Couldn't we protect the vulnerable rather than close everything down?

[DoubleAction]

Couldn't we have a situation where those most at risk are isolated rather than restricting the movements of people who will likely recover well?

Obviously there would be difficult practical considerations but we're going to face plenty of those whatever action is taken.

This way we'd have heard immunity for when it crops up next time and the economy could be protected at least to some extent.

Herd!

That's actually the most sensible thing I've seen about this

i Agree

But the virus could mutate the longer it goes around, and get stronger. Viruses don't stay the same, that's why you get colds so often and people need flu jabs every year.

Great in theory, but problematic in practice. The biggest at risk group is the frail elderly. They need visits from care workers or relatives to help them at home. If those people have been freely socialising outside, they will bring the infection in with them.
The plan is to reduce all social contact across the board, not in any hope of stopping the virus, but rather to delay and spread it out over weeks or preferably months.
That way, hospital intensive care units will not be overwhelmed with thousands of cases all presenting in the same week.
We have a massive shortfall of ventilators across the country - my own hospital has only 4 ITU beds and a max of 20 ventilators if we borrow all the theatre ones. 10% of all Corona virus patients will need ITU. In my area, if even half the population all got ill at the same time, we would need over 3,000 ventilators. Do the maths!
Our only hope is to reduce social contact for everybody and spread the cases out over as long as possible.
Otherwise we will be In Italy’s position - having to deny ventilators to the frail and elderly to prioritise trying to save younger patients with more chance of recovery.

This would be my strategy. Let it rip through the general population now it’s here (although if they’d quarantined people coming back from Italy we would not be in this mess) while elderly people, their carers and people with underlying health conditions are given financial support to isolate themselves for the duration.

I have an underlying health condition so am locked in my flat until the risk falls significantly.

Yes. But how.
As a care home manager that also has kids and an elderly dependant at home should I and my staff self isolate with my service users at work?

You can tell the staff that then

It's unfortunately not just the elderly that need hospitalisation. In Italy lots of 40-50 year olds are intensive care!

Not as simple as it sounds
Vulnerable people is quite a big group (not always immediately obvious as to who they are) and they are often looked after by people who are in the wider population or even look after people in the wider population so we need to stop or at least slow wider population transmission to stop those people passing it on to them and protect them, also need to protect healthcare workers and the people who surround them so they can treat people , where do you draw the ring of isolation

It really difficult to strike the right balance
I'm a vulnerable person (immunosuppressed), DH is a hospital consultant so we have the awful risk that he comes in contact (there is a case in his hospital & they are expecting more) and passes to me, however he can't take time out (because he's part of the emergency response & they are already understaffed) to pick up the slack if I have to self isolate - we have two kids not old enough to look after themselves and I also look after my elderly mother who has dementia
His parents are busy looking out for elderly GM and are in risk group themselves so can't help.
Ironically the best thing about self isolation would be I would have enough time to concentrate on my job as I have my own practice and bar a few cancelled meetings everything can be done from home

Isn't the OP a little bit like saying 'it's mostly women who get raped, if we lock up all the women then they won't get raped. Problem solved!'

Also everything @Babdoc said.

But those most at risk rely on others for support (carers, pharmacies, HCPs, food deliveries, residential home staff) etc. They’re the ones who are least able to isolate themselves. So then we’d be looking at isolating the vulnerable and anyone who comes into contact with them. Some of those people are likely to low paid and feel unable not to work etc

Then there’s the fact that not everyone who’s most vulnerable will know it.

I need to go to the hospital frequently, does that mean that some hospitals from now on will only be for the vulnerable people? As are the trains and busses to get there? Will the hospital and public transport only be staffed by people in quarantine themselves? Is this even possible in practice?

Herd immunity develops from vaccination, not from large numbers of the population contracting a disease.

It's not really possible as the most vulnerable require care and we can't isolate the care workers can we?

Lots of "vulnerable" people are young, parents, workers, etc. Plenty of people with cancer, diabetes, etc are high risk, but are also very active members of society - still working, running businesses, looking after their children etc!. If you isolate a parent, how do you look after their children? If you isolate the self employed, who does their work, how do they survive financially. The thing is, not all "vulnerable" are elderly just sitting around all day not doing anything useful to society!

Isn’t it the case that many people need ventilators to recover?
There’s a shortage in Italy. What will it be like here in the nhs?

I'm vulnerable and work FT in a job I can't do from home. Until work say I can't come in or we close, I'm a bit stuck

I think that there’s a misconception about vulnerable people that conjures an image of elderly invalids already living largely in isolation from society. The reality is that you probably work with someone who is vulnerable, you commute next to them, your children go to school with theirs. They have jobs and partners and families that they can’t shut themselves away from.

Switzerland is one of the worst affected countries currently (on the face of it). Their strategy is precisely built around this: To protect the old and vulnerable.
This requires two things:

• Preventing the old and vulnerable from being infected
• Slowing the overall spread of the virus, so that the health system does not get overwhelmed, so that those vulnerable patients who do get infected, can get appropriate care.

The first means that anyone over the age of 65 has been advised to stay at home as much as possible, to avoid public transport, to not look after any children (hence schools remain open), and to avoid public gatherings. Visits to care homes have been restricted/cancelled.

The second means that any events with 1000+ people have been cancelled (since end of Feb), any events with 150+ people need special permission from the authorities, employers have been instructed to allow working from home and flexible working so that there is no 'rush-hour' on public transport as people can space themselves out, and in addition to hand-washing, there is a big 'distancing' campaign instructing people to stay apart physically e.g. when queueing.

The worst affected canton (bordering Italy) has further reaching measures including school and university closures (but not for the under-16s - see the point about protecting the elderly) and these are expected to be adopted nation-wide very soon.

I think Switzerland has a chance of making this work - especially given their extremely high density of doctors/intensive care beds per population. There are problems of course - e.g. how to protect those vulnerable people who require close contact with carers, you can't just tell them to 'stay at home' - but it is a fight worth fighting.

But here in the UK I have my doubts. I don't think it will be possible to really 'protect' the vulnerable as everything is already at breaking point as is. The government has shown little desire to put measures into place that would slow the spread. So the likelihood is that the NHS - starting from a strained place already - will quickly be overwhelmed. I think perhaps after 10 years of austerity, this was a foregone conclusion and even best efforts wouldn't have changed that massively.

So instead of trying, as the Swiss are doing, to do everything to protect the vulnerable, in particular by making sure the health system doesn't get overwhelmed, so that the over-65s who do end up needing hospitalisation and ventilation, will get the appropriate care - instead of that, it seems to me that the UK has resigned itself to the fact that the three wise men principle will become necessary. They can't prevent the NHS from becoming overwhelmed. So there will be a big individual and economic cost, direct from the coronavirus. So why create additional economic pressures by attempting 'lockdown' measures that are not going to change the fact that the system will become overwhelmed? Best get it over with quickly and save resources for re-building afterwards (mitigating economic effects).

So what to do? I don't think any of us can really make much difference to the speed and extent of spread, in absence of decisive advice/instruction from the government and/or all big employers. What we can do is affect the likelihood of becoming infected ourselves, and we can do things to keep our vulnerable loved ones safe.

I think a lot of the most vulnerable are already effectively self isolating.

The biggest problem with the OPs suggestion is it would require rolling back years and years of not giving a toss about the vulnerable, and resurrecting the infrastructure to deliver it.

Getting the virus this year won't protect against anyone if it comes back. It's a virus. They mutate. Why did you think we need a new flu jab every year?

"Won't protect...anyone" Bad editing on my part

Restricting movement isn’t to prevent people catching it, it is to slow the rate of new infections such that the health services aren’t overcome and tough decisions about which of the 2 or 3 very deserving patients that need to be ventilated and which are going to be allowed to die.
Have you seen the ‘flatten the curve’ pics on social media. That’s what it is about. If you slow the rate of new infections then all may stay manageable. If not, it won’t.

@Purplewithred don't be ridiculous of course you can't relate COVID-19 to a rapist. Rapists actively choose to rape, the Coronavirus is a virus.