 1,966 have recovered, so the mortality rate is probably less than 90%.

Now those two numbers are very far apart, so you might be inclined to wait and see whether the final number will lie, but the problem with that is, once the final number is known, it is too late to act.

We either have the option of acting now, as seems best with our current information, and correcting course as the new information reveals itself, or doing nothing at all, and waiting for better information, and our current information says that doing nothing at all is not the best option.

> Now, the US government values the lives of its citizens at $7-9 million dollars a piece.

Wait, where does that figure come from?

I mean, honestly it varies department to department, and when you start talking "lives" versus "YoQL": https://en.wikipedia.org/wiki/Value_of_life#United_States

COVID-19 is rapidly becoming the centre of attention for the entire global medical community and every government on the planet. It threatens the wealth of billionaires and the power of the powerful. I have a remarkable amount of faith that progress on treatments and medical practices will be swift and impressive.

Delaying the pain by a month or two could well be an extremely good move.

You're betting on 1) a therapy being found in that interval, 2) that therapy being highly effective (no significant side effects), 3) easily available 4) affordable 5) you still have medical personnel with which to apply it.

I wouldn't take those odds.

One more, by the way: that the virus doesn’t mutate.

> The economy is a tool to get people goods and services. It is less important than life & death on a mass scale.

This just isn’t true. The definition of an economy is a system to determine the production and allocation of scarce resources.

To the extent that those resources include food, shelter, and other elements required to stay alive then the economy literally is the determinant of life and death.

Furthermore, significant contractions of economic activity cause death in measurable predictable ways.

All of this closing down of the economy is — literally — killing people as we speak.

(warning: conspiracy theory, but at least an original one)

I'm thinking this only makes sense in the context of Brexit. Brexit will be a massive hit to the competitiveness of British businesses... somebody in government is hoping to counteract this by taking an approach different to the rest of Europe. If the UK's approach works, it will end up economically ahead of all the other European countries, something like the US post-WWII (but to a lesser extent).

> I'm thinking this only makes sense in the context of Brexit. Brexit will be a massive hit to the competitiveness of British businesses

Bad theory. This virus could have been used as an excuse to lock down borders while the rest of Europe got economically destroyed by the virus.

No it already spread to the UK so it was to listen for that

That seems like the exact gamble. IMO, the US has taken the right approach. Keep things going until it starts to replicate in the community, then get aggressive before the hospitals are overrun.

Some communities will have too many cases, but most will hopefully be ok. And we will have a first step of Hurd immunity, concentrated on people most likely to transmit later like package delivery, restaurant workers, drivers etc.

The US should have had testing procedure set up early to relieve stress for citizens.

> Keep things going until it starts to replicate in the community, then get aggressive before the hospitals are overrun.

How is that not a bad strategy? By this point the disease will have some sort of transmission inertia, so establishing containment just before hospitals are overrun pretty much guarantees they will be overrun.

We won’t know for 2 weeks. If the hospitals are overrun, that is a massive policy problem. If they aren’t, it’s a massive policy success.

Math was known and the results fall on our politicians

The US approach has been awful. Things are running completely out of control. The "aggressive before the hospitals are overrun" thing won't work.

Herd immunity means something like 60% of the population get it and maybe 1.3 million Americans die ghastly deaths.

I don't think killing a larger portion of Britons than of Continental Europeans is going to be good for the British economy.

That's ignoring intent they expressed to implement very long isolation measures for the elderly. Thier approach might be flawed, but let's debate it based on what has actually been stated.

They can intend what they please, but the facts show that you can't save the elderly without quarantining and social distancing of the non-elderly. "Stiff upper lip" is such a caricature of Britishness that I wonder if Johnson is doing it as a piece of patriotic method-acting. It is not a medically sensible method to fight COVID-19.

.. fewer elderly to take care of?

Although I'm personally offended, being unimaginably (for me) old, this does make some sense. After all, many countries have been angsty about demographic inversion. And SARS-CoV-2 could resolve that within a decade or less.

Apologies for the offense, but I was being serious for the reason you mentioned.

NP. I was mostly joking about the offended part :)

The other interesting factor is how it will impact Gerontocracy which is the norm for most eastern and western governments alike. We see this playing out in in Iran.

Counter-point: is Brexit Britain actually going to be worst off than post-pandemic EU or what's left of the EU?

I don't think the risk of this pandemic approach is worthwhile, especially given how poorly the EU is doing in general. Terrible economy, catastrophic pandemic response, and the symbolism of countries closing borders on fellow EU states are all quite telling.

By contrast Britain almost seems like it dodged a bullet - although they seem to have jumped in front of a train instead with their pandemic gamble.

Only the EU economy has been doing pretty well - much better than the UK has been.

I think that their strategy is more smoke and mirrors - they're looking for the massive uproar so that the public understands that what we're facing is the real deal and will accept the harsh restrictions to freedom better once they have to be made.

The damage caused by an extra day or two of waiting will be small in comparison to the benefits of good compliance.

Plus don't forget that it's the weekend. No schools. The schools won't be open on Monday.

Dominic Cummings and his team are sharp and extremely good at manipulating the exact group of unthinking idiots who would otherwise ignore curfews and restrictions..

I should also add: all of the other Western countries are doing the same thing, UK included. Do whatever is possible to keep the health system working until. Eventually you get herd immunity either via people getting it or a vaccination.

Britain reminds me of the drunk guy who falls down a flight of stairs and then rolls back onto their feet unharmed.

the uk is bust - germany is injecting 600 billion in the economy, while the uk a mere 30. the uk NEEDS people to work so they keep the country afloat.

The UK can raise as much cash as Germany so it is a choice they are making.

may be a conspiracy theory, but as the uk gov is injecting only 30 bil in the economy while germany is injecting 600 billion shows the uk is financially in a weak position. if the country stops working the economy is bust. the uk _needs_ to be ahead of europe to stay afloat, so that these measures as a state of war, in which economic sovereignty can be lost unless some people die on the battle front.

You're confusing two different measures.

The UK government has increased spending by £30B, £12B to be spent on tackling COVID 19.

The Bank of England has suggested lending £190B to businesses in need.

The roughly equivalent numbers appear to be 12B and 600B (Euros) for Germany.





thanks for the clarification, still a pretty small number considering. all i am saying is these numbers might explain the logic behind going against all scientific advice.

Yeah, it will make Britain Great Again as it gets rid of the old population and increases its competitiveness. It almost feels natural that after getting rid of the migrants it's time to get rid of some less desired locals as well.

In a very dark-humour fashion, it sounds like this would change the balance of brexiters-vs-remainers fairly drastically too. No longer ~50/50. ;)

This is NOT a creative experiment.

It's exactly the same as everything that's being done, no one knows what's best, they are all creative or none are.

We have no idea what the downsides are for massive lockdowns. Look at the deaths that happened over summer in Britain when the heatwave struck. What will happen to the elderly in a lockdown?

Lockdowns are not conservative. They are what the rest of the world's doing so they are politically conservative for weak governments.

Lockdown has been shown to work in wuhan and china, except for the political willingness and population willingness in western democracies.

We don't know that yet. This hasn't even begun. We have another 6 months before we'll understand anything. Wuhan might just break out again.

Following others lead is only political conservative. It's the learned behaviour of risk managers, push responsibility to others even if it's not the best action. They are there to manage internal risk.

Great point - but - shutting down the economy is not a 'conservative' policy, it's up there with 'extreme risk'.

Many sectors will crumble, it will ripple through the economy like dominos, credit dries up, investment halts, you get into an economic death spiral. There's very real possibility existential meltdown which will indirectly cause a lot of pain and death.

So 'lockdown' is 'conservative' from the viral perspective, from any other perspective, it's 'very risky'.

"Nobody ever got fired for buying IBM"

Interesting way of managing risk. Curious - Does this rule of thumb have a name?

I think you can draw a direct line between the personality of Johnson and adoption of this strategy.

Covid19 will unfortunately kill a lot of people. As a silver-lining, it may also kill populism.

Populism seems to be "democracy that I don't like the result of".

To add to your risk management analysis, I believe we're looking at more of a capped downside if you consider the timing. It's better to come down with it now, before hospitals are overflowing with the sick. We're just at a point where hydroxychloroquine is gaining traction as a treatment, so we have a viable response. We won't have a definitive cure or vaccine for several months, before which the number of people who are contaminated will skyrocket.

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