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Covid

The probable reason why deaths are so slow to fall

101 replies

Kokeshi123 · 30/04/2020 14:07

(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 posts:
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Mynydd · 01/05/2020 07:49

If there was solid science to back up the fact that I was putting my family at risk by staying at home of course I would quarantine elsewhere. I'm not selfish. I am slightly anxious about both me and my husband falling very ill at around the same time and struggling to look after our 4 year old. If I could avoid that and leave one healthy adult at home I would.

I haven't heard about quarantine away from home but it makes sense. Sanatoriums existed for a reason I imagine. If there was some form of medical and practical help I could access if I needed it, and if it was completely voluntary I probably would quarantine away from the home. It would be an easier and safer proposition than trying to quarantine in my tiny house with 1 bathroom and a child who does not understand or respect the idea of a closed door!

I'm clearly in the minority. Why? Does it not sound vaguely sensible to anyone else?

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Mynydd · 01/05/2020 07:52

While I typed my essay some other posters agreed that it's not an insane idea! I'm a slow typer but glad I'm not alone!

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JacobReesMogadishu · 01/05/2020 08:05

How would this work with single parents

Not that they’d do it here but in China they took the adult and left and kids/pets at home to fend for themselves, even very young kids. My Chinese friend said she heard reports of neighbours pushing food through windows/doors with a long stick to make sure the kids had food.

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Biscuit0110 · 01/05/2020 08:06

You make a very sound point, and I for me definitely agree with you. China brutally stamped out coronavirus, and was able to do so because they have such tight control of the country. We did witness people being dragged away from their apartments on masse, with children screaming and I don't think those images will leave the western consciousness any time soon, as most considered the action to be ruthless and barbaric.

I agree it worked, and when you are trying to contain a virus on the rampage in a country the size of China it pays to make those hard choices, it was that or see the whole country capsize.

It could work in western society if the places were considered centres of recovery and were sold to the public as voluntary places to stay and be looked after to protect their own families, this would take much time and a huge PR effort. We are nearing the point of control now, so it is possible to consider how we can manage the virus during the second wave.

I do agree with your point about lockdown, lockdowns alone don't work especially well we can see that in the stats, they simply blunt the curve.

I would prefer to see a Swedish model emerge personally. Maybe that is wishful thinking on my part!!

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Biscuit0110 · 01/05/2020 08:06

*me - one

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AvalancheKit · 01/05/2020 08:10

@Kokeshi123

You have made your point and I agree with you on some of this, but if you keep posting many links exclusive to volume newspapers and Twitter then your message gradually gets weaker. Are you not able to rebalance your message by some scientific citations?

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MarshaBradyo · 01/05/2020 08:17

It is in homes that it’s most likely passed on. So it would help.

Not sure about whether it could happen, both people being able or wanting to do it, but also where would they go. The nicer the place the more takers I reckon.

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RevolutionofourTime · 01/05/2020 08:23

Hong Kong has centralised quarantine- anyone who tests positive remains in hospital until recovered. Their close contacts are sent to quarantine facilities (in hotels, holiday villages and housing estates).

The model has proved highly successful: there have been 1000 cases since the beginning of the pandemic and only 4 deaths. No new cases reported for nearly a week now.

If you compare cases per million population and deaths per million, the UK figures are 2,523 and 394.
HK figures: 125 and 0.5

No lock down, although schools have been closed since Chinese New Year. They are now planning to reopen in early June.

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Bananabixfloof · 01/05/2020 08:25

It could work in western society if the places were considered centres of recovery and were sold to the public as voluntary places to stay and be looked after to protect their own families

So a hospital then?

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totallyyesno · 01/05/2020 08:32

I read an article about the situation in Hong Kong and it sounded really well organized. I don't think we are actually in a position to organize anything like that! Also, I agree that it would probably save lives but at what cost? If I get it, I don't want to infect my kids but I also don't want them to be left on their own or with strangers. That brings its own dangers.

I do think that the UK should probably have implemented a proper lockdown though. As it stands, people are being encouraged to stay at home but a lot of people are still out which surely will just drag it out for longer.

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Sourcat · 01/05/2020 08:43

I'm in Austria, no centralized quarantine here, but the government acted early and decisively. Our numbers are low, deaths especially so, and we flattened the curve quickly.

The UK had weeks of forewarning and just dithered about.

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Mintychoc1 · 01/05/2020 08:51

sourcat the population density of Austria is a quarter of the population density of the UK. That is the crucial difference. We are too crowded here.

OP I must admit to finding it slightly galling being told what we should be doing by someone who isn’t even experiencing basic lockdown, never mind more draconian measures.

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totallyyesno · 01/05/2020 09:00

@Mintychoc1 the OP is questioning what Boris said not telling you personally what to do! I find it galling that the Boris supporters seemed determine that no lessons must be learnt from any other country unless that country has exactly the same population density, georgraphy and borders as the UK!

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ShanghaiDiva · 01/05/2020 09:01

My dh did two weeks quarantine in China. To answer a few questions:
You pay for the quarantine yourself
Young children can be quarantined together with parents
Tested on arrival and tested on day 13, then released following day
Twice daily temp checks
Quarantine was for due to arrival back in China and not due to any symptoms

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DodgyTrousers · 01/05/2020 09:05

Interesting what Chris Witty said at the briefing yesterday regarding comparing death rates between countries...

I'm inclined to believe chief medical advisers and scientific advisers.....


www.telegraph.co.uk/news/2020/04/30/uk-nowhere-near-end-coronavirus-epidemic-chief-medical-officer/

www.facebook.com/10downingstreet/videos/678737192960124/

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LangClegsInSpace · 01/05/2020 09:19

I completely agree OP. I have been saying this for weeks. WHO have been saying this since the beginning of January. This is still part of WHO's criteria for coming out of lockdown with minimum risk.

www.who.int/docs/default-source/coronaviruse/covid-strategy-update-14april2020.pdf

Lockdown does nothing in itself, it just buys us a bit of time to put in place effective measures. It's like the Little Dutch Boy staying all night with his finger in the dike to avert disaster. The villagers still had to come and mend it properly the next morning because the little boy could not stay there forever.

We need to find and isolate as many cases as we can. We also need to trace as many contacts as we can and quarantine them. And we need decent, early medical care for everyone with the virus so we can catch people before their symptoms take a nosedive on days 7-10.

Community isolation and community quarantine would be my preferred terms.

The Nightingales should not be empty, they should be refitted to care for people with milder symptoms, with some hotel capacity used for overflow.

The bulk of hotels, holiday parks, air bnb etc could be used for quarantining contacts, with regular medical checks and an easy route into medical care for those who become unwell.

The outrageous thing is that Chris Witty and Neil Ferguson KNOW all this. Here is what they did during the West African ebola crisis:

The UK government has decided to support another strategy: passive case-finding with community isolation. This is at the request of the government of Sierra Leone and endorsed by the World Health Organization. The strategy, also called voluntary sequestration, encourages those with suspected Ebola infection to gather in units where they can receive basic health care and avoid infecting members of their families and communities. By quickly isolating suspected cases (and boosting the proportion of such cases isolated early), this approach aims to keep people with Ebola from infecting others, until R is pulled below 1.

www.nature.com/news/infectious-disease-tough-choices-to-reduce-ebola-transmission-1.16298

Of course not everybody would be able to leave their household and of course some would refuse. Of course some cases will be missed and not all contacts will be traced.

We must not let the perfect be the enemy of the good.

The probable reason why deaths are so slow to fall
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HorseRedArrow · 01/05/2020 09:35

Hypothetical since I think we’ve already had it, but why is it even desirable for my whole household not to get it? Adds a few more to the immune herd doesn’t it? (Adults in family are low risk, and I’m comfortable that the risk to children is negligible.) It means it takes longer to get case numbers down, but only by a couple of weeks and why do the case numbers matter anyway. We’d be isolating at home so presumably very low risk to anyone else. Obviously very different if you live with someone shielding or vulnerable.

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LangClegsInSpace · 01/05/2020 09:38

Because herd immunity is bullshit.

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cantory · 01/05/2020 09:39

@horseredarmy You were lucky you had it mild. But no one knows long term impact. There was talk coming out of China about a possible impact on male fertility. For some it causes lung damage, Then covid toes. And plenty of people are still at home and classed as mild, but are very ill.

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Spikeyball · 01/05/2020 09:52

If my profoundly autistic teenage son with challenging behaviour got it where would he go to quarantine? If we got it who would care for him if we had to go into quarantine? We have already been told that if we had to go into hospital they would struggle to find carers for him.

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GailForceWarning · 01/05/2020 09:53

I agree OP but whilst there are posters banging on about opening schools in x weeks time unable to see they may be about to limit a whole populations long term health (including children and young adults because this is novel virus, with no known trajectory) for the sake of short term fiscal issues now, you won’t get them to volunteer to quarantine outside of the home in what will be described as “death camps” as people inevitably die in them. The Chinese had to drag people out of their houses 🤷‍♀️

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cantory · 01/05/2020 09:57

I am so upset that a lot more people will die unnecessarily and some will be left with long term health problems. We will be told this could not be foreseen and with benefit of hindsight.

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megletthesecond · 01/05/2020 10:15

I think more children would die and have life long MH issues if they were left to fend for themselves than if their ill parent stayed at home with them.

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LangClegsInSpace · 01/05/2020 10:16

There is scope within the coronavirus act to make testing and isolation compulsory:

www.legislation.gov.uk/ukpga/2020/7/schedule/21/part/2/enacted

I don't think that should be needed. I do think we should seriously be considering the overall strategy of finding and isolating cases, tracing and quarantining contacts because we know now what the alternatives are:

  1. long term lockdown conditions with the inevitable destruction of the economy and the massive toll on mental health.

  2. second wave (third? fourth? ...) of infection and deaths when we don't even know if long term immunity is a thing.
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LangClegsInSpace · 01/05/2020 10:17

Of course we wouldn't leave children to fend for themselves!

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