We lost the chance at containment weeks ago. It's in the community. We need to stop all flights, close all schools, and discourage travel. Our best chance now is in flattening the curve so our healthcare system isn't overburdened.
Garmine's recommendation is in line with expert opinions I've been reading for the last couple of days. There is at least one really great case study from the Spanish Flu: St Louis proactively closed schools and reduced deaths by 50%, compared to Pittsburg who closed schools relatively. It seems a decidedly good idea to get ahead of these things.
Children aren't at risk, but can still act as vectors of infection. And it's not just kids, many adults work in the school system.
Shutting down schools is almost assuredly an effective measure to slow the spread of the disease. And slowing the spread is the overriding public health imperative. Even if the same number of people get infected, fast transmission means the healthcare system gets overloaded with all the patients at once.
A 5% reduction in the rate of transmission could plausibly reduce the number of fatalities by 50% or more. We need to do everything possible to institute "social distancing" to slow the process done.
But you need to provide daycare at least for some children. Otherwise police, fire departments and hospitals will cease to work. Doctors can't work long shifts if there's no one at home taking care of children. You could make school voluntary and encourage everyone to stay home who can take care of their children. But closing all schools sounds dangerous.
I agree completely. But I think the status quo of just continuing normal school procedures is a potential epidemiological nightmare. We could still provide childcare to those who need it, but in a format that drastically reduces transmission potential.
First, like you very astutely pointed out, stop making school mandatory. Even encourage families to keep kids home if they have childcare available. That probably entails ceasing any academics, since parents will otherwise feel pressured to keep their kids in school lest they fall behind.
Second, we can keep kids isolated in small groups, so they're not intermingling as is typical during a school day. A child should be assigned to a single pod, and only interact with his assigned pod for the remainder of the epidemic. Obviously childcare workers should be assigned a single pod, and stay in that pod. The smaller we can sub-divide pods, the better.
Finally big common activities, like lunch or recess should be staggered so that kids aren't ever exposed to anyone else outside their pods. Other than that pods should stay confined to the same classroom for the duration of the epidemic. Pods should probably be assigned based on busing routes, so that kids only bus with their pod.
Part of the worry is that even for completely non-essential jobs, managers will say "you can still send your child to school so I expect you to come in and work". "Schools are closed" is a much simpler message, and I imagine the vast majority of doctor parents can arrange for a non-doctor parent (from another family) to provide their childcare.
> But you need to provide daycare at least for some children.
Here's a problem: what's the difference between state-provided daycare and school, from an infectious disease standpoint?
Both are a bunch of kids in one building, attended to by adults. Both will require busing kids to said building, with buses driven by adults.
Might as well just leave the schools open.
I don't have a solution, just pointing out that daycare == school for this situation, so closing schools but providing daycare in it's stead won't make a difference.
The issue with schools is that they're daily large gatherings where the virus can be transmitted. Children can be carriers with schools providing the network effect for spreading covid-19.
> We lost the chance at containment weeks ago. It's in the community. We need to stop all flights, close all schools, and discourage travel. Our best chance now is in flattening the curve so our healthcare system isn't overburdened.
If it's already out, how will stopping flights and closing schools really help? How long will you stop them? At best, this will just slow the spread, not stop it.
Each sick person will only, on average in unmitigated conditions, get two or three other people sick. If you consider just a single infected person that doesn't seem that infectious at all. Yet because this is an exponential process that won't slow down until a significant fraction of the population is infected or immune 2-3 is enough to go from a couple people sick to most of the world in fairly short order.
Yet if you can reduce that 2-3 down to 1 or below even with relatively half-assed measures like telling some people to stay in inside, isolating known-infected and likely-infected persons, closing down some major spreading venues, telling people to wash their hands or use surgical masks... presto chango the disease dies out and no more than a tiny percentage of the population will get infected.
If the half-assed measures reduce the exponent but don't get it below 1, eventually most people will still get infected but it will take a lot longer. That extra time means the hospitals get less overloaded and lots of additional lives are saved because many covid19 cases require serious medical intervention (forced respiration). It also potentially creates time for better treatments to be created/discovered.
The best time to start seriously addressing this would have been weeks ago when it became clear that it was spreading from unknown and non-isolateable sources inside the country-- at least to the extent that it could be done without major damage... before there were thousands (likely hundreds of thousands now; given the observed spreading rates) of cases circulating in the US. But so long as the vast majority of the people who could eventually be infected are not yet infected, it's STILL a good idea.
On top of the risk we're facing from hospitals overloading, there is also a lot of potential for widespread panic once testing catches up and the numbers go from a rounding error to "big and scary looking" overnight. Beginning countermeasures earlier should help reduce the panic both by decreasing the peak infected numbers and by making it clear that the issue is being addressed.
There’s 60,000 icu beds in the US. We are in full flu season and a lot of those beds are being used. We need to slow down this virus till summer and hope it that inverts the curve so we have time to develop methods and drugs to minimize the risk of hospitalizations. If we don’t slow it down, we’ll see 3% mortality rates instead of sub 1%. Our path is similar to other countries, we’re just a few weeks behind.
Forgive my ignorance but I recently saw a video of two women fighting over bathroom tissue in Australia or New Zealand. If they have infections there where summer is just ending why do people think that warmer weather will some how stop the spread?
Flu and cold is seasonal. There’s a bunch different theories around it from cold air lowers our defenses to vitamin d production from sun light. Sars burned out during the summer months so hopefully we see a reduction with this virus.
Thanks that makes sense, I'm still a bit confused as to the fact it's going to be summer in the northern hemisphere but winter in the southern, does that mean things will get better in Europe and North America but worse in South America, Australia etc?
Flu seasons are usually judged by what is happening in the other hemisphere. During our summer Australia had a bad flu season which corresponded to the US having a bad flu season during our winter months.
90% of the people in the world live in the northern hemisphere, and a significant chunk of the people who live in the southern hemisphere live near to the equator (i.e. they have no winter). Also, it's not about to be winter in the southern hemisphere, it's about to be fall.
Even if it isn't, there will be fewer cases of other diseases so hospitals are typically emptier. Also, it's less likely to contract COVID in combination with other diseases.
Slowing things down is important in order to keep the medical system from being overwhelmed.
We already know we don’t have enough ventilators or enough staff to care for the ill if we end up with a similar growth curve to what they’ve seen in Italy.
> If it's already out, how will stopping flights and closing schools really help? How long will you stop them? At best, this will just slow the spread, not stop it.
Yes, it will.
One thing that tends to get neglected is that in a lot of diseases, most people don't pass the disease on very well (maybe infect one other person) but a small number of people (superspreaders or superinfectors) pass it on EXTREMELY effectively.
If you can block the superinfectors by quarantines, that is like putting control rods into a nuclear reactor--you slow the progress dramatically.
Same areas will be able to snuff it out with luck, social distancing and contact tracing. Stopping flights prevent them from being reinfected. But quarantining incoming travelers might achieve the same thing with fewer drawbacks.
Quarantining incoming travelers from high-risk destinations will likely help, but will NOT achieve the same thing. COVID-19 is already here and circulating in the community. It has been for weeks. We just aren't testing for it (this will change in days or maybe a week, so wait for the big explosion in cases). Two weeks ago, there was capacity to administer and process 700 tests. Not 700 per day. 700 total. It has improved a little since then. But it is only now that actual significant testing capacity is being brought on board. Something S. Korea has had for about a month. We are way way behind.
If by community you mean the US as a whole, yes. But there are many areas and smaller cities in which it has not arrived. Those could be helped. And if a smaller city is infected and then gets clean, they could be helped too. That's what I was referring to. Stopping domestic flights.
Slowing the spread is exactly what we need to do. Around 15% of the people who get COVID-19 need ICU care in order to keep breathing. The fatality rate with care is no higher than around 2%, and maybe less. Without medical access, it is around 15%, guaranteed.
The problem is there are only so many ICU beds available. If we self-isolate and slow the spread, then we can keep the number of dangerously ill people below our capacity limits, and make sure that everyone who needs care gets it. This is what Japan and South Korea have done. Italy did not react fast enough and now the fatality rate there is approaching 8%(!!).
With very strict measures, we might even stop the epidemic in its tracks. So far, only China is on track for doing that.
> Around 15% of the people who get COVID-19 need ICU
I'm usually the doomssayer, but that's 15% of people who are diagnosed. Usually people who are asymptomatic or nearly asymptomatic don't get diagnosed.
Only a few countries have testing programs widespread enough to start estimating case vs infection rates... and certainly not the US, where there are plenty of people who have been obviously infected who are still not included in the official counts because of god-knows-what-the-CDC-is-doing.
What is clear enough is that whatever the rate of serious cases are, it's more than high enough to overload the hospitals-- just as is happening now in Italy. So I fully agree with your point, I just don't want to see if lost in the noise because some people will notice the 15% claim is almost certainly an overestimate.
Other countries don't have the problem with widespread testing that the US has. That number comes from China, Italy, and South Korea. 15% of people who show symptoms need intensive medical care.
Yes, but what percentage of people who get infected need intensive medical care? :)
The difference matters because it's likely that 60-70% of the population or so will eventually be infected. But it won't be 15% of that which need intensive medical care but some lesser number because some infections will be asymptomatic or nearly so.
In South Korea and China they are testing everyone who has been exposed to the virus. Obviously they're not testing everybody so some are slipping through, but these are broad tests that are capturing some of the asymptomatic cases as well.
If you want you can calibrate against the Diamond Princess numbers.
~15% need serious medical intervention. That's at the very beginning of the article I linked, the "severe" cases in the table.
Now under normal circumstances this intervention is not life threatening--that's the smaller "critical" category. But without access to common hospital equipment, the symptoms do become critical. Basically the patient becomes unable to breath normally, and without access to a breathing machine they'll suffocate themselves.
Most "severe" cases are treatable with access to a hospital. But if we peak at once and that equipment is all occupied by other patients... that 15% of severe cases become fatal.
I just made a map with state-by-state data about ICU beds and vulnerable (older) population. Some states have less than half the number of ICU beds per vulnerable population than others.
Slowing the spread is the point. We have a lack of capacity for handling the urgent care cases. Once the capacity is over limit, in particular ventilation, people will die who otherwise would not die. The difference is in thousands of deaths.
Slowing the spread gives vaccine and antiviral researchers a fighting chance to win the race, gets us to summer where if we’re lucky enough that this virus is seasonal it’ll go away, and, most importantly, “flattens the curve”, as your parent commentator already pointed out.
Everyone keeps hoping the virus is "seasonal." That warmer temperatures will dampen the spread. The data on that is total hokum. The flu is seasonal because everyone in the WORLD is exposed in a matter of months and either develops immunity or gets sick first and then develops immunity. The next season's flu comes from viruses incubating in animal populations and agricultural wildlife patterns are seasonal (e.g., pig/chicken raising in Asia, global bird migration patterns). Influenza circulates year around, but in the Summer months, we are mostly immune due to prior exposure. The new version of the flu starts going in Winter and we are all immune again by the Spring/Summer. IMHO, COVID-19 will only have the same pattern by happenstance.
