The big Coronavirus thread

rjsterry

pangolin said:

rjsterry said:

Stevo_666 said:

Longshot said:

Stevo_666 said:

The only true exit strategies in my mind are a vaccine or herd immunity. If we don't get the first in time, then we will get the second by default.

I would see that some level of social distancing will need to be maintained even after certain restrictions are relaxed (I also mentioned up thread that the isolation of the old and vulnerable may need to stay). Clearly this is by no means a full solution, but I'm not pretending to know all the answers.

This is right I think. I cannot see any way we get testing done comprehensively enough for this to provide a true picture. Therefore we'll need to take some measured risk but not with the highly vulnerable.

I do see that the likes of us (i.e. not old and/or vulnerable) will have to take some degree of risk going forward. We can't all keep living under a rock until a vaccine is available.

The other point here is that keeping that set of people isolated will do relatively less economic damage give the proportion of them that will be economically inactive. So in that case the medical/health aims are not running contrary to the economic aims.

I think I saw somewhere yesterday that someone had worked out that isolating a carefully targeted 10% (those testing positive and those at increased risk, presumably) was as effective in slowing the spread as isolating a randomly selected 50% of the population. The point being that an economy can function with 10% out of action but not 50%. At the moment we are doing the latter and need to move to the former.

Tough luck if you're in that 10% and say, at school or early on in your career. 90% of the country carries on and you're stuck in limbo. Not disagreeing with you mind.

I don't think it was saying 10% was a magic number - more that targeted isolation based on testing is much, much more effective 'per isolated person' both from a lives-saved and an economic point of view, than blanket lockdown. Obviously if you have missed the boat on early testing then you have to start with blanket lockdown and work up the testing.

Stevo_666

rjsterry said:

Stevo_666 said:

Longshot said:

Stevo_666 said:

The only true exit strategies in my mind are a vaccine or herd immunity. If we don't get the first in time, then we will get the second by default.

I would see that some level of social distancing will need to be maintained even after certain restrictions are relaxed (I also mentioned up thread that the isolation of the old and vulnerable may need to stay). Clearly this is by no means a full solution, but I'm not pretending to know all the answers.

This is right I think. I cannot see any way we get testing done comprehensively enough for this to provide a true picture. Therefore we'll need to take some measured risk but not with the highly vulnerable.

I do see that the likes of us (i.e. not old and/or vulnerable) will have to take some degree of risk going forward. We can't all keep living under a rock until a vaccine is available.

The other point here is that keeping that set of people isolated will do relatively less economic damage give the proportion of them that will be economically inactive. So in that case the medical/health aims are not running contrary to the economic aims.

I think I saw somewhere yesterday that someone had worked out that isolating a carefully targeted 10% (those testing positive and those at increased risk, presumably) was as effective in slowing the spread as isolating a randomly selected 50% of the population. The point being that an economy can function with 10% out of action but not 50%. At the moment we are doing the latter and need to move to the former.

Re: my point above and assuming we are talking about a test for who has it rather than who has developed antibodies, then testing someone today doesn't help if they catch tomorrow for example, the the level of testing to be able to identify and isolate is absolutely huge. Add to this the asymptomatic incubation period where nobody can tell who has it without a test, I simply don't see how it is feasible to do this on a comprehensive basis.

I'm not saying there is no point to testing - far from it. But it will need to be targeted where needed most and can only be part of a wider strategy to slow the spread until a vaccine or treatment is available.

coopster_the_1st

Stevo_666 said:

rick_chasey said:

kingstonian said:

Where does the stat of Germany doing 500,000 tests a day come from? Genuinely interested as it doesn't seem to correlate to the Worldometers site that shows 1.7m tests in total having been conducted.

That article TWH linked to.

The difference between Germany and Italy is partly statistical: Germany’s rate seems so much lower because it has tested widely. Germany has carried out more than 1.3 million tests, according to the Robert Koch Institute. It is now carrying out up to 500,000 tests a week, Drosten said. Italy has conducted more than 807,000 tests since Feb. 21, according to its Civil Protection Agency. With a few local exceptions, Italy only tests people taken to hospital with clear and severe symptoms.

I got it wrong - it's 500,000 per week, not day!!

OK, so that makes it 0.086% of the population daily, or the whole German population once every 3.5 years.

My point here is that if Germany is top of the class on testing, even for Germany this shows the practical issues with a test, track and trace strategy. In the end it isn't an exit strategy, just part of managing the on-going situation and helping to slow the spread.

The only true exit strategies in my mind are a vaccine or herd immunity. If we don't get the first in time, then we will get the second by default.

I would see that some level of social distancing will need to be maintained even after certain restrictions are relaxed (I also mentioned up thread that the isolation of the old and vulnerable may need to stay). Clearly this is by no means a full solution, but I'm not pretending to know all the answers.

There is an added variable to the herd immunity option and that is the anti-body test. That would simplify this option somewhat.

coopster_the_1st

Stevo_666 said:

rick_chasey said:

kingstonian said:

Where does the stat of Germany doing 500,000 tests a day come from? Genuinely interested as it doesn't seem to correlate to the Worldometers site that shows 1.7m tests in total having been conducted.

That article TWH linked to.

The difference between Germany and Italy is partly statistical: Germany’s rate seems so much lower because it has tested widely. Germany has carried out more than 1.3 million tests, according to the Robert Koch Institute. It is now carrying out up to 500,000 tests a week, Drosten said. Italy has conducted more than 807,000 tests since Feb. 21, according to its Civil Protection Agency. With a few local exceptions, Italy only tests people taken to hospital with clear and severe symptoms.

I got it wrong - it's 500,000 per week, not day!!

OK, so that makes it 0.086% of the population daily, or the whole German population once every 3.5 years.

My point here is that if Germany is top of the class on testing, even for Germany this shows the practical issues with a test, track and trace strategy. In the end it isn't an exit strategy, just part of managing the on-going situation and helping to slow the spread.

The only true exit strategies in my mind are a vaccine or herd immunity. If we don't get the first in time, then we will get the second by default.

I would see that some level of social distancing will need to be maintained even after certain restrictions are relaxed (I also mentioned up thread that the isolation of the old and vulnerable may need to stay). Clearly this is by no means a full solution, but I'm not pretending to know all the answers.

You are also highlighting how stupid the backlash against herd immunity was. It just shows anyone who disagreed with it was not understanding this

Wheelspinner

Stevo_666 said:

Longshot said:

Stevo_666 said:

The only true exit strategies in my mind are a vaccine or herd immunity. If we don't get the first in time, then we will get the second by default.

I would see that some level of social distancing will need to be maintained even after certain restrictions are relaxed (I also mentioned up thread that the isolation of the old and vulnerable may need to stay). Clearly this is by no means a full solution, but I'm not pretending to know all the answers.

This is right I think. I cannot see any way we get testing done comprehensively enough for this to provide a true picture. Therefore we'll need to take some measured risk but not with the highly vulnerable.

I do see that the likes of us (i.e. not old and/or vulnerable) will have to take some degree of risk going forward. We can't all keep living under a rock until a vaccine is available.

The other point here is that keeping that set of people isolated will do relatively less economic damage give the proportion of them that will be economically inactive. So in that case the medical/health aims are not running contrary to the economic aims.

Have to say my view is this is rather simplistic. There are infinite variations at an individual level of what these types of "policies" actually translate to in implementation.

Exhibit A: Me.

I am still in my 50s, and in pretty good shape, so in the fairly low risk category. Retired, yes, but still economically "active" in that I pay bills, buy lots of stuff and hire people to do things.

My *entire* family consists of my partner/husband, who is 70 and also pretty reasonably fit and healthy, and my mother who is 86, lives alone still about 20 minutes drive away. She's still independent in that she drives herself about, is self-funded in income from a considerable investment portfolio which she actively manages, and has few "underlying health issues" beyond a dodgy hip and bad knee. There are no other siblings, nieces, nephews, relatives of any kind in the state.

What does your "isolation" strategy mean for my family? Answers on a postcard please!

I am (trying) to be the principal hunter/gatherer and we are already minimising our interactions with the big bad infected world, but in the event of "relaxing" a lockdown, what do you suggest we do? How do I "take some risk" without potentially exposing my family to it?

Makes no sense to me at all. Am I supposed to go live in the shed for the foreseeable future and not speak to or visit either of my family members?

If you think there's some way that there will be zero interaction of any kind between the (say) under and over 65 age groups, I reckon you're delusional.

Stevo_666

coopster_the_1st said:

Stevo_666 said:

rick_chasey said:

kingstonian said:

Where does the stat of Germany doing 500,000 tests a day come from? Genuinely interested as it doesn't seem to correlate to the Worldometers site that shows 1.7m tests in total having been conducted.

That article TWH linked to.

The difference between Germany and Italy is partly statistical: Germany’s rate seems so much lower because it has tested widely. Germany has carried out more than 1.3 million tests, according to the Robert Koch Institute. It is now carrying out up to 500,000 tests a week, Drosten said. Italy has conducted more than 807,000 tests since Feb. 21, according to its Civil Protection Agency. With a few local exceptions, Italy only tests people taken to hospital with clear and severe symptoms.

I got it wrong - it's 500,000 per week, not day!!

OK, so that makes it 0.086% of the population daily, or the whole German population once every 3.5 years.

My point here is that if Germany is top of the class on testing, even for Germany this shows the practical issues with a test, track and trace strategy. In the end it isn't an exit strategy, just part of managing the on-going situation and helping to slow the spread.

The only true exit strategies in my mind are a vaccine or herd immunity. If we don't get the first in time, then we will get the second by default.

I would see that some level of social distancing will need to be maintained even after certain restrictions are relaxed (I also mentioned up thread that the isolation of the old and vulnerable may need to stay). Clearly this is by no means a full solution, but I'm not pretending to know all the answers.

There is an added variable to the herd immunity option and that is the anti-body test. That would simplify this option somewhat.

True, I referred to it in my post just above yours. Clearly that is more useful as that is a one time only test (assuming the immunity point holds true), rather than one that must be continually repeated in the case of the 'is someome infected' test.

Once somebody is immune then they should be able to go out and about as normal. Targeted de-isolation if you like. It might even make some people want to get a dose!

DeVlaeminck

I see the Imperial scientists (or one of them) strongly favours Rick's track and trace option as the only currently available way of avoiding either indefinite lock down or a huge spike in cases. Even then some social distancing measures would have to be maintained. Until a vaccine becomes available of course.

Stevo_666

Wheelspinner said:

Stevo_666 said:

Longshot said:

Stevo_666 said:

The only true exit strategies in my mind are a vaccine or herd immunity. If we don't get the first in time, then we will get the second by default.

I would see that some level of social distancing will need to be maintained even after certain restrictions are relaxed (I also mentioned up thread that the isolation of the old and vulnerable may need to stay). Clearly this is by no means a full solution, but I'm not pretending to know all the answers.

This is right I think. I cannot see any way we get testing done comprehensively enough for this to provide a true picture. Therefore we'll need to take some measured risk but not with the highly vulnerable.

I do see that the likes of us (i.e. not old and/or vulnerable) will have to take some degree of risk going forward. We can't all keep living under a rock until a vaccine is available.

The other point here is that keeping that set of people isolated will do relatively less economic damage give the proportion of them that will be economically inactive. So in that case the medical/health aims are not running contrary to the economic aims.

Have to say my view is this is rather simplistic. There are infinite variations at an individual level of what these types of "policies" actually translate to in implementation.

Exhibit A: Me.

I am still in my 50s, and in pretty good shape, so in the fairly low risk category. Retired, yes, but still economically "active" in that I pay bills, buy lots of stuff and hire people to do things.

My *entire* family consists of my partner/husband, who is 70 and also pretty reasonably fit and healthy, and my mother who is 86, lives alone still about 20 minutes drive away. She's still independent in that she drives herself about, is self-funded in income from a considerable investment portfolio which she actively manages, and has few "underlying health issues" beyond a dodgy hip and bad knee. There are no other siblings, nieces, nephews, relatives of any kind in the state.

What does your "isolation" strategy mean for my family? Answers on a postcard please!

I am (trying) to be the principal hunter/gatherer and we are already minimising our interactions with the big bad infected world, but in the event of "relaxing" a lockdown, what do you suggest we do? How do I "take some risk" without potentially exposing my family to it?

Makes no sense to me at all. Am I supposed to go live in the shed for the foreseeable future and not speak to or visit either of my family members?

If you think there's some way that there will be zero interaction of any kind between the (say) under and over 65 age groups, I reckon you're delusional.

I realise that it is not as simple as my very high level take on a possible way forward. However I think you would agree it would not be wise to put the elderly and vulnerable in harms way as far as possible. How that translates into real life approach in the coming months - as mentioned specifically in my post above, I don't claim to have all the answers.

The only point I am clear about is that the only proper exit strategy is a vaccine (or other effective treatment). Failing that, herd immunity will eventually come about one way or another. It is a far from easy situation, especially for people in the sort of position that you set out.

pangolin

rjsterry said:

pangolin said:

rjsterry said:

Stevo_666 said:

Longshot said:

Stevo_666 said:

The only true exit strategies in my mind are a vaccine or herd immunity. If we don't get the first in time, then we will get the second by default.

I would see that some level of social distancing will need to be maintained even after certain restrictions are relaxed (I also mentioned up thread that the isolation of the old and vulnerable may need to stay). Clearly this is by no means a full solution, but I'm not pretending to know all the answers.

This is right I think. I cannot see any way we get testing done comprehensively enough for this to provide a true picture. Therefore we'll need to take some measured risk but not with the highly vulnerable.

I do see that the likes of us (i.e. not old and/or vulnerable) will have to take some degree of risk going forward. We can't all keep living under a rock until a vaccine is available.

The other point here is that keeping that set of people isolated will do relatively less economic damage give the proportion of them that will be economically inactive. So in that case the medical/health aims are not running contrary to the economic aims.

I think I saw somewhere yesterday that someone had worked out that isolating a carefully targeted 10% (those testing positive and those at increased risk, presumably) was as effective in slowing the spread as isolating a randomly selected 50% of the population. The point being that an economy can function with 10% out of action but not 50%. At the moment we are doing the latter and need to move to the former.

Tough luck if you're in that 10% and say, at school or early on in your career. 90% of the country carries on and you're stuck in limbo. Not disagreeing with you mind.

I don't think it was saying 10% was a magic number - more that targeted isolation based on testing is much, much more effective 'per isolated person' both from a lives-saved and an economic point of view, than blanket lockdown. Obviously if you have missed the boat on early testing then you have to start with blanket lockdown and work up the testing.

No sure I get it might not be 10% that ends up being isolated. Just saying it's going to be rough for those people whatever the actual number is.

rjsterry

pangolin said:

rjsterry said:

pangolin said:

rjsterry said:

Stevo_666 said:

Longshot said:

Stevo_666 said:

The only true exit strategies in my mind are a vaccine or herd immunity. If we don't get the first in time, then we will get the second by default.

I would see that some level of social distancing will need to be maintained even after certain restrictions are relaxed (I also mentioned up thread that the isolation of the old and vulnerable may need to stay). Clearly this is by no means a full solution, but I'm not pretending to know all the answers.

This is right I think. I cannot see any way we get testing done comprehensively enough for this to provide a true picture. Therefore we'll need to take some measured risk but not with the highly vulnerable.

I do see that the likes of us (i.e. not old and/or vulnerable) will have to take some degree of risk going forward. We can't all keep living under a rock until a vaccine is available.

The other point here is that keeping that set of people isolated will do relatively less economic damage give the proportion of them that will be economically inactive. So in that case the medical/health aims are not running contrary to the economic aims.

I think I saw somewhere yesterday that someone had worked out that isolating a carefully targeted 10% (those testing positive and those at increased risk, presumably) was as effective in slowing the spread as isolating a randomly selected 50% of the population. The point being that an economy can function with 10% out of action but not 50%. At the moment we are doing the latter and need to move to the former.

Tough luck if you're in that 10% and say, at school or early on in your career. 90% of the country carries on and you're stuck in limbo. Not disagreeing with you mind.

I don't think it was saying 10% was a magic number - more that targeted isolation based on testing is much, much more effective 'per isolated person' both from a lives-saved and an economic point of view, than blanket lockdown. Obviously if you have missed the boat on early testing then you have to start with blanket lockdown and work up the testing.

No sure I get it might not be 10% that ends up being isolated. Just saying it's going to be rough for those people whatever the actual number is.

Undoubtedly. If you are stuck on your own, the lockdown is already pretty grim.

morstar

DeVlaeminck said:

I see the Imperial scientists (or one of them) strongly favours Rick's track and trace option as the only currently available way of avoiding either indefinite lock down or a huge spike in cases. Even then some social distancing measures would have to be maintained. Until a vaccine becomes available of course.

I see the appeal. But if you can’t contain it in Singapore, what chance do you realistically have in a larger more complex nation state.
Maybe I am being defeatist but I think of this as a hypothetical solution, not a practical one.

In a short while we will have c10% of the population immune and plenty of other low risk individuals thinking certain economic pain is a guaranteed bad outcome whereas taking chances with the virus is a manageable risk.

pangolin

Stevo_666 said:

rjsterry said:

Stevo_666 said:

Longshot said:

Stevo_666 said:

The only true exit strategies in my mind are a vaccine or herd immunity. If we don't get the first in time, then we will get the second by default.

I would see that some level of social distancing will need to be maintained even after certain restrictions are relaxed (I also mentioned up thread that the isolation of the old and vulnerable may need to stay). Clearly this is by no means a full solution, but I'm not pretending to know all the answers.

This is right I think. I cannot see any way we get testing done comprehensively enough for this to provide a true picture. Therefore we'll need to take some measured risk but not with the highly vulnerable.

I do see that the likes of us (i.e. not old and/or vulnerable) will have to take some degree of risk going forward. We can't all keep living under a rock until a vaccine is available.

The other point here is that keeping that set of people isolated will do relatively less economic damage give the proportion of them that will be economically inactive. So in that case the medical/health aims are not running contrary to the economic aims.

I think I saw somewhere yesterday that someone had worked out that isolating a carefully targeted 10% (those testing positive and those at increased risk, presumably) was as effective in slowing the spread as isolating a randomly selected 50% of the population. The point being that an economy can function with 10% out of action but not 50%. At the moment we are doing the latter and need to move to the former.

Re: my point above and assuming we are talking about a test for who has it rather than who has developed antibodies, then testing someone today doesn't help if they catch tomorrow for example, the the level of testing to be able to identify and isolate is absolutely huge. Add to this the asymptomatic incubation period where nobody can tell who has it without a test, I simply don't see how it is feasible to do this on a comprehensive basis.

I'm not saying there is no point to testing - far from it. But it will need to be targeted where needed most and can only be part of a wider strategy to slow the spread until a vaccine or treatment is available.

I suggested a while back that to be really effective you'd need to be testing all NHS staff every day to check they haven't caught it that day. I think someone responded that it wasn't a very pleasant test?

Stevo_666

pangolin said:

Stevo_666 said:

rjsterry said:

Stevo_666 said:

Longshot said:

Stevo_666 said:

The only true exit strategies in my mind are a vaccine or herd immunity. If we don't get the first in time, then we will get the second by default.

I would see that some level of social distancing will need to be maintained even after certain restrictions are relaxed (I also mentioned up thread that the isolation of the old and vulnerable may need to stay). Clearly this is by no means a full solution, but I'm not pretending to know all the answers.

This is right I think. I cannot see any way we get testing done comprehensively enough for this to provide a true picture. Therefore we'll need to take some measured risk but not with the highly vulnerable.

I do see that the likes of us (i.e. not old and/or vulnerable) will have to take some degree of risk going forward. We can't all keep living under a rock until a vaccine is available.

The other point here is that keeping that set of people isolated will do relatively less economic damage give the proportion of them that will be economically inactive. So in that case the medical/health aims are not running contrary to the economic aims.

I think I saw somewhere yesterday that someone had worked out that isolating a carefully targeted 10% (those testing positive and those at increased risk, presumably) was as effective in slowing the spread as isolating a randomly selected 50% of the population. The point being that an economy can function with 10% out of action but not 50%. At the moment we are doing the latter and need to move to the former.

Re: my point above and assuming we are talking about a test for who has it rather than who has developed antibodies, then testing someone today doesn't help if they catch tomorrow for example, the the level of testing to be able to identify and isolate is absolutely huge. Add to this the asymptomatic incubation period where nobody can tell who has it without a test, I simply don't see how it is feasible to do this on a comprehensive basis.

I'm not saying there is no point to testing - far from it. But it will need to be targeted where needed most and can only be part of a wider strategy to slow the spread until a vaccine or treatment is available.

I suggested a while back that to be really effective you'd need to be testing all NHS staff every day to check they haven't caught it that day. I think someone responded that it wasn't a very pleasant test?

I think it isn't too nice.
https://metro.co.uk/2020/03/31/far-back-doctors-swab-test-coronavirus-12482026/
That aside, the sheer overall numbers of tests which would be involved means it just isn't practical, as I've argued above.

kingstongraham

pangolin said:

Stevo_666 said:

rjsterry said:

Stevo_666 said:

Longshot said:

Stevo_666 said:

The only true exit strategies in my mind are a vaccine or herd immunity. If we don't get the first in time, then we will get the second by default.

I would see that some level of social distancing will need to be maintained even after certain restrictions are relaxed (I also mentioned up thread that the isolation of the old and vulnerable may need to stay). Clearly this is by no means a full solution, but I'm not pretending to know all the answers.

This is right I think. I cannot see any way we get testing done comprehensively enough for this to provide a true picture. Therefore we'll need to take some measured risk but not with the highly vulnerable.

I do see that the likes of us (i.e. not old and/or vulnerable) will have to take some degree of risk going forward. We can't all keep living under a rock until a vaccine is available.

The other point here is that keeping that set of people isolated will do relatively less economic damage give the proportion of them that will be economically inactive. So in that case the medical/health aims are not running contrary to the economic aims.

I think I saw somewhere yesterday that someone had worked out that isolating a carefully targeted 10% (those testing positive and those at increased risk, presumably) was as effective in slowing the spread as isolating a randomly selected 50% of the population. The point being that an economy can function with 10% out of action but not 50%. At the moment we are doing the latter and need to move to the former.

Re: my point above and assuming we are talking about a test for who has it rather than who has developed antibodies, then testing someone today doesn't help if they catch tomorrow for example, the the level of testing to be able to identify and isolate is absolutely huge. Add to this the asymptomatic incubation period where nobody can tell who has it without a test, I simply don't see how it is feasible to do this on a comprehensive basis.

I'm not saying there is no point to testing - far from it. But it will need to be targeted where needed most and can only be part of a wider strategy to slow the spread until a vaccine or treatment is available.

I suggested a while back that to be really effective you'd need to be testing all NHS staff every day to check they haven't caught it that day. I think someone responded that it wasn't a very pleasant test?

That might have been me, and wasn't intended to be an argument against it. You'd also need to get the results back pretty damned quick

pangolin

kingstongraham said:

pangolin said:

Stevo_666 said:

rjsterry said:

Stevo_666 said:

Longshot said:

Stevo_666 said:

The only true exit strategies in my mind are a vaccine or herd immunity. If we don't get the first in time, then we will get the second by default.

I would see that some level of social distancing will need to be maintained even after certain restrictions are relaxed (I also mentioned up thread that the isolation of the old and vulnerable may need to stay). Clearly this is by no means a full solution, but I'm not pretending to know all the answers.

This is right I think. I cannot see any way we get testing done comprehensively enough for this to provide a true picture. Therefore we'll need to take some measured risk but not with the highly vulnerable.

I do see that the likes of us (i.e. not old and/or vulnerable) will have to take some degree of risk going forward. We can't all keep living under a rock until a vaccine is available.

The other point here is that keeping that set of people isolated will do relatively less economic damage give the proportion of them that will be economically inactive. So in that case the medical/health aims are not running contrary to the economic aims.

I think I saw somewhere yesterday that someone had worked out that isolating a carefully targeted 10% (those testing positive and those at increased risk, presumably) was as effective in slowing the spread as isolating a randomly selected 50% of the population. The point being that an economy can function with 10% out of action but not 50%. At the moment we are doing the latter and need to move to the former.

Re: my point above and assuming we are talking about a test for who has it rather than who has developed antibodies, then testing someone today doesn't help if they catch tomorrow for example, the the level of testing to be able to identify and isolate is absolutely huge. Add to this the asymptomatic incubation period where nobody can tell who has it without a test, I simply don't see how it is feasible to do this on a comprehensive basis.

I'm not saying there is no point to testing - far from it. But it will need to be targeted where needed most and can only be part of a wider strategy to slow the spread until a vaccine or treatment is available.

I suggested a while back that to be really effective you'd need to be testing all NHS staff every day to check they haven't caught it that day. I think someone responded that it wasn't a very pleasant test?

That might have been me, and wasn't intended to be an argument against it. You'd also need to get the results back pretty damned quick

True. But I guess the more frequently you test them, the smaller the lag ends up being between infection and detection, even if you never get the lag down to 0.

rick_chasey

So how does this exit strategy without testing work?

kingstongraham

rick_chasey said:

So how does this exit strategy without testing work?

Loads of olds die.

pangolin

rick_chasey said:

So how does this exit strategy without testing work?

Which strategy are you referring to?

At the moment the things I imagine are fairly likely to happen are:

- They look at mortality rates and continue to refine who is most at risk
- Maybe do as mentioned upthread and unlock those who are deemed less at risk
- Review how that affects the NHS and maybe do a hard 2nd lockdown, though I bet they will try to avoid this if possible
- Continue to ramp up volumes and accuracy of testing (though slower than we'd all like)
- Social distancing, weird supermarket experiences etc are here to stay for a year or more
- Eventually get a vaccine
- Several months/a year after that becomes available, enough of us will have either had the vaccine or had the virus and life will somewhat return to the new normal

With the virus so widespread around the world, does 1 country reducing its rates to a point where track and trace is feasible really help? That only works if travel restrictions stay in place until there's a vaccine, you test everyone who enters, or you quarantine everyone who enters.

rjsterry

kingstongraham said:

rick_chasey said:

So how does this exit strategy without testing work?

Loads of olds die.

And quite a lot of not-olds, too. But it's OK because they have underlying health conditions. Obviously I'm being sarcastic, but this is slowly being equated with was-going-to-die-soon-anyway, as opposed to had-a-condition-that-with-management-would-have-minimal-impact.

rjsterry

Stevo_666 said:

pangolin said:

Stevo_666 said:

rjsterry said:

Stevo_666 said:

Longshot said:

Stevo_666 said:

The only true exit strategies in my mind are a vaccine or herd immunity. If we don't get the first in time, then we will get the second by default.

I would see that some level of social distancing will need to be maintained even after certain restrictions are relaxed (I also mentioned up thread that the isolation of the old and vulnerable may need to stay). Clearly this is by no means a full solution, but I'm not pretending to know all the answers.

This is right I think. I cannot see any way we get testing done comprehensively enough for this to provide a true picture. Therefore we'll need to take some measured risk but not with the highly vulnerable.

I do see that the likes of us (i.e. not old and/or vulnerable) will have to take some degree of risk going forward. We can't all keep living under a rock until a vaccine is available.

The other point here is that keeping that set of people isolated will do relatively less economic damage give the proportion of them that will be economically inactive. So in that case the medical/health aims are not running contrary to the economic aims.

I think I saw somewhere yesterday that someone had worked out that isolating a carefully targeted 10% (those testing positive and those at increased risk, presumably) was as effective in slowing the spread as isolating a randomly selected 50% of the population. The point being that an economy can function with 10% out of action but not 50%. At the moment we are doing the latter and need to move to the former.

Re: my point above and assuming we are talking about a test for who has it rather than who has developed antibodies, then testing someone today doesn't help if they catch tomorrow for example, the the level of testing to be able to identify and isolate is absolutely huge. Add to this the asymptomatic incubation period where nobody can tell who has it without a test, I simply don't see how it is feasible to do this on a comprehensive basis.

I'm not saying there is no point to testing - far from it. But it will need to be targeted where needed most and can only be part of a wider strategy to slow the spread until a vaccine or treatment is available.

I suggested a while back that to be really effective you'd need to be testing all NHS staff every day to check they haven't caught it that day. I think someone responded that it wasn't a very pleasant test?

I think it isn't too nice.
https://metro.co.uk/2020/03/31/far-back-doctors-swab-test-coronavirus-12482026/
That aside, the sheer overall numbers of tests which would be involved means it just isn't practical, as I've argued above.

Oh, heavens! Well if it's mildly uncomfortable, let's not bother. Part of the the overall problem with UK testing is the infrastructure. That will need to be in place whether we are talking about the current swab test or a thumb-prick antibody test so let's stop finding reasons why it won't be perfect and start building.

Stevo_666

rick_chasey said:

So how does this exit strategy without testing work?

See my exit strategy above. Once we have a vaccine, testing isn't needed. There is no painless way out in the meantime.

IMO anything else isn't really an exit strategy, it's managing and keeping a lid on an on-going situation.

Pross

I think they just said on the news that of the people who have died so far they had an average of three underlying health issues but it's probably not uncommon that someone who has one serious condition has other problems.

As stated by others it doesn't necessarily follow that these would have killed them anytime soon though (or even would have been the likely cause of death in the long term.

rick_chasey

Stevo_666 said:

rick_chasey said:

So how does this exit strategy without testing work?

See my exit strategy above. Once we have a vaccine, testing isn't needed. There is no painless way out in the meantime.

IMO anything else isn't really an exit strategy, it's managing and keeping a lid on an on-going situation.

So to check, you are suggesting lockdown till the vaccine?

Longshot

rick_chasey said:

So how does this exit strategy without testing work?

Rick, you can argue the academics for ever. We all know that testing everyone would be great in order to allow a well planned exit strategy. It's not going to happen though so what do you suggest? We all stay locked down until a vaccine is discovered and distributed?

morstar

Testing is not the silver bullet. Testing AND early lockdown with contact tracing is where the best outcomes have been.

Rightly or wrongly, that horse has bolted. + Nobody has suggested no testing so it's disingenuous to suggest that strategy is being proposed.

https://theconversation.com/coronavirus-as-a-health-economist-im-not-convinced-the-case-for-mass-testing-stacks-up-135257

Jeremy.89

rjsterry said:

kingstongraham said:

rick_chasey said:

So how does this exit strategy without testing work?

Loads of olds die.

And quite a lot of not-olds, too. But it's OK because they have underlying health conditions. Obviously I'm being sarcastic, but this is slowly being equated with was-going-to-die-soon-anyway, as opposed to had-a-condition-that-with-management-would-have-minimal-impact.

Potentially they are conditions that would have been extremely problematic without the aid of modern medicine though.

A not insignificant number are dying with no previously diagnosed health conditions too.

It's basically just a censored sandwich all around.

Stevo_666

rick_chasey said:

Stevo_666 said:

rick_chasey said:

So how does this exit strategy without testing work?

See my exit strategy above. Once we have a vaccine, testing isn't needed. There is no painless way out in the meantime.

IMO anything else isn't really an exit strategy, it's managing and keeping a lid on an on-going situation.

So to check, you are suggesting lockdown till the vaccine?

No. I outlined in a post above some outline thoughts, but as mentioned I don't pretend to have all the answers.

Pross

49% of critical care beds in Wales are vacant and one third are in use by Covid patients. So it looks like we are thankfully some way from being over-whelmed. Ambulance arrivals at A&E are 20% down on normal, emergency admissions are similarly down. That can be seen as good as people aren't calling ambulances for relatively trivial matters and / or that people staying indoors is reducing accidents, it could also be a sign as discussed above that people aren't attending hospital when they should.

Hopefully going forward it will have made people reconsider whether they need to call an ambulance or even attend A&E with minor injuries but I suspect things will eventually go back to normal.

morstar

And you are totally ignoring the growing number of people who are through this (or not) who will start simply wanting to get on with life.
That is not a policy proposal by me, it is a simple fact. I am still trying to work out (like Wheelspinner) how I both engage with the world while trying to keep my family safe. I don't know the answer.

Anybody mentioned there isn't an easy solution? Stop pretending lots of testing is it. It f*cking well isn't unless we can do multiple hundreds of thousands per day and have a follow up mechanism that uses that data to direct benefit.

Stevo_666

Longshot said:

rick_chasey said:

So how does this exit strategy without testing work?

Rick, you can argue the academics for ever. We all know that testing everyone would be great in order to allow a well planned exit strategy. It's not going to happen though so what do you suggest? We all stay locked down until a vaccine is discovered and distributed?

Its a nice theory, but the practical issues have been mentioned by a few people above. As such it can only be part of the strategy of managing the spread until a vaccine is ready.