The probable reason why deaths are so slow to fall

[Kokeshi123]

(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

[mathanxiety]

I suspect that once the government gives in to calls to reopen the economy there will be a spike in cases and hospitals will soon be overwhelmed. Then we will see centralised quarantine and it will eventually be mandated. It will be put to the voters that this is the price for a functioning economy.

[Mintjulia]

In countries with decent human rights, the govt has to carry public opinion with them. People will not accept being separated from their families, their children.
Populations in Europe have mostly accepted lockdown as a short term necessary evil, but compulsory centralised quarantine would cause mass civil unrest, and a voluntary version might be accepted by 5%.
I would never accept being separated from my dcs and any attempt to inflict this woud send me on the run, risking us spreading the virus further.
So not practical

[mathanxiety]

People accepted long term quarantining for TB many decades ago. Patients sometimes spent years in sanatoria.

[LiesHumansTellThemselves]

There is quite simply a cost benefit analysis to be done.

In a modern western democracy we are likely to accept a higher number of deaths over a certain level of incursion into our rights. It isn't palatable to say that out loud but I believe that is the reality.

The US is a case in point, many of the protesters there value their freedom above theirs (and others lives). I (and most of the planet) recognise that there is a place between those two points.

I would be protesting in the streets if Australia tried anything approaching a Wuhan style lockdown. Luckily, they know better than that.

[Namenic]

I believe quarantining for tb still exists - and is covered by the law (but only if it is transmissible eg in the sputum)?

[Shitsgettingcrazy]

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

Who is paying for it in America? He says its good for low income families who have a lot of people in an apartment.

He also says its good for the hotels, that may go under. So someone is paying for it?

And who is paying for not only the hotel being used but it being deep cleaned after every visitor? And then a whole deep clean of corridors etc. And another when its no longer needed.

The main problem here is that you have probably already spread to your family before you have symptoms. Do you go off to a hotel, your family still get sick and one by one go to the hotel? That's not cheap. Not sure it will come at no cost to the users. Will medical insurance cover it? How many of the low income families have a decent health insurance?

How does it work for single parent families. Or families where both parents get it?

How does it work if you go then decide to go for a walk, while symptomatic? Then go back?

Who is paying for the medical staff on site?

What happens if you are too ill to call for help?

Obviously, if you want to quarentine away from your family, its nice to have the choice. But there's nothing in those tweets that suggest this will actually help reduce cases. Since you wouldn't be going until you already had been spreading it.

[SquashedFlyBiscuit]

Iguess if like Germany you went into hospital earlier (the nightigales... ) you would kn effect have centralized quarantine but under the guise of hospital care.

Im more likely to seek hospitsl help earlier (oxygen yay!) Than going to a random hotel to surround myself by others with virus....

[Knocksomesense]

@Kokeshi123 can I just add - I have a family member who teaches in Vietnam. Schools there have been closed since January and are showing no signs of opening up yet

[LemonTT]

Well of course we have compulsory quarantine in this country. All countries do as part of their public health provisions. We even used it as part of the uk response for repatriated Wuhan residents. And where people flaunt or breach laws on distancing and isolation. Someone was arrested and convicted for leaving home whilst knowingly being infected. But it is neither practical or socially acceptable at a mass level.

By all means keep quoting twitter feeds on how it is being used in America. Just take sometime to read the news reporters of people with guns protesting outside the state house in Michigan and invading the legislature.

Then consider how the families of NHS and care staff would feel to see their loved ones dragged out of their home. Or being told to live in a hotel. Think how the BMA would react. Then read the news reports on how many of these staff are voluntarily staying in hotels to avoid contact with their family. That’s before you say it could be voluntary not compulsory.

I am not sure that any reasonable person can build a contention based the hypothesis that the unreliable and discredited data shows that the curve came down quicker. We should believe the false data trend.

[Aridane]

Some thought provoking posts by OP.

Interesting how the world looked on with horror as Chinese authorities forcibly ‘dragged’ away the The Infected and how That Would Never Happen Here. And how now, perhaps somewhat wistfully, we now wonder if we might have adopted a s similar model...

[Aridane]

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.

Looks for nodding emoticon

[Kokeshi123]

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

(Ironically, I'm in a country with no lockdown, so no restrictions on being outside.... I stay well away from people and wear a mask, however!)

No, I do totally understand that I am coming across as a bit OTT on this matter. I have been banging on about this issue for a while, and when people bang on (and on!) about an issue, they do start to sound a bit like a stuck record (frankly, I am beginning to bore myself about this issue, let alone what I must be doing to other people....!)

However, the reason I keep saying the same thing is because the evidence is pretty strong and the stakes are really high. From everything I have seen, the refusal to consider out of home quarantine is going to cost a) a lot of lives and b) huge bleeding chunks of the UK (and other countries') economies.

The argument will shift on this one soon, just like it is currently shifting on masks, which were also being dismissed as "too Asian for us" a short while back. But a lot of lives and jobs will be lost unnecessarily while we are waiting for that.

[Shitsgettingcrazy]

The argument for masks, for the majority of peolle had nothing to do with 'too Asian for us'.

Masks generally don't help that much. There evince it actually makes it worse because peolle become complacent.

The wind, is changing for one reason. PR. Nicole Sturgeon gave some real non advice on wearing masks, because its what a very vocal part of the public want. Even though there's not much evidence either way.

Thats why she didn't make it compulsory. She said it so it looked good.

You have carers on TV with their masks pulled down to their chin. People wearing them in supermarkets touching them, pulling them down to talk, forgetting social distancing etc.

In 'Asian' countries where people wear them as usual, it doesn't improve infection rates of flu or respiratory infections.

Masks make some people feel safer. So they want other people to wear them.

Theres no solid evidence that masks will save lives. Or that it will improve things.

You arenr answering any points.

What about single parent families?
Or families where 2 parents get sick?
Who is paying for it in new York?
Will it actually benefit low income families?
Since you spread it before you have symptoms, how does this stop your family getting it?
If you can come and go as you please, while symptomtaic, how is that stopping the spread?
Who is paying for the medical staff at these hotels?

[TheProdigalKittensReturn]

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.

At least in China, what happened in at least one case was that the child died (a disabled teenager who was left on his own) because there was nobody around to take care of him, so he starved to death. Which is not really an example anyone sensible would wish to follow.

Totalitarian governments can and will do things that democracies can't or won't. By all means let's look at what every country has done and see what seems to be working, but "let's do what the Chinese government did" is rarely a good suggestion given the track record that government has in terms of complete lack of regard for human rights. I keep wondering if people making that suggestion (and assuming that whatever statistics the Chinese government publish about death and infection rates are reliable) are too young to remember the tanks rolling into Tiananmen Square.

Voluntary quarantine could be a good idea, and quarantining people arriving from abroad for a few weeks would make sense and probably be accepted with a bit of grumbling, but having the police or the army turn up and strongarm citizens into quarantine against their will is another matter entirely.

[Di11y]

I got symptoms and stayed in the bedroom. my DH slept elsewhere and I only left to use the bathroom. I can see how if you have a vulnerable family member and confirmed covid you might be interested in CQ.

[daisypond]

People will not accept being separated from their families, their children.
Of course people would accept that! They would not want their families or children to be infected! They did it in this country with a few groups returning from abroad. They were quarantined in hotels. I would think most sensible people would agree. Obviously for some groups, it would not work.

[TheProdigalKittensReturn]

Also the idea that involuntary quarantine is fine but people can't and won't accept being asked to wear masks is a bit odd. I'd think given the choice between the two most would opt for the latter, but OP seems to think that it would be the other way around. We're already in masks mandatory in certain places status where I am and the only real issue most people seem to have with it is sourcing the masks. It's a bit of a nuisance but you get used to it.

[TheDrsDocMartens]

A lot of medical staff have moved out of their houses temporarily.

[JudyCoolibar]

A populace willing to do it (not a snowballs chance in hell in the UK - just look at Lockdown!)

Why? We've actually been much more compliant with lockdown than was anticipated.

[SnuggyBuggy]

Where would we send people? Reading about people who ended up in hotels on lockdown it sounded really unpleasant.

[derxa]

Would you go OP?

[Fucket]

I was about suggest sanatoria but see it’s already been mentioned. People are making the assumption that we’ve never experienced a killer respiratory disease like covid 19. Sure the virus is new but it has many similarities to nasty viruses we’ve had to suffer throughout human history. We have become complacent through the advent of antibiotics and vaccines. In the old days hospitals had to be extremely clean and sterile, they would look at our wards in horror with windows bolted shut. Fresh air over virus harbouring air con. People suffering from respiratory disease need clean, airy environments preferably away from pollution. It would probably be better for staff too (air changes to get rid of the virus all around them). It would stop cross infection in hospitals if we could keep the corronavirus patients away from other patients.

My grandfather had TB, he spent over a decade in and out of the sanatorium. Funnily enough he didn’t want his wife and children to catch TB either. My grandmother may as well have been a single mother. Sure it was shit times in their household but at least no one else got sick.

Life has changed, we have passed a watershed we are going to have to put others before ourselves and think of personal sacrifice for the many over the self. If I got sick of course I’d go away until it was safe to return. We are not talking years, we are talking weeks. Children of single parents will have to be cared for in the community if no relatives can be found.

[nannieann]

Interesting and there are arguments in favour of a voluntary facility for out-of-home quarantine. It wouldn't work for all families however, and I can't see our UK government introducing anything compulsory. It might be particularly useful where people are living in larger households with several generations living together. This isn't generally the case in the UK, although it is the pattern in some communities.

[bumblingbovine49]

I would definitely go into quarantine if I was ill. As long as I could take all my stuff and as long as the quarantine areas have adequate medical oversight so that if I deteriorate I can get help/ oxygen quickly.

I agree that centralised quarantine would help a lot but I do think most people won't accept it in this country anyway

[SnuggyBuggy]

Would people really be willing to care for virus exposed children?