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

[fascinated]

In Germany one if the major pieces of advice is “air your home” . Why isn’t that mentioned here more? Simple measure.

[AlexisCarringtonColbyDexter]

(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!

This just invalidated your entire argument. What a ridiculous thread.

♟♟♟

[cantory]

@fascinated That is interesting thanks. I know when infectious diseases were more common in the UK people were big on airing their homes.

[Spikeyball]

So who would take care of the children when their parents are taken away to isolate. Do you think there are enough foster carers willing to take on children who are probably infected Including children with complex needs like mine.

[Shitsgettingcrazy]

You pay for the quarantine yourself
Young children can be quarantined together with parents

So not helping the poor in new York then, as the pps 'evidence' stated.

And this is the point. Theres so many holes in it.

If you are a single parents and go to this centralised quarentine areas. With your kids, you may well stay home. If both parents go, with their kids, they may as well stay home.

How are the low income families of new York affording this?

It actually sound like people are saying want hospitals to act as a quarentine. Maybe they could do that.

But, by the time you got there, you would have probably already spread it to your family.

And hospitals need to used....as hospitals.

[TheProdigalKittensReturn]

I don't see how we can possibly make good long range plans until we know for sure whether surviving the virus does confer immunity, and if it does how long that immunity lasts. The herd immunity plan was based on the assumption that surviving would confer lifelong immunity, or at least long term, but we don't actually know if that's true, and there have been a few cases that strongly suggest that it's not.

[fascinated]

We do a “Stossluftung” every day, even in winter. Open strategic windows and doors on opposite sides of house for about five mins to get a good draught through, then shut again.

I appreciate it’s not as easy in an older house that is harder to heat, but I take the approach that fresh air is crucial so I accept the loss of a small amount of warmer air. I don’t like a very warm house anyway and usually wear jumpers eg even now and over the last few weeks of sunny weather I have been generally still wearing a woollen sweater indoors.

[fascinated]

Good news, I think, on immunity:

www.thetimes.co.uk/past-six-days/2020-04-30/news/coronavirus-patients-cant-relapse-south-korean-scientists-believe-rkm8zm7d9

[Gatorgator]

What about if it’s a child?
No way would I wave my sick child off to a centralised facility on their own. It’s just not happening. My four year old? Nope. My eleven year old? Still nope. Horrendous.

[fascinated]

Obviously there would be exceptions. But those who could do it, could .

[TheProdigalKittensReturn]

That's hopeful, fascinated.

[fascinated]

I thought so! Need some good news! Watching for developments.

If no immunity was conferred... don’t know what we would do!

[derxa]

(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! This just invalidated your entire argument. What a ridiculous thread. Yes it is and really quite sinister

[LangClegsInSpace]

It is hopeful in the sense that it appears unlikely that the virus stays long term in the body like HIV. They are saying that people who recover, test negative then test positive again do not relapse because the fragments of retained virus RNA do not make them unwell or infectious to others.

This is not the same as antibodies giving long term immunity from reinfection. We still don't know that.

[TheProdigalKittensReturn]

Yeah I read the initial news about people being reinfected and was all, well, may as well hit the booze then!

[fascinated]

To whoever said about perfect being the enemy of the good ... it’s a bit like mask wearing, is it not? Ok, it might not always help but surely it can’t make things worse? The only objection I have seen is (very much simplifying) that you might make your own incubation of any early stage worse by trapping germs under it thereby creating a better environment for them... but that would surely only apply to people who already had it? My understanding is that you wear it to protect others? Right? So that shouldn’t matter. Or am I missing something?

[fascinated]

Ah, right. Thanks Lang. I wasn’t sure about that but I am no scientist or medic. Frazzled brain at the mo, too. Reading comprehension not optimum!

I thought I had read about antibody tests somewhere though?

[DanielleHirondelle]

Interesting thread!

I remember in the early days of CV we were advised that if a person in the house had/suspected had it, they should self isolate within the house. Use a different bathroom etc. I thought at the time that this would be unachievable for many people. For example not everyone has a 2nd bathroom (I don't) and the advice there was that the sick person uses the bathroom last and then thoroughly cleans it after. Again, in my view, not practical (the person is sick!).

So it seems sensible to provide the option or encouraging use of quarantine facilities. I think many people would consider this, though of course it wouldn't be possible for many either (e.g. single parent household). At least it would be another option to try to avoid everyone in the house getting ill.

[LangClegsInSpace]

Yes, people definitely develop antibodies but we don't know how long they last or whether people with mild symptoms develop enough of them for protection.

www.who.int/news-room/commentaries/detail/immunity-passports-in-the-context-of-covid-19

[Easilyanxious]

I think having a large population makes some thing's a little more difficult for us and by saying some could quarantine and some couldn't surely unless everyone does it , it's pointless
Regarding air isn't one of the things your told to do if have symptoms stay in rooms separate to your family with windows open ?? Who would work in these quarantine places ?our nurses and Drs are all quite busy in hospital .

[LangClegsInSpace]

I think having a large population makes some thing's a little more difficult for us and by saying some could quarantine and some couldn't surely unless everyone does it , it's pointless

No, it's not. The more cases we can find and isolate and the more contacts that can be traced and quarantined the better. But it doesn't have to be perfect to get R0 well below 1 and keep it there.

We don't have a particularly large population. Like most countries we have some very densely populated urban areas and some much more sparsely populated rural and semi-rural areas. London and Birmingham are nowhere near ready to effectively put such a system in place but areas like Cornwall, Lincolnshire and large parts of Wales, Scotland and Northern Ireland have few enough cases that they could consider moving out of lockdown fairly soon if these measures were in place.

Unfortunately our government seems wedded to the idea that any measures, and any easing of measures, must apply to the whole of the UK all at once, so the whole country is stuck with lockdown until London is under control.

For quarantined contacts and most isolated cases we don't need highly skilled doctors and nurses, just people who can check symptoms, refer when necessary and make sure people have what they need for self care.

[fascinated]

Well, I don’t want everyone from big cities coming to my rural home if lockdown in cities is lifted... and they would, you know they would...

[Derbygerbil]

I don’t see the point in extracting people from their families for quarantine as:

a) unless there are vulnerable shielding people within the family unit, in itself, this would only speed things up by a week or so, as if family members catch it from you they will get ill (unless asymptomatic) in 5 days or so.

b) the social issues of having to look after children would be enormous, and probably impossible, to manage... Attempting to do this would probably just increase transmission further as the children are quite likely to have already been infected by the parent.

[Kokeshi123]

This just invalidated your entire argument. What a ridiculous thread.

What a strange response. You do realize that even in the UK, people are allowed out for exercise and going to the shops?

The government here (note) has been very slow to issue any instructions about social distancing and lockdown is legally not possible here, but I and most of my friends have voluntarily socially distanced since March or earlier. No restaurants, cafes, or shops (except for essential shopping) and no meeting with other households.

Being outside however, is OK, as long as people socially distance. We (my kids and I) always go out for exercise every day in parks, the river bank and so on. We always keep away from other people, avoid touching surfaces, scour hands and wear masks. Not quite sure what we are doing wrong? Or are you one of those people who believes that people in flats should literally just stay within four walls for weeks or months on end? If so, I'm afraid we will have to disagree.

(note) I am in Japan, which has never issued any actual lockdown restrictions, not least because the state does not have the powers to do so. This should not make any difference to people's behavior, because people should voluntarily social distance right now, regardless of what the government is saying.

[Frangipanini]

I think our death rate will remain high whilst there are many cases of catching the virus because according to the news a few days ago, 95% of people who have died in England, had serious underlying issues. So, 5% didn't or not that they know of.

If you have many people hospitalised because catching Coronavirus has had a very bad effect on their already, life limiting illnesses, then of course it follows that the mortality rate could be quite high. These people may not be ventilated.

I've said it a few times on here and I still maintain it. We should not be asking why our death rate is so high. Instead we should be asking why so many people in the UK are unhealthy, overweight/ obese and have underlying conditions which has made them more more vulnerable to dying from this disease.