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What's the end game here? - Printable Version

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RE: What's the end game here? - Goose - 04-04-2020

(04-03-2020, 11:46 PM)BostonCard Wrote:  There are 10 million newly unemployed people who could be trained pretty quickly to do the legwork for contact tracing and testing.

BC

For sure, but it may be that most of these people aren't very suitable for this work. YMMV. However, whatever we are going to do we need to do it and do it yesterday. Not seeing any sign of it happening. County not hiring like mad. I don't know how many folks Santa Clara County would need for legwork. Assume for the sake of argument that we have to drop from our current 75 or so cases per day down to 10 cases a day before we go into track, trace mode. I would guess that somewhere between 100 and 500 people could for sure handle that type of load. However, I know nothing at all about how many people "conventional wisdom" requires for this contact tracing. Anybody here know?

RE: What's the end game here? - Mick - 04-04-2020

(04-03-2020, 11:46 PM)BostonCard Wrote:  There are 10 million newly unemployed people who could be trained pretty quickly to do the legwork for contact tracing and testing.

BC

And in two more weeks there will be 10 million more.  20 million idle folks looking for something to do.  Maybe they can help.
(04-04-2020, 10:11 AM)Mick Wrote:  
(04-03-2020, 11:46 PM)BostonCard Wrote:  There are 10 million newly unemployed people who could be trained pretty quickly to do the legwork for contact tracing and testing.

BC

And in two more weeks there will be 10 million more.  20 million idle folks looking for something to do.  Maybe they can help.

Actually, I'm fairly certain I'm low.  It will be more than 20 million idle folks.

RE: What's the end game here? - magnus - 04-04-2020

(04-04-2020, 09:09 AM)magnus Wrote:  In the Wapo article chronicling the white house's response to the novel coronavirus (that burger posted in another thread), the nugget i get out of that article...we have a (national?) tracking network for the flu.   Could that be expanded to track Covid-19?
Something like this?
[Tweet]https://twitter.com/CDCDirector/status/1246535264840945664?s=20[/tweet]

RE: What's the end game here? - dabigv13 - 04-04-2020

(04-04-2020, 09:13 AM)stupac2 Wrote:  
(04-04-2020, 07:08 AM)dabigv13 Wrote:  Been saying for weeks this is what's gonna happen, at least in places that have the capability. The "Survivors" (feel like there is a better name, keep thinking of that episode of Curb, but I can't figure it) get a special pass.

https://www.nytimes.com/2020/04/04/world/europe/italy-coronavirus-antibodies.html?action=click&module=Top%20Stories&pgtype=Homepage

My reaction is basically this paragraph:

Quote:That debate is in some ways ahead of the science. Researchers are uncertain, if hopeful, that antibodies in fact indicate immunity. But that has not stopped politicians from grasping at the idea as they come under increasing pressure to open economies and avoid inducing a widespread economic depression.

I guess it makes sense to plan ahead of time, but we don't know if antibodies actually grant immunity yet, and as someone pointed out via some twitter thread somewhere, even in relatively heavy-hit countries you need a damn good test to actually have confidence that the result is true (with incidence low enough you'll get more false positives than true positives even with >90% sensitivity).

If this virus behaves like almost all other viruses, antibodies will grant immunity, for an unsure duration of time but probably at least a good several months and likely a year or longer, with second exposures being much less severe once the immune system knows how to make the antibodies. I feel pretty comfortable with that assumption. 

A good serology test is required, true. I suspect we will be able to get a pretty decent test though considering how many different research groups around the world are working on this. Similar tests we can get spec and sens at 98 or 99%, so it's certainly feasible.

I think the logistics and the optics could sink it here in the US, but smaller areas or ones with less regard for liberty issues will likely pursue it.

RE: What's the end game here? - teejers1 - 04-04-2020

(04-04-2020, 04:21 PM)dabigv13 Wrote:  If this virus behaves like almost all other viruses, antibodies will grant immunity, for an unsure duration of time but probably at least a good several months and likely a year or longer, with second exposures being much less severe once the immune system knows how to make the antibodies. I feel pretty comfortable with that assumption. 

I've heard this almost uniformly (again, from my relatively limited following of articles and interviewees).  I don't understand why those raising specter of "second wave" are getting the run they do . . . unless the goal is fear-mongering.  And we certainly have enough of that going around.

RE: What's the end game here? - dabigv13 - 04-04-2020

A second wave is a different problem unrelated to the idea of non immunity after an infection.

A second wave would occur if social distancing measures are relaxed without any other sort of tracking/quarantining, because the population has no intrinsic immunity to this disease. So even if we distance for two months and transmission goes down a lot. There's still 90% of populace (this is a rough number and will be different in different areas,  but just know it will be a majority everywhere unless an area takes no precautions and lets virus spread without restriction) that hasn't caught it yet and remains susceptible until a vaccine.

RE: What's the end game here? - BostonCard - 04-04-2020

(04-04-2020, 04:30 PM)teejers1 Wrote:  
(04-04-2020, 04:21 PM)dabigv13 Wrote:  If this virus behaves like almost all other viruses, antibodies will grant immunity, for an unsure duration of time but probably at least a good several months and likely a year or longer, with second exposures being much less severe once the immune system knows how to make the antibodies. I feel pretty comfortable with that assumption. 

I've heard this almost uniformly (again, from my relatively limited following of articles and interviewees).  I don't understand why those raising specter of "second wave" are getting the run they do . . . unless the goal is fear-mongering.  And we certainly have enough of that going around.

Because only a small fraction of the population will have become infected. Most people will still be susceptible to coronavirus after the first wave is passed, and unless you maintain some amount of social distancing, the virus will quickly spread amongst the majority of the population that is still susceptible.

As a rough guide, with a virus that spreads this quickly, you need about 70 - 80% of the population to have been infected and recover for too many people to be immune for it to spread efficiently.  Even if you figure that the true caseload in New York, the city most affected by the virus is understated by a factor of 10, you are still talking about 1 million people with antibodies out of a metro area of about 11 million.  Which leaves 10 million people ripe for the picking if we let down our guard.

BC

RE: What's the end game here? - magnus - 04-04-2020

When asked about the return of packed stadiums to CA, Newsom replied:
"So look, I'm not here to second-guess anybody, but I am here to say this, our decision on that basis, at least here in the state of California, will be determined by the facts, will be determined by the health experts, will be determined by our capacity to meet this moment, bend the curve and have the appropriate community surveillance and testing to confidently determine whether that's appropriate. And right now I'm just focused on the immediate, but that's not something I anticipate happening in the next few months."

Here's hoping "appropriate community surveillance and testing" is what many on here have been pining for. 

https://www.espn.com/nba/story/_/id/28995745/sources-nba-espn-working-televising-h-o-r-s-e-competition

RE: What's the end game here? - chrisk - 04-04-2020

Epidemic control staff in China

http://www.ecns.cn/video/2020-03-03/detail-ifztzycc4786867.shtml

shows mostly temperature sensing, only a brief mention of QR codes at the end of the video

RE: What's the end game here? - OutsiderFan - 04-05-2020

Is there any proof SARS-CoV-2 will produce a wave? I’m not seeing any evidence any country has seen a true wave, without dramatic distancing. I get wanting to apply seasonality to this virus, but I see scant evidence warmer weather is stopping spread. I’m starting to entertain the idea this is more like a boiling pot of water. Take the lid of distancing off, and the virus steam comes out without containment. Put the lid of extreme distancing on and the steam of spread is contained.

Italy has slowed spread by shutting the country down, but even it is seeing maybe a 20% drop in new infections since its peak, and still staying around that number for a week now. China tried to open things up again, like its hoops league and movie theatres and ended up delaying the planned restart and closing them.

I’m all for there being a wave, or even waves, but is there any evidence anywhere that shows any evidence this particular virus recedes before coming back again? My observation demonstrates not a wave but a rising tide as a better metaphor for what is happening. I don’t see things slowing in Brazil. I don’t  see things slowing in SEC country. And we see that when distancing is relaxed, the virus comes back again. 

There just seems to be more evidence the waves are all about human action not the virus per se. And if this is the case, it raises profound questions for us, especially if we find the serology tests identify who has been exposed to the virus, but we learn the virus can spread from asymptomatic to those without immunity, like herpes or AIDS. I mean how does the virus all of a sudden start spreading when the distancing lid is taken off the pot of boiling water? We need the source of heat that enables the boiling of the virus’ easy transmissibility to be extinguished, and I don’t see anything to suggest what this is for the remainder of 2020 at minimum.

RE: What's the end game here? - OutsiderFan - 04-05-2020

Just happened upon this, that adds to the gravity of my last post in this thread. It does appear we are starting to see a higher overall mortality rate in the population in general, regardless of coronavirus, as a result of health care systems becoming overwhelmed by this pandemic.  This is precisely what we have been trying to avoid.

[tweet]https://twitter.com/J_CD_T/status/1245739661449977867[/tweet]

A roadmap to reopening - BostonCard - 04-06-2020

Since a number of people have asked, how we get to something approaching normalcy from our current situation, here's one fairly detailed roadmap, from the American Enterprise Institute:



https://www.aei.org/research-products/report/national-coronavirus-response-a-road-map-to-reopening/



Former FDA commissioner Scott Gotlieb is the lead author.



The TL;DR version is that there are four phases.



1) Slow the spread (as we are doing now)

2) Reopen, state by state (the trigger to moving to phase 2 is as follows):

3) Establish protection, then lift all restrictions (the trigger for moving to phase 3 is the development of a vaccine or therapy that significantly reduces the morbidity/mortality of the disease)

4) Rebuild Our Readiness for the Next Pandemic

My guess, if everything goes right, we can get to stage 2 by summer, stage 3 by next year, stage 4 should be ongoing (and at a minimum will take years).

BC

RE: A roadmap to reopening - magnus - 04-06-2020

https://thecardboard.org/board/showthread.php?tid=19255&pid=274603#pid274603

=p

Just giving you grief.  

To add something more useful to my post, looks like Massachusetts is taking steps towards enabling full fledged contract tracing. 

[Tweet]https://twitter.com/nataliexdean/status/1247329658288431104?s=20[/tweet]

RE: What's the end game here? - BostonCard - 04-07-2020

If effective contact tracing could be done in Africa during an Ebola epidemic, it can be done in the US. Yes, it is laborious, time consuming, and there are no magic bullets.  But the idea that it is "too hard" is ridiculous.

BC

RE: What's the end game here? - Goose - 04-07-2020

(04-07-2020, 07:40 AM)BostonCard Wrote:  If effective contact tracing could be done in Africa during an Ebola epidemic, it can be done in the US. Yes, it is laborious, time consuming, and there are no magic bullets.  But the idea that it is "too hard" is ridiculous.

BC
+1. I just hope we are getting ready to do so. Again, I don't see the evidence we are, but maybe it is just below my radar. USPHS deployed about 300 officers to Liberia during the outbreak there. They pretty much ran the effort in that country (as I understand it). Obviously there were lots of people trained by them doing most of the work. We know how to do this.

There are 3,142 counties (or equivalents) in the US. Probably many of the more rural ones don't need to do much about COVED-19, as a very small staff can handle it. However, the rest of the counties need to really step up their game. This is possible, but these counties need to act. Get the people, train the people, and get to it.

RE: A roadmap to reopening - burger - 04-07-2020

(04-06-2020, 11:21 PM)BostonCard Wrote:  1) Slow the spread (as we are doing now)
2) Reopen, state by state (the trigger to moving to phase 2 is as follows):
  • A sustained reduction in cases for at least 14 days,
  • Hospitals in the state are safely able to treat all patients requiring hospitalization without resorting to crisis standards of care,22
  • The state is able to test all people with COVID-19 symptoms, and
  • The state is able to conduct active monitoring of confirmed cases and their contacts.23
3) Establish protection, then lift all restrictions (the trigger for moving to phase 3 is the development of a vaccine or therapy that significantly reduces the morbidity/mortality of the disease)
4) Rebuild Our Readiness for the Next Pandemic

My guess, if everything goes right, we can get to stage 2 by summer, stage 3 by next year, stage 4 should be ongoing (and at a minimum will take years).
BC

Reopening after 2 weeks of reduction in cases is super ignorant.  There will still be tons of cases at that point and many asymptomatic ones that can spread the virus further.  It's highly likely that we'll get second outbreaks in that case.  Will their be public or political will to close things again or have more bailouts?  I don't know. 

Maybe by the fall numbers will be low enough that we can open things up again in many states.  A month from now, NY, CA, WA, etc. will look a lot better in terms of active cases.  So those states will be able to start pivoting to the contact tracing/testing/quarantine triad that needs to happen next (described well here https://www.nytimes.com/2020/04/07/opinion/coronavirus-smart-quarantine.html), even if they are not open for business yet.

A hitch is that the states are all about to go broke.  Tax revenue is plummeting and the states can't just run deficits.  The federal government is going to have to start shoveling tons of money at the states to implement the testing and contact tracing.  The feds could run the contact tracing and quarantine operation themselves, but since Trump et al. have shown zero leadership or even a hint of a plan so far, I don't think they're up to the task.  This is worrisome because some states have very little know-how or staffing left in their public health agencies: https://www.nytimes.com/2020/03/14/us/coronavirus-health-departments.html

Maybe a few well-run states and/or private organizations can come up with a detailed gameplan for implementing the contact tracing etc. so that it can be followed by everyone else.

RE: A roadmap to reopening - BostonCard - 04-07-2020

(04-07-2020, 09:25 AM)burger Wrote:  
(04-06-2020, 11:21 PM)BostonCard Wrote:  1) Slow the spread (as we are doing now)

2) Reopen, state by state (the trigger to moving to phase 2 is as follows):
  • A sustained reduction in cases for at least 14 days,
  • Hospitals in the state are safely able to treat all patients requiring hospitalization without resorting to crisis standards of care,22
  • The state is able to test all people with COVID-19 symptoms, and
  • The state is able to conduct active monitoring of confirmed cases and their contacts.23
3) Establish protection, then lift all restrictions (the trigger for moving to phase 3 is the development of a vaccine or therapy that significantly reduces the morbidity/mortality of the disease)

4) Rebuild Our Readiness for the Next Pandemic



My guess, if everything goes right, we can get to stage 2 by summer, stage 3 by next year, stage 4 should be ongoing (and at a minimum will take years).

BC



Reopening after 2 weeks of reduction in cases is super ignorant.  There will still be tons of cases at that point and many asymptomatic ones that can spread the virus further.  It's highly likely that we'll get second outbreaks in that case.  Will their be public or political will to close things again or have more bailouts?  I don't know. 


That's why all of the conditions have to be met.  The sustained reduction of cases has to be linked with hospitals being away from surge state, and the capability to test all people with symptoms, and to conduct active monitoring of cases and contacts.  Also, it is meant to be a partial reopening; lifting all restrictions wouldn't occur until protections can be established.  A sustained reduction in cases is necessary but not sufficient for reopening.

Also, I don't think the transition from 1 to 2 to be a discrete event.  While the reduction in cases is happening, the state will have to ramp up testing and tracking.  And I expect reopening to be done in a phased fashion.  For example, one can start increasing the exemptions to the shelter in place rule, while maintaining some restrictions.  Schools might be re-opened in a blended fashion, with students alternating between studying from home and going into a half-full school, to maintain more social distance.  If cases continue to decline then further restrictions can be lifted, while they can be re-tightened in response to surveillance showing a localized increase in cases.

BC

RE: A roadmap to reopening - burger - 04-07-2020

(04-07-2020, 09:52 AM)BostonCard Wrote:  That's why all of the conditions have to be met.  The sustained reduction of cases has to be linked with hospitals being away from surge state, and the capability to test all people with symptoms, and to conduct active monitoring of cases and contacts.  Also, it is meant to be a partial reopening; lifting all restrictions wouldn't occur until protections can be established.  A sustained reduction in cases is necessary but not sufficient for reopening.

Also, I don't think the transition from 1 to 2 to be a discrete event.  While the reduction in cases is happening, the state will have to ramp up testing and tracking.  And I expect reopening to be done in a phased fashion.  For example, one can start increasing the exemptions to the shelter in place rule, while maintaining some restrictions.  Schools might be re-opened in a blended fashion, with students alternating between studying from home and going into a half-full school, to maintain more social distance.  If cases continue to decline then further restrictions can be lifted, while they can be re-tightened in response to surveillance showing a localized increase in cases.

BC
My point (not well stated, I admit) was that 14 days of reduction in cases from the peak implies a very large number of cases in the community still.  That would seriously strain any testing/tracing regime, especially a newly implemented one.  Eventually we will have a lot of experience and expertise in tracing contacts and mitigating small outbreaks, but not at first.

I'd want to see at least a month or two of sustained declines in cases before we even start to open things up.  This article: https://fivethirtyeight.com/features/coronavirus-case-counts-are-meaningless/ makes a good case that the peak in the number of positive tests is a poor indicator of the timing of the peak of infections.  So, to be safe, lets wait a few extra weeks or even an extra month before opening things up again.  A few extra weeks of lockdown will be less costly, financially and socially, than having to shut everything again.

RE: A roadmap to reopening - Goose - 04-07-2020

(04-07-2020, 10:23 AM)burger Wrote:  A few extra weeks of lockdown will be less costly, financially and socially, than having to shut everything again.
It will be difficult to do a second lockdown, as many will say the first one failed so why do a second? If 30% or more of the population feels that way, a second lockdown will not be effective. People will just not comply, you can't arrest 30% of the population, and they will know it. We really don't want to mess up the progressive reopening.

RE: A roadmap to reopening - burger - 04-07-2020

(04-07-2020, 10:30 AM)Goose Wrote:  
(04-07-2020, 10:23 AM)burger Wrote:  A few extra weeks of lockdown will be less costly, financially and socially, than having to shut everything again.
It will be difficult to do a second lockdown, as many will say the first one failed so why do a second? If 30% or more of the population feels that way, a second lockdown will not be effective. People will just not comply, you can't arrest 30% of the population, and they will know it. We really don't want to mess up the progressive reopening.
I strongly agree.  There has not been any serious social unrest yet in the US (aside from isolated acts of "resistance" by churches etc.).  But I'd expect to see a lot more of that if people are free to resume their lives again and then are asked to quarantine for a second time.  I suspect most of us here would comply (it's still better than getting the virus!).  But young people, those skeptical about government overreach, etc. will be a harder sell.  And what about unemployed people who finally get to go back to work and then face losing their jobs _again_.  It would be a mess.

Let's get the number of cases way, way down and have a fantastic tracing/testing system in place before we open things up.