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The probable reason why deaths are so slow to fall

(102 Posts)
Kokeshi123 Thu 30-Apr-20 14:07:06

(In the UK, in Italy, in Spain, in France. In spite of harsh lockdowns)

As we all know, Wuhan (China) was the model. "We need a lockdown. Like they did in Wuhan! That's how they shut the virus down."

Except that in Wuhan, they did NOT only do lockdown.

They started off with the lockdown. But as it became clear that this would not be enough, the Chinese also added in centralized quarantine (or "out-of-home quarantine")

"Centralized quarantine" simply means, you find people who are infected and have them leave their own households and go and recover in a facility where they can't infect anyone (often a hotel or school that's not being used at the moment due to social distancing). That way, it's far less likely that they will infect the other people in their households.

Analysis of death rates in Wuhan, adding in the time lag for infections and the incubation period, are pretty clear: the lockdown was not enough. It was really the centralized quarantine that bent the curve.

In the UK, Italy, Spain and many other western countries, governments decided to hold lockdowns, inspired by Wuhan. The problem is, they have decided to ignore the other bit of the equation--the need to provide a safe quarantine place for infected people, so that other members of their families can stay safe.

By the time these countries held their lockdowns, the virus was already entrenched, meaning that a LOT of households already contained an infected person. When you then hold a lockdown, without removing those infected people, what you are literally doing is trapping infected people and uninfected people together in quite small spaces (households) and forcing the healthy people to breathe in a thick fog of virus that's being shed by the infected person. Hour after hour, day after day.

Guess what happens? The virus burns its way through households. The death rates remain stubbornly high, with the number of new infections sometimes even increasing a little for a while after the lockdown commences. Eventually, the virus will be left with nowhere to go after it has infected all family members that it was going to infect, and the number of deaths will start to fall. But my goodness, a lot of people will have died by this time. Hence those grim, grim figures we are seeing from several European countries, including the UK.

Household infections---and preventing them---should be our no. 1 focus, apart from containment in medical settings.

COVID19 spreads most easily when people are close together for prolonged periods of time. An infected person wandering around a not-particularly-crowded beach or park is extremely unlikely to infect anyone else there---the literature suggest that infections in outdoor environments are very rare. Infection is more likely in a school or workplace, where people are close together for longer periods. But the household trumps all. People living together spend long periods of time together, especially if lockdown means they have nowhere else to go. If someone is infected, the odds of other people catching COVID19 from them are very high. Worse still, the severity of the disease does appear to be linked with the size of the viral dose. People getting big doses of virus seem far more likely to come down with a severe case of COVID19, probably because the immune system is overwhelmed and does not have time to rally. People stuck at home with an infected person are exposed to huge amounts of the virus.

If the UK wants to come out of lockdown with any sort of economy left, it is absolutely crucial to get death rates and hospitalization figures down as quickly as possible through testing and centralized quarantine. There are lots of unused hotels and other facilities right now that can be used. Many industries like the hotel industry will need financial help at some point anyway. They can earn their assistance by helping out with quarantine right now. This is what is being done in other countries.

And just a plea but.... we might have got going on the centralized quarantine a bit earlier, if we had not wasted weeks on end being distracted by trivia. No, the continuing high numbers of new infections, deaths, hospitalizations are NOT being caused by people taking a dog for a walk twice a day, by people jogging, by kids scootering through a park, by people eating a sausage roll and an apple on a **ing bench. They are being caused because huge numbers of infected people have been left, by the governments, to spray huge doses of virus all day every day all over the rest of their families until those family members get sick as well, often much much sicker than the original infected person.

www.nytimes.com/2020/03/30/opinion/coronavirus-new-york-quarantine.html New York starts quarantine

www.washingtonpost.com/world/asia_pacific/being-sick-and-alone-is-miserable-being-sick-at-home-with-your-family-might-be-dangerous/2020/04/13/cfe63b32-744e-11ea-ad9b-254ec99993bc_story.html "Being sick and alone is miserable, being sick at home with your family might be dangerous"

twitter.com/nataliexdean/status/1250225520551346177 Data from Iceland shows how easily COVID19 spreads within households

www.nytimes.com/2020/04/24/world/europe/italy-coronavirus-home-isolation.html isolating the sick at home, Italy stores up family tragedies

www.theglobeandmail.com/world/article-out-of-home-quarantine-measures-in-china-helped-limit-spread-of/
Out-of-home quarantine’ measures in China helped limit spread of COVID-19, epidemiologists say

www.nytimes.com/2020/04/01/opinion/coronavirus-viral-dose.html It looks like dose matters a lot with COVID19

OP’s posts: |
Lumene Thu 30-Apr-20 14:22:48

There is no way that people in the U.K. are going to agree to leave their houses and go somewhere else to quarantine. How would this work with single parents? Would the state enforce removal of people’s children? Not going to happen.

Aside from that is there reliable data on how much of a difference it would make? How many household infections occur? Etc

I agree advertising measures such as hygiene, ventilation etc at home makes sense to minimise spread.

HorseRedArrow Thu 30-Apr-20 14:30:41

I’m confident government and scientists are fully aware of that. But China has a very different view of human rights and individual welfare. I just cannot see our society going along with this (what happens to the children of a single parent for example, what happens if the infected person is a child, or a vulnerable elderly person?!) or our government or police removing people and forcibly locking them up.

I also don’t believe any data or success stories or strategies coming out of China. Either they have a vaccine they’re not telling anyone about or (much more likely) it’s still smouldering away there.

imsooverthisdrama Thu 30-Apr-20 14:40:46

Hmm I do agree with some of what you have said . The death rate is not falling as quickly as we would like at this rate it's going to take a long time . I also would not believe china's data , I don't think they have been honest how long this virus has been around and how many have died .
I don't have a answer and I'm not going to disagree with your theory as it's interesting opinion.

Kokeshi123 Thu 30-Apr-20 14:50:06

Thanks for your thoughts! I just wanted to clarify one point: centralized quarantine does not have to mean compulsory quarantine. Just offering it as an option would be a huge step forward.

One thing we will need is for people to be given very clear information about viral load and transmission risk.

Because I think that a lot of people have been given the impression that if you are ever exposed to a wisp of virus you are guaranteed infection, and that all infections are equal. This brings the risk that people are going to say "Hmm, I know I've got a positive test result, but my family members have all been in a room with me several times, surely they're all going to get it anyway? Quarantine must be a waste of time now."

People need to be given straightforward but clear information: COVID19 tends to require prolonged contact before the risk of infection gets high; big viral doses appear to make serious disease more likely; if you agree to go into quarantine now, you can hopefully save your loved ones from infection, or make it more likely that they will only be slightly ill. Using terms like "out-of-home quarantine" (rather than "centralized quarantine") or even something quite different like "protective care" or whatever, might change people's mindsets.

It's not very long since we were being told that westerners would never accept lockdown (they have), would never wear masks (increasingly common across the west now), would be selfish and stockpile things (actually, very few people have genuinely engaged in stockpiling), would refuse to participate in social distancing.... In fact, the great majority of people in western countries have shown themselves to be very cooperative and civic minded. It looks to me like it's their governments that have let them down, rather than the other way round! Why not give this a try?

OP’s posts: |
Kokeshi123 Thu 30-Apr-20 14:51:41

Re China: I don't have much trust in Chinese data either, but other countries (most of which are not nightmarish regimes like the CCP) have been using CQ to stamp this wretched virus out. Vietnam, for example, has done an amazing job with COVID19, despite being only a middle-income country, and one that shares a long border with China no less. CQ has been a key part of their strategy. And that is just one example.

OP’s posts: |
Shitsgettingcrazy Thu 30-Apr-20 14:55:55

I just wanted to clarify one point: centralized quarantine does not have to mean compulsory quarantine. Just offering it as an option would be a huge step forward.

Total bullshit. If its an option most people won't go for it.

It was not an option in china.

And it seems numbers are on the rise again, in china.

Everyone knows their numbers are bullshit. It was milling around China for weeks before they locked down. Their low numbers, dont follow anyone else's pattern. If you look up to the point of their full lockdown.

That's either luck....or bullshit.

What is a with a small, but vocal part of society that are begging the government to take all our freedoms away?

Does be an adult scare you so much, you would rather someone else make all the decisions for you.

cantory Thu 30-Apr-20 14:56:02

I agree OP.
The other option is if you can self isolating in 1 room in your house as soon as you get any symptoms. Viral load does seem to play a large role so chances are family members will get it worse than you.

Northernsoullover Thu 30-Apr-20 14:59:23

Its interesting. I have been doing a little survey (from a safe distance) when I'm shopping. This has been done over a few weeks. In my local pharmacy, Boots, Lidl, M & S food and Sainsbury's staff have said not one member of staff has been taken ill with it.
I'm shitting myself doing my weekly shop and there they are fully exposed on an 8 hour shift. It would be interesting to find out where people have been infected.
My friend who had it is convinced she got it from a 40th birthday party in a steamy social club.
Another friend who is awaiting a test result is very ill and is likely to have picked it up from work where 2 people have already received a positive result.

Sarahandco Thu 30-Apr-20 15:02:12

But we saw the pictures of people being dragged from their homes to go to the central quarantine - were some of those people being condemned to death, if they were being quarantined with lots of other infected people?

It may be that it is the only way to bring this to a halt but people will not want to do that.

cantory Thu 30-Apr-20 15:10:19

@Northernsoullover Are they younger healthier people. Because I suspect younger healthier people who do get it will be more likely to have no symptoms.

Northernsoullover Thu 30-Apr-20 15:20:49

Cantory a complete mix of ages. I guess as time goes on we'll learn much more about transmission but until its safe to adapt behaviour I'm more than happy to keep taking precautions.

Jaxhog Thu 30-Apr-20 15:29:44

In order for this to work, you need :

1. Serious testing (or you won't catch everyone with it)
2. Central control over people's movement (we don't have this)
3. A populace willing to do it (not a snowballs chance in hell in the UK - just look at Lockdown!)

Lumene Thu 30-Apr-20 15:30:36

It's not very long since we were being told that westerners would never accept lockdown (they have), would never wear masks (increasingly common across the west now), would be selfish and stockpile things (actually, very few people have genuinely engaged in stockpiling), would refuse to participate in social distancing.... In fact, the great majority of people in western countries have shown themselves to be very cooperative and civic minded.

I never doubted the majority would do these things and was happy to. No way would I go to a central quarantine area and leave the rest of my household.

You could ask people to do it voluntarily I guess, and see if many would.

goingoverground Thu 30-Apr-20 15:31:44

The aim in Wuhan was containment and eradication, whereas the aim now worldwide is for mitigation, it's too late for eradication.

The government and scientists are well aware that lockdown will not prevent household transmission. It was accounted for in the Imperial model that the government based its current strategy on. Household quarantine largely prevents onward transmission outside the household, self isolation within the home reduces transmission within the household (and probably viral load) and shielding protects the most vulnerable.

Given that viral load has been observed to be highest just before symptoms appear, it is likely that transmission can occur before a person is symptomatic. Furthermore, many people are asymptomatic. Unless you are out testing people at home before they have symptoms, out of home isolation is not going to make a huge difference over effective self isolation at home.

I think that the real difference between Wuhan and the rest of the world is that lockdown was stricter.

Kokeshi123 Fri 01-May-20 03:23:08

But we saw the pictures of people being dragged from their homes to go to the central quarantine - were some of those people being condemned to death, if they were being quarantined with lots of other infected people?

You don't have to do it this way. You can just make voluntary quarantine available and encourage people to use it.

Other countries/municipalties are increasingly doing this.

Japan: www.japantimes.co.jp/news/2020/04/19/national/science-health/210000-hotel-rooms-secured-treat-coronavirus-patients/#.XquFSy09zoA

New York: twitter.com/MarkLevineNYC/status/1252668136110862337

Vietnam: www.wsj.com/articles/some-countries-are-squashing-the-coronavirus-curve-vietnam-is-one-11587989361?mod=e2tw

Taiwan: focustaiwan.tw/society/202003190024

There are many more cases.Please note the use of voluntary CQ in most cases, and the use of CQ in democratic countries.

More discussion here: www.vox.com/2020/4/28/21238456/centralized-isolation-coronavirus-hong-kong-korea

The British public HAS accepted lockdown--the great majority of people have followed the guidelines.

I think centralized quarantine will go the same way as masks appear to be going already:

A lot of time will be spent saying "Well, these are things that are inherent to Asian countries, and you can't expect westerners to agree with this."

The evidence will add up. More and more westerners in more and more countries will start to shift towards this position.

Leaders start to accept that unfortunately there is probably no long-term way out of lockdown that does not involve masks/CQ.

Official policy changes in western countries, and everyone braces themselves for a backlash/civil disobedience... which never happens.

Everyone gets used to the new situation and is relieved to see the pandemic situation improving as a result.

But at the same time, we all find ourselves looking backwards and wondering "How many deaths, and how much of that economically devastating lockdown, could have been avoided, if we had faced reality and started doing this sooner?"

There is probably no way long-term way out of lockdown that does not involve centralized quarantine (and masks)---if these things are not done, the UK and other countries will just be setting themselves up for a second waves. Even Singapore could not make things work without CQ and masks. They tried for a bit. They have now introduced both CQ and masks, after that scary second spike convinced them that this was pretty much the only way to go.

OP’s posts: |
Kokeshi123 Fri 01-May-20 03:28:18

And I confess to being somewhat baffled by the idea that "providing even VOLUNTARY centralized quarantine for a minority of people and merely ENCOURAGING people to use it" is somehow a greater threat to liberty than keeping an entire nation under house arrest, complete with police officers questioning people and ordering people back into their homes!

We need some serious discussion, especially given that other western polities such as American cities are now starting to do this.

Testing is finally being ramped up. But testing is not actually very useful if you are just sending positive cases back to shower their nearest and dearest with virus for 23 hours out of 24.

OP’s posts: |
Kokeshi123 Fri 01-May-20 03:30:40

It was not an option in china.

CQ is being adopted in American cities as well. See above.

OP’s posts: |
Thepigeonsarecoming Fri 01-May-20 03:33:32

@Kokeshi123 I mean this in the nicest way possible, but you need to get out more!

T0tallyFuckedUpFamily Fri 01-May-20 03:47:11

I mean this in the nicest way possible, but you need to get out more!

But only for exercise and essential shopping. 😁

Thepigeonsarecoming Fri 01-May-20 03:51:01

@T0tallyFuckedUpFamily of course!!! (Ice cream and wine)

Namenic Fri 01-May-20 04:07:25

the Most logical thing to do for centralized quarantine is to make it mandatory for people who enter the country from abroad. They have been away from their home anyway, so shouldn’t be too much of a problem to keep them in a certain room/flat for 14days. The number of people will be small at this time also.

It should also prevent people from higher infectivity areas (hard at the moment as uk is high on the league table - but maybe US ) spreading more.

0DimSumMum0 Fri 01-May-20 04:17:35

Namenic This is what should have happened from the beginning, mandatory quarantining positive cases entering the UK from overseas but I think it is a bit late now that it is widely circulating within the community.

StSaulOfSnacks Fri 01-May-20 04:54:59

Or China's numbers are totally unreliable..

Hopeisnotastrategy Fri 01-May-20 04:58:51

This has been under active consideration in Spain OP.
The autonomous regions have been asked to provide the government with a list of suitable premises and costs. ( Strangely enough, there are a lot of hotels in Spain standing empty at the moment).

english.elpais.com/spanish_news/2020-04-09/coronavirus-measures-in-spain-a-horizon-of-normality.html

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