Covid-19 and purity spirals

[DreadPirateLuna]

Covid-19 is a very serious illness which threatens our most vulnerable and risks overwhelming the NHS. We should all do what we can to flatten the curve and save lives. People whose behaviour risks lives (e.g. urban residents traveling out to holiday homes in rural communities) should face criticism and sanctions.

However, I can't help feeling that some of the outrage at some behaviours is less about reducing the spread and more about getting caught in a "purity spiral".

Take all the outrage about people in parks. Fresh air and sunshine is good for physical and mental health, it improves the immune system which is particularly important during an epidemic! Many urban residents have no other source of open space except the local park. The ability to get outside can be lifesaving for victims of DV. Risks of contracting disease are very low if you keep your distance from others outside your household.

Yet I've seen photos of walkers and family groups in parks, keeping far away from others, but accused of selfishness and killing the elderly and disrespecting the NHS. Parks in London have been closed, meaning more congestion of other areas and residents confined to homes, which is damaging for reasons outlined above.

And it's usually (though not exclusively) women and esp mothers who get blamed. Those selfish Karens and their broods.

A more sensible solution would be to allow restricted access to the parks. Maybe allow only locals in nearby flats without gardens. But it seems we're not doing sensible these days.

I've challenged that wherever I've seen it appear - and not just icw this crisis. The same misunderstanding was rife during the London riots.

It's simply that people confuse and conflate MACA/MAC-P (terms they've probably never heard) with martial law. When the difference is pointed out, they readilymagree they mean MACA

They aren't stupid, just unaware of the difference between the terms.

MACA is quite an important part of the pandemic (and other catastrophe) plans.

Clearly you weren't on the AIBU thread that I was.

hooves Just fyi re: track, trace and contain- Singapore are no longer as successful with that
www.google.com/amp/s/www.bbc.co.uk/news/amp/world-asia-52232147

It is magical thinking. With a dash of god complex on top, thinking we can control nature.

It's not magical thinking at all.

I completely understand that this isn't going away. I don't think that we will get a vaccine in the next 18 months. The fastest vaccine ever developed took four years. No reason to believe that this will be any faster. I am completely realistic about that.

I am also realistic ( when many of you aren't) that widespread infection cannot be the plan. Within two months of this virus arriving in the UK they have had to put us into lockdown. Close everything. Spend billions of pounds, lose millions of jobs in order to not overwhelm the NHS yet we still have 1000+ deaths per day now. Good estimates look like only 10% of the population has developed antibodies. No one knows how long those antibodies will remain.

So think about it. Coming out of lockdown 90% won't be immune to this but there will be more cases in the community than there were in January, so, within two months we will be back to the point of overwhelming the NHS again, if they do nothing else to control the spread. They cannot spend billions again putting the country into lockdown. So, what do you suggest?

Do you think it should be left to run unabated? Let it overwhelm the NHS? What will you do with the very sick people? Just leave them at home to die without medical help? Maybe employ euthanasia squads to go and end the suffering quickly? Seriously, what do you think will happen? What do you think would have happened if they hadn't locked us down? Because that is what will happen a couple of months after we come out of lockdown.

The best solution bthat I've heard is to follow South Korea. They have plateaued cases but, yes are vigilant for the second wave. No reason to suspect that the can't control the second wave in the same way they did the first. They certainly haven't tanked their economy to control this.

The experts that I've heard have said that we had an opportunity on the way up to control it by testing, tracing and quarantine but we didn't. We have the same opportunity on the way down. That is the only way out. In order to do this though they have to reduce the number of infections to a low enough level for this to work. That is where my "follow the rules and this will end quicker" comes from. The quicker we get the numbers down to a level where test, track and trace can be implemented the quicker lockdown can end. That isn't magical thinking. They aren't going to ease lockdown while potential for infection is still high. How can they? They can't ease lockdown and then quickly get to the point where hospitals are in crisis and a thousand people a day are dying and do nothing about it can they? So the longer people bend the rules and go out for reasons that aren't allowed - Easter egg hunts, picnics, sunbathing, say in the park playing games with the kids because they don't like exercise, day long bike ride plus picnic, jogging with symptoms ( have seen all of these examples today of what people are planning to do on mn) then the longer lockdown continues simply because they can't ease lockdown and risk a thousand people buying every day only a few weeks later.

mpsw

Im happy to be told to google but do you have an idiots guide to the differences?

I went to my local park yesterday. Surprisingly empty. People in the distance walking. No sunbathers, picnickers, teenagers kicking a ball about. Just walking for exercise and getting some sun and fresh air at the same time. I live in SW London. I am pleasantly surprised how well my area is complying with everything. I thought there would be more flouting of rules.

The quicker we get the numbers down to a level where test, track and trace can be implemented the quicker lockdown can end. That isn't magical thinking. They aren't going to ease lockdown while potential for infection is still high.

You are disregarding how widespread the virus is in the U.K., and how woeful the testing is. Where are the tests? What is the plan?

Let’s look at the numbers. The official number of infected people in the U.K. is 78991 with deaths of 9875. But that gives a death rate of 12.5%, which is way too high.

Let’s look at South Korea. 214 died, number tested is 10512. This gives a death rate of 2% which is likely still an underestimate, but better than 12.5%.

Assuming that the U.K. death rate is actually about 2% that means that 78991 is a massive underestimate and the actual number of infected people is more like 493 693 (also likely an underestimate).

Broadly, social distancing helps, but the numbers are huge and given open borders, people still going out for shopping etc and people still at work they what you call the “potential for infection” will remain high till either most people get it or there’s a vaccine. It’s not going to go away unless everyone freezes in place for 3 weeks which is impossible.

You’re hinging your hopes on a comprehensive testing, tracing and quarantine plan that hasn’t happened. Are there plans for it now?

The problem isn’t people sunbathing in an empty park or children hunting for eggs.

That is why lockdown will continue - until the numbers drop sufficiently low. I literally said that in my post.

Yes, they have to be able to do widespread testing ( I said that in a post on this thread yesterday) they also have to develop the app to allow tracing. Apparently Germany is also doing this.

And yes I know the numbers of infections are higher which is why I said best guess is 10%.

You’re hinging your hopes on a comprehensive testing, tracing and quarantine plan that hasn’t happened. Are there plans for it now?

From what I've been reading, yes they are planning for it which is why I think they are refusing to be drawn on exit plans in the press conference.

You are suggesting that the answer is herd immunity - how? How will they prevent the NHS from getting overwhelmed whilst we achieve herd immunity? By locking us down like this repeatedly? Spending billions and billions every few months? Really?

And a vaccine is years away. The quickest vaccine ever developed took four years from start to finish. Usually they are ten plus years so why do you all suddenly think this vaccine will be 12 - 18 months? Are you proposing mass vaccination with an untested vaccine? Where they don't know the efficacy or the safety but just vaccinate the entire population? So, like the Dengue fever vaccine where it turned out that children who had it actually got a far worse case of dengue fever rather than getting immunity. Or thalidomide where they didn't realise the devastating effects until it was too late.

The best hope is to quarantine the disease and to try and develop drugs to make it less serious. That will come before a vaccine.

You are suggesting that the answer is herd immunity - how? How will they prevent the NHS from getting overwhelmed whilst we achieve herd immunity? By locking us down like this repeatedly? Spending billions and billions every few months? Really?

I don’t think you really understand. The virus is not going to stop infecting people just because you don’t want it to and because current life is untenable. Active infections will only reduce either when there is a vaccine or most people are immune. It’s not a question of “letting” or not “letting” the virus infect people, it’s just doing its thing. The numbers in the U.K. are unstoppable especially given some people’s daily movements (work) and people coming into the country.

From what I've been reading, yes they are planning for it which is why I think they are refusing to be drawn on exit plans in the press conference.

You have a lot of faith in your government which severely fucked up the initial response.

You say they are planning for widespread community testing. At present there are supposedly 68772 people with active infections in the U.K., but the death rate is too high by a factor of at least six so current number of the actively infected is more like 430 000. If every infected person has 3 household contacts and does nothing else that’s 1.3 million people at minimum who should be tested in the first instance. where are these tests?

Why are you so confident that all of the contacts will be picked up, given the stats suggest that only about 1/6th of the cases have been?

Given the sheer scope of these numbers is IS magical thinking to insist that people reaching for wine in their shopping is the reason the country can’t re open.

I don’t think you really understand. The virus is not going to stop infecting people just because you don’t want it to and because current life is untenable.

I understand perfectly well. Seeing as you understand it much better do explain how they can both let the infection spread but also keep the numbers below what the NHS can cope with, without resorting to the severe measures we are currently facing?

Why are you so confident that all of the contacts will be picked up, given the stats suggest that only about 1/6th of the cases have been?

Because they will have to implement measures currently being used in the countries that are doing extremely well with containing this.

I think the goal of any track and trace program is going to be keeping the numbers below what the NHS can cope with - not achieving and sustaining extremely low numbers of cases. Combined with at least some ongoing social distancing, probably on/off lockdowns (possibly regionally where cases exceed local capacity), ongoing household isolation, probably sustained shielding of the ultra vulnerable too.

There was a random testing study done in Iceland which found that half of those testing positing were asymptomatic. We're only currently testing those who are sick enough to need hospitalisation (a friend was taken to hospital and not kept in, told it was almost certainly C19, but even she wasn't tested). The number of real cases is vastly in excess of the quoted numbers. As a result, and combined with the number of people who need to still be out and about working even now, we're not going to get down to the very low rates that were achieved by thos countries who went hard core on track and trace when they only had a handful.

I understand perfectly well. Seeing as you understand it much better do explain how they can both let the infection spread but also keep the numbers below what the NHS can cope with, without resorting to the severe measures we are currently facing?

You mean like “flattening the curve”? The severe measures need to continue. For longer than you’d like. This is because the initial response was delayed and poor, not because people in rural areas are going for 2 walks a week.

Because they will have to implement measures currently being used in the countries that are doing extremely well with containing this.

Let me walk you through this. Counties that did well tested early and tested everyone. Through testing and contact tracing and quarantine they contained the spread In South Korea they identified the “super spreader” woman who infected lots of people (was it 160? Can’t remember). They tested everyone she’d been in contact with. They did drive through testing.

It’s too late for this in the U.K. There are too many cases, it’s uncontained, your testing rates per capita are low (even lower than the US who have been criticised for their low number) and there is an underestimate of active cases.

You say they will have to implement these measures of testing, contact tracing and quarantine but they didn’t, they aren’t testing enough even now. The numbers infected are huge now, likely at least 1/2 million. Do your public health workers know exactly where the clusters are? Do they know who to test when this (fantasy) wide scale testing you’re hoping for suddenly starts? Or will they test every single person, assuming a testing capacity that doesn’t exist?

Aside from the public health work force required to implement this there won’t be the numbers of tests required and not enough rapid antibody tests. It’s too late, the coronavirus genie is out of the bottle.

I know it’s shit.

The only way the UK could now do what South Korea did is if someone invented a time machine.

There was a random testing study done in Iceland which found that half of those testing positing were asymptomatic.

Yes, I think there is a similar study starting here? In Oxford?

Combined with at least some ongoing social distancing, probably on/off lockdowns (possibly regionally where cases exceed local capacity), ongoing household isolation, probably sustained shielding of the ultra vulnerable too.

I read a guardian headline today saying that in Europe the elderly may have to prepare for a year of self-isolation. Presumably that includes other ultra-vulnerable people as well. Things won’t be back to normal for a long time.

not enough rapid antibody tests

There aren’t any rapid antibody tests that work

They did drive through testing.

They have had this in the UK for weeks

You say they will have to implement these measures of testing, contact tracing and quarantine but they didn’t

They did. They did this for weeks until it became apparent that it was no longer effective.

There aren’t any rapid antibody tests that work

They’re either out or very close where I work in Australia.

They did. They did this for weeks until it became apparent that it was no longer effective.

Was that before or after they’d pursued the “let’s just wait for herd immunity” plan? Because if it was after it was too late. And if they were testing well, at least for a while, why is the U.K. testing per capita rate still so poor?

nolongersurprised

South Korea didn't just test that first woman and her contacts. They are continuing to do it because the spread continues. It wasn't a one off. It continues and they have successfully flattened the curve and are maintaining it but the infection has t disappeared, they are just successfully managing it.

And yes, once we have reduced the rate of infection down to a suitable level they can implement it here. As I said, we had a chance on the way up and there will be the same chance on the way down.

The UK, Europe and the US cannot use lockdown as a way of managing this. That is impossible. This will be on going until there is a vaccine - so for years. They can't put us into full lockdown every two months and so another way of doing this has to be found.

South Korea and Singapore's way is looking like the way to manage the curve whilst allowing the economy to run.

If they release lockdown, with no measures in place, we will be back right here in two months time. Then what? The NHS has stopped, other than to treat Covid and immediately life threatening conditions nothing else is being addressed, schools have stopped, the economy is non existent. They can't have that going on for a few years. Technology will be the answer.

I read a guardian headline today saying that in Europe the elderly may have to prepare for a year of self-isolation. Presumably that includes other ultra-vulnerable people as well.

This doesn't seem unrealistic tbh. This started here from a fairly small number of people bringing infection in from other countries. For contract tracing and testing to keep infection ultra low we would need the number of cases both in the community and coming in to be at that sort of level or lower - and the infected people to start with will be much harder to identify. Especially if the Icelandic stats are in the correct region (be interesting to see the Oxford one)

Even with an r0 thought to be below 1 during lockdown it would take a long time to get the levels this low. The relatively long incubation period doesn't help from that perspective.

Interesting thread, thanks.

As someone in the shielding group with suspected CV19, I agree that it seems likely that people like me will probably have to lead very limited lives for about a year - nothing else makes any sense. I know it sounds gloomy, but in my personal circumstances I would consider that a win. (I'm feeling much better, if it's of any comfort to any fellow shieldies out there).

Also, it's been really illuminating reading all your responses to the... erm... angrier posters, as it's helped me to clarify my feelings on the social media rants I see daily. I know I shouldn't look, but it's like picking a scab.

I feel that I went through the anger and denial stage really early, so I'm sitting in my smug bubble of acceptance watching everyone howl with rage. I sympathise, but I do hope everyone stops soon.

"For a start off, research is coming out now showing that two metres may well be insufficient and that coughing and sneezing propel the virus much much further than two metres."

This was done in a lab, not a real-life situation.

There is no way that I can live like this, shielded, for a year. No way.

I want to see my children, go to my daughter's graduation, see my parents, go to work, go outside, exercise, have the medical treatment that I need.

If my life, for the next year, is to live cloistered indoors isolated from family and friends then there is no point in being alive

Hooves I think you have found your limit. Everyone has one.

South Korea didn't just test that first woman and her contacts. They are continuing to do it because the spread continues. It wasn't a one off. It continues and they have successfully flattened the curve and are maintaining it but the infection has t disappeared, they are just successfully managing it.

And she wasn’t the first woman, I was just using her as an example of how thorough the early testing was.

If they release lockdown, with no measures in place, we will be back right here in two months time. Then what? The NHS has stopped, other than to treat Covid and immediately life threatening conditions nothing else is being addressed, schools have stopped, the economy is non existent. They can't have that going on for a few years. Technology will be the answer.

You are pinning your hopes on a non-specified treatment that hasn’t been identified or studied or tested and as such is wishful thinking.

You are also hoping that U.K. testing rates will somehow magically ramp up leading to the kind of public health response as engendered from South Korea and Singapore but that’s also wishful thinking. I’ve mentioned the discrepancy between the official numbers of infected versus the likely ones and other posters have pointed out that even that is unlikely an underestimate. The numbers are too high now.

The UK, Europe and the US cannot use lockdown as a way of managing this. That is impossible. This will be on going until there is a vaccine - so for years. They can't put us into full lockdown every two months and so another way of doing this has to be found.

Years of circulating coronavirus with intermittent peaks may not be unrealistic. I agree with statistically that on/off lockdowns with vulnerable people remaining in isolation may need to occur.

While there’s nothing wrong with hoping for a miracle treatment, or the disease curves to suddenly look like those of other countries (whose approaches have been completely different) they’re both unrealistic outcomes.

It all seems to be boiling down to They can't put us into full lockdown every two months and so another way of doing this has to be found.

There might not be another way for countries with high levels of community spread, open borders and ongoing community movement.

Hopefully there won’t be a second or third peak, hopefully there will be an early vaccine or amazing new therapy but there’s never been a COVID-19 pandemic before. It could well be shitty for a long time yet, so it’s reasonable to make mental preparations for that as well.