Two months seems like the minimum. The really hard problem is that even if you reduce spread to near zero, it’s almost guaranteed that cases will continue to spread among the essential workers who are still active during the lockdown. As long as that’s the case, the end of the lockdown will result in the cycle starting over.
It seems to me that what we’re really doing with the lockdown is buying the time to “mobilize,” in the military sense, our healthcare system. If we had the testing capacity to test everyone and contain only the sick, this would be less serious. If we had 10x as many ventilators, and 100x as much protective equipment, this would be less dangerous. If we had an effective treatment (like a Tamiflu for Covid), then this would be less dangerous. Etc.
It seems to me unlikely that we will be locked down less than 2-3 months. But after that, I doubt the public will be willing to endure another global lockdown of this magnitude. Thus I think everything we’re doing now is really about delaying the inevitable long enough for us to get a coherent response in place.
To the extent that anyone is a “winner” in a pandemic, it certainly appears to be Taiwan and South Korea, who responded fast enough to the first wave to keep it from requiring an authoritarian response (or, at least thus far).
I'm skeptical that the public can endure a single 2-3 month lockdown to begin with. But a lot can change in 2 months, so it is far from certain the lockdown will last that long.
For example
- a treatment might be found which reduces the fatality rate, making it a less dangerous disease
- widespread testing might show that a significant portion of the population already had it and were asymptomatic, thus we have herd immunity sooner than expected in places like New York and Spain/Italy
- antibody testing might become mainstream, so if there was a certificate for people who have already gotten it, that subset of the population can return to a normal life.
- the public support for the lockdown evaporates if it goes on for too long and unemployment skyrockets, so the government might move to a more moderate measure - e.g.: only lock down the people at risk, and let everyone else return to a normal life.
- rapid and cheap tests because widespread, so perhaps you can just get tested before boarding a plane, or entering a shopping mall, etc.
(widespread testing might show that a significant portion of the population already had it and were asymptomatic, thus we have herd immunity sooner than expected in places like New York and Spain/Italy)
I think this is a dangerous myth as till now infected people are infecting a lot of the people they come in contact with. Had the virus already passed through a lot of people already the spike in number of ICU cases would not be happening now nor keep increasing at the same rate
Sure, many positive developments may happen, but we should prepare for the likely possibility of not one of those things happening.
What if we don't find a cure and a vaccine takes 3 years?
Cheap, fast testing is almost there but I don't see how that actually helps... What do we do with people who didn't yet get the virus? Should they stay at home? Since they're a majority, it's not very different from the current situation. Or should they go out and "chance it"? Are you willing to do that in the absence of a cure?
Yes, I'm willing to do that in the absence of a cure. I wouldn't like, go to a packed stadium, but I'll happily invite friends over or eat at a restaurant once it's permitted again.
Simply put, yes - staying at home all day isn't living, it's just existing. And giving up 3 of the best years of my life isn't a price i'm willing to pay, even if there is no cure or vaccine.
If you aren't willing to "pay the price" now, then you will pay the price in other ways later. Your actions are not isolated and affect others, and not doing your part to prevent this from getting worse is an extremely selfish action. Obviously it's one thing if you have to go to work, or go out to get food, but if you willingly go out just because you want to experience the "best years of your life" and potentially put yourself and others at risk, you should reflect on that and realise how selfish and potentially dangerous that is.
If you have a difficult time putting this in perspective, just swap COVID-19 and social distancing for HIV and condoms.
I don't follow the analogy. Social distancing restrictions are much more severe than condoms; unless you live with a SO, you're not allowed to even touch anyone right now.
I don't buy this. You can have two populations one that social isolates and one that doesn't. You get pick which one you want to be in. Those two populations can't mix.
Having this level of foresight and the guts to risk millions of unemployed workers for a "maybe scenario" is rare. If you were running the country, or were the governor of a coastal state like NY/CA, at what precise date would you have started ramping up ventilator&mask production?
Would you have instituted a statewide lockdown when there were 1-2 cases in California?
Would you be willing to trade certain unemployment and economic unproductivity for 2+ months, in exchange for the possibility that you might end up like Italy instead of Taiwan/South Korea? The last datapoint we had was SARS-Cov-1, which ended up not becoming a huge pandemic. Of course, the disease characteristics for SARS-Cov-2 are different, but without the benefit of hindsight, was the decision really that clear?
Incompetent US administration aside, the financial markets - which can be thought of as an expensive forecasting computer - certainly did not price in what would happen, so I'm not sure we can expect policymakers to arrive at far-superior decision making.
Considering that China is not completely out of the woods yet either, and the US/Italy lags about 1 month behind them in pandemic progression, how would you advise the US act now, with the knowledge of what China is doing?
That type of “wait and see” approach to leadership and government is exactly what this virus exploits.
The U.S. should have started ramping up supply production in the early days, not because they had some guarantee that this particular virus would wreak havoc in America, but because two things should have been readily apparent:
1) The stockpile of essential supplies was apparently abysmally low, both at a state and federal level
2) That if this specific respiratory virus didn’t end up arriving on U.S. shores, it was just a matter of time before one did.
Aggressive production should have begun long ago, with the assumption that supplies may be needed for this outbreak, and if not, it ought have been treated as a wake up call and at least the country would be more prepared for a future outbreak that could happen at any time.
Not only production, but aggressive public messaging about reasonable social distancing, hand washing, etc. should have begun much earlier.
The inaction was, in my view, bizarre and indefensible, and few elected officials exhibited the true qualities of leadership that are needed to foresee the risk and act swiftly to hedge against the risks that were readily apparent early on.
I'm not talking about locking down early, I'm talking about starting a crash program to produce masks and tests, organizing a national system to redirect resources like masks and ventilators, etc. If we had the testing capacity we have now a month ago, we would be in a much better position.
We didn't know how much it was spreading in the US because we weren't testing cases that didn't have a nexus to China/SK. So we had no idea what the spread was like and there was no data to go on to inform decisions to lock down. Seattle only got there early because some local flu researchers disobeyed their own IRB rules and tested cases for the virus without approval.
California seems to have gotten the lockdown about as early as was practical and has done much better than NYC, so they're actually doing well, all things considered.
I'm talking about starting a crash program to produce masks and tests, organizing a national system to redirect resources like masks and ventilators, etc.
Pretend for a second that you're Andrew Cuomo on January 1, 2020. What information would you have to justify this crash program?
Pretend that you're Andrew Cuomo on April 4, 2020. You're aware of what stage China is in. What would you do differently?
We should have started preparing the day we knew a c19 patient was in the US. I think that was late January. Definitely should have had a lockdown by late February at the latest but earlier would have been better and feasible. When the who and cdc said it was almost a pandemic, we should already have been prepared knowing that "almost a pandemic" to those organizations means the shit has hit the fucking fan and it's no longer preventable. Of course, this would have required leadership from the top and that's non-existent.
SARS wasn't able to spread nearly as quickly as the novel coronavirus, possibly because of the incubation period and prevalence of asymptotic carriers in this coronavirus.
That wasn't true of SARS which made people very sick so it was able to be contained (it's possibly that the novel coronavirus is just far more contagious but I don't know that for sure).
By mid to late January we all knew this. It was happening in China in full view of the world. The question was whether it could be contained, we didn't know that at the moment. But without extreme intervention it was just simple math that this would happen, and it did.
If we had 10x as many ventilators, and 100x as much protective equipment, this would be less dangerous.
Only up to some point, then you run out of specialized personnel who know how to properly treat each patient (including controlling said ventilators). (Re-)training personnel probably takes months to years.
The value of specialized personnel isn't as large as I think you're expecting. Most hospital care boils down to "put them in bed and deliver medication and food at the appropriate times", and patients who need more are likely to die no matter what care they get. It's tragic that some people will die who could have been saved with intensive specialized intervention - but once everyone can be intubated, there's probably no "overload threshold" where lots of people die when they would have otherwise left in good health.
It's not just intubation but varying other protocols for treating sepsis, ARDS, etc depending on the exact set of symptoms. Even the ventilator itself is far from "hook it up and leave it" - there has to be a careful and up-to-date balance between getting enough oxygen into the bloodstream and not damaging the lungs more than absolutely necessary.
The people on a nasal cannula of oxygen probably only need limited skilled intervention and supervision, but once they're intubated it's pretty intensive.
In two if the three studies a third of the people who survived were able to come off ventilation. It’s not a panacea as the article says, but I suspect without ventilators the death rate would be more like 100%, and I’ll take my chances with 1/3 versus 0 any day.
It seems to me that what we’re really doing with the lockdown is buying the time to “mobilize,” in the military sense, our healthcare system. If we had the testing capacity to test everyone and contain only the sick, this would be less serious. If we had 10x as many ventilators, and 100x as much protective equipment, this would be less dangerous. If we had an effective treatment (like a Tamiflu for Covid), then this would be less dangerous. Etc.
It seems to me unlikely that we will be locked down less than 2-3 months. But after that, I doubt the public will be willing to endure another global lockdown of this magnitude. Thus I think everything we’re doing now is really about delaying the inevitable long enough for us to get a coherent response in place.
To the extent that anyone is a “winner” in a pandemic, it certainly appears to be Taiwan and South Korea, who responded fast enough to the first wave to keep it from requiring an authoritarian response (or, at least thus far).