Ask HN: What happens next after a successful lockdown?

[martokus]

Optimistic scenario - lockdown everywhere is a success and after a month there're single cases here and there, maybe even 0 cases. Would countries resume travel and ease gathering restriction before a vaccine has been invented? Or we can expect to be in a lockdown for 12-14 months until a vaccine comes to market, if it comes to market?

[adaisadais]

I remember all of the statistical problems centered around virality that we would have to do in college. The problems always seemed so make-believe and dystopian.

Now my company is close to going out of business and I have just been laid off. Partly due to high-ranking officials not believing in the virality of nCov-19.

I can't get W.B. Yeats "The Second Coming" from 1919 out of my head:

"Turning and turning in the widening gyre The falcon cannot hear the falconer; Things fall apart; the centre cannot hold; Mere anarchy is loosed upon the world, The blood-dimmed tide is loosed, and everywhere The ceremony of innocence is drowned; The best lack all conviction, while the worst Are full of passionate intensity.

Surely some revelation is at hand; Surely the Second Coming is at hand. The Second Coming! Hardly are those words out When a vast image out of Spiritus Mundi Troubles my sight: a waste of desert sand; A shape with lion body and the head of a man, A gaze blank and pitiless as the sun, Is moving its slow thighs, while all about it Wind shadows of the indignant desert birds.

The darkness drops again but now I know That twenty centuries of stony sleep Were vexed to nightmare by a rocking cradle, And what rough beast, its hour come round at last, Slouches towards Bethlehem to be born?"

[8bitsrule]

Yeats, hunh? No; give me Omar

The Moving Finger writes; and, having writ,

Moves on: nor all your Piety nor Wit

Shall lure it back to cancel half a Line,

Nor all your Tears wash out a Word of it

[diN0bot]

i like your comments. send me a note if you're looking for support in your job search. details in profile.

[kidsil]

Do not go gentle into that good night.

Rage, rage against the dying of the light.

[naushniki]

Thank you for quoting poetry in a context. And good luck with employment!

[aqme28]

I thought this interview was illuminating for post-lockdown life in China https://twitter.com/MikeIsaac/status/1238604080571772928?s=2...

It shows just how far behind we are.

TLDW: Temperature checks everywhere. Fever clinics optimized for quarantining the potentially infected.

China is trying to actually contain the virus. The only way out for us unless we significantly ramp up testing and lockdown is to admit defeat and simply optimize for slowing down the onslaught.

[smacktoward]

> The only way out for us unless we significantly ramp up testing and lockdown is to admit defeat and simply optimize for slowing down the onslaught.

This has already happened. “Flatten the curve” takes it as written that most people will be exposed to the virus, and thus aims instead to just spread those exposures over a long enough period to avoid overwhelming the health care system.

[smoyer]

I saw a statistical analysis of the flatten the curve idea but assuming we couldn't ramp up the number of intensive care beds, it took 3600 days to fit everyone in under the "available health care" line.

It's still a good strategy for right now because it gives us some extra time to ramp testing and healthcare up.

[samatman]

The more optimistic way of looking at this is: the 'flatten the curve' scenario has to get so close to R0 < 1, that we may as well put in a bit of extra effort to actually get R0 < 1, like China did. At which point the virus will start to isolate in pools and eventually be extinguished.

This is difficult, not impossible. We'll see what actually happens.

[neuronic]

Looking at the people happily strolling around and gathering in public cafes as if nothing was going on, I severely doubt it. (large city in Germany btw)

[asdfasgasdgasdg]

They will get with the program once one or two people they know die.

[Touche]

Those Darwin award winners will be the first to get it.

[mirimir]

Maybe in some countries. But it's a big world.

[phkahler]

If it's drawn out slow enough, the spread should nearly stop without lockdown once 20-25 percent of the population has recovered. Assuming prior infection offers immunity of course.

[fuckknows]

I think it's a pretty safe prior to have that our immune system will work effectively against this virus post exposure. This isn't the first time a virus has crossed the species barrier in all of our evolutionary history and we've survived so far.

[shock]

I don't know we can count on that at this stage: https://thehill.com/changing-america/well-being/prevention-c...

[Engineering-MD]

Why do you get 25%? I thought it largely depended on the R0 value

[Misdicorl]

Assuming immunity in the recovered population, R0(25% immune) = 0.75R0(~0% immune)

[tonystubblebine]

Was this the article you were reading with the 3600 days analysis? I just read it. Not sure what to make of it yet.

https://medium.com/@joschabach/flattening-the-curve-is-a-dea...

[makomk]

The "Containment works" part seems questionable. In particular, South Korea almost certainly wasn't "tracking its first 30 cases very well, until patient 31 infected over 1000 others on a church congregation". Patient 31 didn't have any known source of exposure - she hadn't travelled abroad or had any contact with known cases, didn't even meet South Korea's criteria for testing, the most likely place she got Covid-19 is from the congregation. There was an entire thousand-person cluster that had slipped through the net and only got spotted because one person happened to get in a car accident and the doctors tested her on a hunch despite not meeting their testing criteria.

If things had gone slightly differently, it's entirely possible that we'd be pointing at Italy as an example of successful containment that South Korea should have followed. They tested and contact-traced and thought they were doing quite well for the first 30 or so cases too, but reality hit them once it was far too late to do anything.

[roenxi]

A very important part of the public discourse is how many tests can conducted and at what cost.

For something with a long incubation period and potentially mild symptoms (ie, infected might not go to a hospital) only widespread statistical sampling will give a reliable picture of what is happening.

When I heard countries talking about 'testing criteria' that involved travel - I think this was in mid/late February - it seemed inevitable that things were going to drift out of control. There was no way that would pick up the mild inbound cases that could spread to become clusters. It probably developed that way because actual monitoring programs were infeasible but it'd be nice to know.

[ArnoVW]

It is my understanding that the church is sort of a cult, and it's followers hide their membership.

This illustrates the challenge with tracing approaches: if people are not open, or not sufficiently aware of the consequences of their actions, it's very easy to miss infections.

[JamesBarney]

Many countries seemed to operate with the assumption community spread wasn't happening. And due to this assumption didn't test for community spread.

[smoyer]

That is the article ... I don't think it had the "My back-of-the-envelope calculation is not a proper simulation, or a good model of what’s going on either. Don’t cite it as such" part at the bottom when I read it a couple days ago though.

[netsharc]

Yeah, I noticed the flatten the curve graphs have a horizontal line about "available beds". It probably also represents available healthcare workers, equipment, etc. Surely this line can be made to move. E.g. when China sent a plane with doctors and equipment to Italy. Or simpler, find suitable buildings and make hospitals out of them (easier said than done, obviously).

[rtkwe]

The issue is the people who need to be hospitalized in the worst cases go on to require ventilation to force air into their lungs and those machines have a limited supply. On top of that people on ventilation require pretty close observation so you need about 3:1 patient to nurse ratio. Those are the numbers that are hardest to increase rapidly, nurses and ventilator equipment.

[jodrellblank]

I heard a radio program about the life of a UK (I think) surgeon who worked in war zones and crisis regions like Syria, and one thing he found in a hospital was an intensive care unit staffed mostly by Skype cameras to a hospital in Washington, so the very few nurses on site could be directed to the patients most in need, and the remote nurses could watch the vital signs of many patients without having to spend time walking around.

If that was long enough ago to become part of a biography, it must be even more possible these days to get cameras and connectivity to remote hospitals anywhere on Earth with spare capacity of nurses.

[treis]

I seem to post this everywhere, but the flatten the curve math doesn't work. There's very little excess capacity in the system and in a scenario where half the country is infect about 1% of people would get care. Even if we perfectly flattened it over the rest of the year.

[netsharc]

Assuming the curve represents the amount of people needing hospitalization; realistically, right now, even flattened, the peak will go above that capacity limit line, and everything inside the curve but above that line are the people who need the hospital but won't get it, so... dead people?

But hey, without the flattening, the number of dead will be a shitton, and they will come fast. Probably causing social panic. With the flattening (but still not enough capacity), there will be a few deaths a day but no "Holy fuck a whole Titanic's worth of people died today"...

[rtkwe]

The actual required time is probably much lower than that. Not everyone who gets the virus needs critical care so what we have to do is keep those numbers below the healthcare capacity line.

[dharmab]

Presumably not everyone needs a hospital bed. Most are fine to take a few days of bed rest, many who would normally be hospitalized out of caution can be cared for by family at home with teledoc guidance, it's a small percentage at high risk who need hospital care.

[smoyer]

Yes ... it used the current percentage of those who get it and require hospital stays and those who need the IC along with the average number of days that they stay. Unfortunately, 70% of our capacity was full before the Coronavirus arrived so there's simply not that much capacity.

[aqme28]

About 10-20% of people need a hospital bed and we have concurrent beds for about a hundredth of that.

[bosie]

a small percentage of a large number is still a large number. 80% infected within 1 year and ~10% of those require hospitalization. usa: 350m => 80% is 280M => ~30 million hospital/ICU beds for 2-4 weeks. this is on top of regular/ongoing hospitalisation. hence it hitting any african country or india with the same force would be devastating.

[markhahn]

much less than 10% require hospitalization, though.

[DoofusOfDeath]

How would that analysis change if we (optimistically) assume that in 2 years, we have a vaccine that's 90% effective?

I would assume that under that scenario, the backlog would disappear shortly after the 2-year mark.

[jopsen]

We'll have vaccine within the 3600 days -- I hope :)

[simonh]

The UK government is revising its plan. A new simulation estimates that if we allow enough transmission to achieve herd immunity, it would cost about 260,000 lives. That’s not acceptable and would massively overwhelm health services. So it looks like we’re going to go for a strict lockdown strategy, but the problem with that is without a vaccine there’s no way out. If you relax the lockdown, you just get another outbreak. The best you can do is dynamic lockdowns per city or region.

[lozenge]

If anybody is interested - report 9 here https://www.imperial.ac.uk/mrc-global-infectious-disease-ana...

[agumonkey]

a globalized MOOC on over-capacitated system DDoS

[haunter]

Or just watch this video https://www.youtube.com/watch?v=YfsdJGj3-jM

[physicles]

I live in Beijing and came back early Feb after the new year holiday. We’re doing all that stuff too, even the single use tissue in the elevators.

The day after I got back we found out we had a case of covid-19 in our apartment block, so we were one of the first to get restricted entry/exit — each unit gets 2 cards and you have to present it when you enter or leave through the single open gate. I did 2 weeks going outside just twice to buy food, then slowly relaxed a bit. Many of my chinese friends are still basically not going out at all.

Now’s an exciting time for China because we’re at basically zero new cases in the country (had 4 new ones in Hubei yesterday, the rest were all retournees from outside the country). So since yesterday, it’s mandatory hotel quarantine for everyone who enters the country.

Really getting worried for my family and friends in the states though. Gonna have some long talks about how to prepare.

[markhahn]

It's not clear to me whether the no-new-cases in China is real, temporary or biased sampling. Lockdown is a temporary measure to prevent any new infections is betting that something will change (vaccine, season-related drop in R0). It can't go on forever without destroying the economy. Do you think it's reasonable to trust reports of no new cases? Is the sense that is just "no new symptomatic cases that get reported officially", or really none? I find it difficult to believe that there can be no new cases in a vast country where almost everyone is susceptible, but perhaps I underestimate the degree of lockdown.

[ekidd]

This is a really interesting video. I'm not sure how accurately it represents the situation on the ground in China, of course. But the video shows a society with temperature checks at every place of business, a location-tracking system, an isolation system, and a number of other precautions.

It's a picture of a society on a war footing, certainly. But people aren't locked in their apartments, and the hospital system isn't collapsing under its own weight.

So far, this is the most optimistic answer I've seen to "What comes after total lockdown but before a vaccine?"

[prewett]

People actually were locked in their apartment compounds for about a month, at least in Beijing.

[lokedhs]

Singapore is doing the same. At first I thought their response was a bit excessive with the temperature checks in every office building, etc

However, even though the borders are now heavily restricted, inside the country most things goes on as normal. There are fewer people out, but I'm still having trouble finding parking at the mall for example.

Of course this may not last, and at some point we might see a huge increase in the number of cases, but the total daily new cases has been low until now.

I'd take that an indicator that the strategy works, at least as a tool to slow down the spread.

[Bombthecat]

So, the uk approach? Let god sort them out?

[kordlessagain]

Sorry, I have to go get tea.

[duxup]

The total lockdown system seems almost untenable as it is.

Let's say China has managed to isolate the virus to some pockets... that means the rest of China is not exposed and vulnerable for who knows how long.

The sheer amount of effort to prevent what seems like the inevitable might be wasted effort.

That's not to dismiss the casualties or the impact of a widespread outbreak or the desire to SLOW it. But man do you spend forever and all that effort isolating A from B & C ... and then B from A ... until there are huge amounts of vaccine available (late fall?)

[kstenerud]

It's your typical pandemic response:

- denial

- placating measures

- minor lockdowns

- major lockdowns and panic (running to the store to stockpile toilet paper, for some reason)

- total quarantine

- life slowly returns to normal

China is now on the final stage (restaurants and stores reopening, etc), with the rest of the world between 2 and 3 months behind.

Most people are unable to comprehend exponential growth, so this is the pattern that gets followed.

[grawprog]

>It's your typical pandemic response: - denial

- placating measures

- minor lockdowns

- major lockdowns and panic (running to the store to stockpile toilet paper, for some reason)

- total quarantine

- life slowly returns to normal

When in the last 100 years has this happened that you're basing your 'typical pandemic response' examples on?

It certainly hasn't happened in my lifetime...

[dijit]

Depends where you are in the world.

H1N1, SARS and Ebola are in recent memory, but they didn't reach my neck of the woods.

[MiroF]

H1N1 was not the same, at least. And SARS wasn't pandemic

[asix66]

And those who don't understand, or need a refresher on, exponential growth should watch this great video by 3Blue1Brown.

Exponential growth and epidemics:

https://www.youtube.com/watch?v=Kas0tIxDvrg

[voxadam]

While not specifically about the exponential growth of pandemics I've always liked the lecture "Exponential Growth, Population and Energy" by Dr. Albert Bartlett.

https://youtu.be/kZA9Hnp3aV4

[mirimir]

> - major lockdowns and panic (running to the store to stockpile toilet paper, for some reason)

Americans use lots of toilet paper.

[falcor84]

To save others like myself the time, here are some figures corroborating this on statista: https://www.statista.com/chart/15676/cmo-toilet-paper-consum...

[mirimir]

Thanks. Didn't know it was that bad.

I also suspect that most US consumer toilet paper is fluffier than the non US norm, with far fewer sheets per roll. So the 90g per roll conversion is misleading.

My favorite institutional style paper comes in 1000 sheet rolls, which weigh 187g. The consumer brand that I recently bought comes in 220 sheet rolls, which weigh 106g.

[cmurf]

It's not clear anyone avoids a second wave. Nor do we know how significant it could be.

We don't know about natural immunity duration, or if and when there's a vaccine, and for how long it will be effective. We don't know about mutations.

I think a lot of the questions are only answered 2 years from now.

[drstewart]

Total quarantine isn't happening in any western country

[drclau]

That is not correct for some days now. Many other countries in EU have entered a state of emergency with various levels of quarantine at national level: Italy (but that's old news), Spain, France, Belgium, Estonia etc. None as extreme as China, but measures are intensifying gradually.

In Czech Republic, only essential businesses are allowed to function, although the measures are not as extreme as they were in China. Restaurants are closed, or serve food only for takeaway, shopping centers are pretty much deserted, gatherings in large numbers are banned. Although, the quarantine is far from total: people still go outside, and parks are very crowded (some look like superspreaders congresses - that is, lots of kids playing), and surprisingly we are allowed to go to work, regardless of the type of business. In my opinion, this is allowed because doing otherwise would have significant economic costs, and so far it's hard to justify it: there are just 300+ confirmed cases in CZ. Of course, there will be plenty more unidentified cases, and the sh*t will hit the fan. It's just a matter of time.

[tartuffe]

As of tonight in France, the governement just forbad citizen to go outside FOR WHATEVER REASON unless you have an authorization delivered by the prime minister site for : 1) essential work that cannot be done remotly, 2) essential shopping and 3) walking / jogging alone to not get mad and stay healthy. For now, nobody really know anything about this authorization whose details will be available in the following hours.

[kyriakos]

How's this enforced?

[Noumenon72]

When you see the police, you will be arrested unless you begin jogging and sign an affidavit that you were getting mad. Then it's OK.

[tartuffe]

As long as you are lucky enough not to get caught by the cops, everything is fine. However, they start to deploy heavely and there is really poor chance you don't meet cops.

Once they caught you, they ask for the printed document [1] either properly filled with required information or handwritten on a paper. Next they keep it, so you have to provide another one the next time.

If you don't comply with the rules, you get fined from 38€ to 135€.

If you go out to buy food or other vital important goods (soap, toothpaste, ...), you are required to go only on governement approuved shops. For now, few people succeed to get that list of official shops and you see almost everyone going were they can find food.

Honestly, people are really scared and very angry because three to four days ago, the government said everyting is fine, no need to worry, let's keep calm, let's be goods citizen, don't hurry on shops, and bla and bla and bla.

In the end, civilized people like me just understood they have been abused because while they tried to stay good citizens, bastard emptied shops and as of now, you are very lucky if you can find something to eat or even a soap, at the price of hours long waiting queue on the parking of the shops.

By the way, even before the quarantine, you couldn't buy as many goods a you wanted : since yesterday morning and in almost every shops, supply is very, very limited and you can only buy a limited number of the same item, although the limits are not official and/or legal (for now).

It's not North Korea, but it's almost like ...

[1] https://www.interieur.gouv.fr/content/download/121663/976885...

[m4rtink]

Well, here in Czech Republic (in between Germany, Austria, Poland and Slovakia):

- state wide quarantine from Monday morning, people can go only to work, to get groceries or to hospital/doctor

- all puliblic gathering over 30 people banned, but probably moot due to the above

- borders closed, foreigners can't go in and citizens can't travel travel out

- cross border trains/buses shut down, flights stopped

- schools closed for ~week already

- only food, medicine and drug stores are open, all other shops are closed

- there is a new exception for stores selling fabrics and clothes, as people are using clothes/fabric to manufacture their own protective masks

- all restaurants closed, only food takeout is allowed

- public transport is generally running, but the driver is extra-protected to not be in contact with riders (no selling of tickets, etc.), in some cities public transport is free to avoid any contact with riders and personnel at all

- everyone who arrived from the outside from an at risk country needs to do 14 day quarantine or else get crazy fines and possibly jail time

- a couple towns and villages (around 20k people) have got extra quarantined due to of-nominal number of cases, people can't leave the are for at least 14 days

- the army is helping out the police with patrolling the border crossings and to distribute medical supplies, army aircraft also just went to a round trip to China for more medical materials from Shenzen

- hospitals are clearing of any non essential surgeries and patients who can go home

- medical school students have been drafted to help in hospitals

There is a nice Wikipedia page summarizing many of the restrictions and overall progress (case numbers, etc.):

https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_t...

Pretty tough and so far surprisingly well executed measures I would say. People are generally respecting the special rules and there is a rather low amount of grumbling, considering this is Czech Republic.

Also a lot of solidarity - theaters sewing face masks, universities enrolling computer labs to Folding@Home, teaching student taking care of children of medical personnel, middle school student doing grocery shopping for old people who are most at risk, etc.

Now let's hope this all works and we can get this over with in a reasonably time in good shape.

[kstenerud]

... except Italy

[drstewart]

Then what's the difference between total quarantine and major lockdown?

[panta-rhei]

Id assume, that the differences between minor lockdown, major lockdown and total lockdown (quarantine) are the same as for minor/major/total in every other context too. Minor x = a small quantity of all possible x, major x = a large quantity of all possible x, total x = all of all possible x. X in the given context would then be something like "measures to achieve isolation (on different levels) to decrease infection rate".

Practical example: Minor lockdown could be shutting down public places and canceling events that attract large crowds (>1000 people). Major lockdown could be shutting down all public places and closing borders. Total lockdown would be complete isolation of all individual people, as far as possible, for example via curfews and special protocols like for example (as they did in China) mailmen dropping packages on the doorstep instead of handing them over to you, and similar protocol changes to avoid direct contact between people. — And these three steps are in fact exactly what has been done or is in the process of being implemented right now in many countries.

[throwaway4787]

and France

[friede]

and spain

[mkurz]

and Austria: https://fm4.orf.at/stories/3000031/

[DanielleMolloy]

Germany is close, they just announce new measures bit by bit every day. Next step not unlikely to be total quarantine.

[mirekrusin]

Switzerland is in state of emergency since today, it's great because they can deploy military to help.

[LordHumungous]

And parts of the US

[AnimalMuppet]

Parts of the US have total quarantine? Which parts?

[geverett]

Total quarantine in Puerto Rico as well since 9pm on March 15th.

[tmpz22]

Rumors are it's about to happen in France

[tartuffe]

rumors are dead as it really happened : https://news.ycombinator.com/item?id=22599579

[deviantfero]

It is close to happening in El Salvador

[zamfi]

I’m surprised that no one here is mentioning the example of South Korea. [1]

They are not in total lockdown, but they are doing extensive testing and contact tracing, and substantial isolation of anyone who might be contagious.

Once we get testing infrastructure ramped up, this is not an unreasonable plan in the United States.

[1]: https://www.bbc.com/news/world-asia-51836898

[bcrosby95]

Because it's too late. The time for that in the US was at least two weeks ago. This is why the US response to this has been driving so many of us crazy. The later you respond the fewer options you have.

[vinay427]

To be fair, every western country has missed this boat as far as I can tell. People are similarly confused and angry in the country (in Europe) I live in even though the testing rate is far higher here.

[zamfi]

The original question was what to do post-lockdown.

To be clear, lockdown is the only option for the US right now. But then what?

[seunosewa]

Wait until the rest of the world catches up with you, else they'll reinfect you as soon as lockdown ends.

[mdavidn]

One other consideration: The population of the United States is six times larger than South Korea's. Keep this in mind when comparing the total number of cases in each country.

[unlinked_dll]

See I disagree with this perspective.

Yea, we're bigger. We also have more cities with high populations. But What SK did primarily in Seoul is the perfect pilot program to expand into national policy.

The problem is our government is filled with people deferring upward for decision making until it was too late.

Even today, the President went on TV with "guidelines." Not policy, not action, and certainly not teeth behind those guidelines. This is the inaction that we're fuming about.

[cperciva]

If social distancing can bring the number of cases down to a manageable level, you can switch to a traditional public health approach: Test anyone showing symptoms, and aggressively trace and test any contacts of known cases.

[fspeech]

You also need universal mask wearing. South Korea had a huge cluster, but mask wearing practice saved it from spiraling out of control.

[martokus]

Wouldn't they be afraid that if the rules are relaxed the single cases would spiral up and start it all over again?

[cperciva]

If you can identify the remaining cases and isolate them, you're fine. The danger is that some cases slip through the contact tracing procedure (e.g. the identified patient forgot about someone they were in contact with) which is why you also want to aggressively test anyone presenting with symptoms.

[fspeech]

The South Korean model:

1. Build up testing and contact tracing capabilities.

2. Massive mask making, everyone required to wear a mask in public.

3. Hospitals reconfigured to deal with covid patients.

People can then go outside and mingle again.

[superpermutat0r]

What kind of masks are effective? The one I have seems weird, I just feel the water vapour touching my eyes when I exhale. I guess the mask would block the sneeze/cough projectiles and small spits while talking but if I were sitting in the public transit the water vapour would float around.

[fspeech]

Wearing a mask is to protect others from your own droplets. This is CDC protocol: if a doctor suspects covid, the patient is given a mask to put on. If that is enough to protect the doctor in close proximity, it is good enough to protect the general public. Like herd immunity if we all wear masks in public, the chance of droplet exchange is greatly reduced. The quality of mask and the manner of mask wearing become irrelevant. This is why we need universal mask wearing. It is the fastest and cheapest way to get the economy back on its foot again.

[matt_the_bass]

I don’t understand why this is not mandated now everywhere. Yes I know supplies are limited but factories could start making these quickly if govt mandated them.

[Aweorih]

I don't know the names just that there are 2 variants. One which is cheap and one which is expensive. The cheap one does not protect you but shall protect others if you've got the virus. The expensive one shall protect you but you cannot wear it for long because it's hard to breath with it. That's what was said in germany from official site a week ago or so. May be outdated now. I Think they also said that you can get infected through eyes.. So a mask MAY not be enough at all

[DanBC]

Masks are not effective unless you combine them with all the other PPE and have training in how to use them.

Without those masks increase your risk.

Don't wear masks.

Listen to literally all the medical advice telling you not to wear masks, unless you've been advised by people treating you to wear a mask. (eg one person in a family is infected and the family is self isolating).

[j7ake]

That is not a good argument to not wear masks.

You could also say "don't wash hands" because it's not effective unless you combine them with social distancing and other quarantine measures.

A preventive measure does not need 100% effectiveness to be recommended. For example, washing your hands.

[DanBC]

No, washing hands is effective even if you don't practice social distancing.

The problem with masks is not that they aren't 100% effective, it's that they are worse than no mask. They increase risk.

The only people who should be wearing masks are healthcare professionals are people with the illness who are self-isolating in a family home.

Here's an effective mask: https://twitter.com/missemjo/status/1239520762815488000/phot...

https://twitter.com/kimbo2205/status/1238089278565031936/pho...

Why are you pushing masks to cover the nose and mouth, and not goggles to cover the eyes? Or gloves for the hands?

[j7ake]

If wearing masks increase risk, why are they recommending healthcare professionals and those with symptoms to wear a mask? I don't see how you can explain that masks reduce risk for healthcare professionals but increase risk if you are not. The virus is unlikely to distinguish whether you are a healthcare professional or not.

If the argument is that training is needed to use mask effectively, then simply put out a video on how to properly wear mask. This is how they push out hand washing. They have posters and videos to show how to do it properly.

Goggles to cover eyes can decrease risk, just like mask. Gloves for the hands will prevent your bare hands getting dirty but won't help the spread of of the virus onto other surfaces as you touch things throughout the day.

[agumonkey]

it seems obv that mask wearing would have slowed the spread immensely

they also have large distribution of sanitizer so you can shrink the contact vector too..

I wish europe went this way

[hackermailman]

There's vids all over YouTube from WuHan what to expect. First the jubilant singing and party slogans, then screaming for help all night https://m.youtube.com/watch?v=Zp3jH6iYrnw

Then each block is allowed movement after 2 months with community punishment if they hide cases and monetary incentive to follow rules, such as keeping contaminated clothing outside. Workers in critical industry will live at work and not allowed home to prevent contamination https://m.youtube.com/watch?v=yyucJekT87E

[RickJWagner]

Is anybody else wondering about authoritarian power grabs?

It's all so surreal, I can just imagine it. (In the US, I think some primary elections are under discussion for delays.)

I'm not worried, just wondering how to best disarm it from a distance.

[zaptheimpaler]

I would hope the lockdown gives us enough time to do thorough testing & tracing of the virus. Also a lockdown + messaging should convince people to take this thing seriously and follow the precautions.

If we know who has it well enough then we can focus care on them, wait until they can fight off the virus and go back to normal after. That is assuming people don't transmit the virus after recovering from it.

[shartshooter]

The primary goal right now is to flatten the curve so the growth doesn't stay exponential for any longer than it has to.

Once that flattens out and the growth rate slows or decreases a concerns is that folks will head back out, assuming the coast is clear.

That could cause a second wave of infections that restarts this whole thing.

Folks not taking this seriously is a problem, imagine what happens when folks who don't take this seriously think that it's finally over, when it really isn't.

[danenania]

Subsequent waves should be a lot easier to contain if we’re prepared for them and act immediately at the first signs of renewed spread. Apart from contact tracing, judicious use of targeted, local lockdowns in areas where community spread pops up again can prevent the need for country-wide lockdowns.

[gbersac]

Health worker will be exhausted, so it will be harder

[Leary]

Resume work after countries have the capacity to test everyone who has a fever. Maintain strong hygiene and social distance if possible. Firefight clusters of outbreaks where they occur. Wait for treatment and vaccine.

[baytrailcat]

This is my line of thinking too. Let's face it, the entire economy can't be shutdown till vaccines are available. Use this borrowed time (when we can afford total lockdown) to mass produce tests, medicines, ventilators, build hospitals, train staff etc. Relax restrictions slowly. Test everyone. Lock down specific areas where outbreak occurs. I really hope our leaders have experts in their staff who can model this.

[notyourday]

> Wait for treatment and vaccine.

Isn't this a virus? There's not a single virus that we have a treatment for - we know how to deal with bacteria but not viruses.

[Leary]

Treatment won't be completely effective but can reduce death rate. There are hundreds of trials ongoing, 1 or 2 or 3 may work well enough to give to people.

[notyourday]

So this is 1-2 years out.

[lultimouomo]

You mean like aciclovir for herpes, or the various antivirals for HIV, or the monoclonal antibodies for ebola?

[notyourday]

They are suppressors of symptoms/disease management helpers not cures.

Ebola patients either die or their immune system fights off the disease.

[lultimouomo]

That's patently false. Antivirals slow the reproduction rate of the virus giving your immune system the upper hand; monoclonal antibodies do exactly what your immune system would do, they bind to the virus either neutralizing it or allowing macrophages to detect and destroy it.

[notyourday]

Except that CDC disagrees:

Herpes:

https://www.cdc.gov/std/herpes/treatment.htm

Is there a cure or treatment for herpes? There is no cure for herpes. Antiviral medications can, however, prevent or shorten outbreaks during the period of time the person takes the medication. In addition, daily suppressive therapy (i.e. daily use of antiviral medication) for herpes can reduce the likelihood of transmission to partners.

Several clinical trials have tested vaccines against genital herpes infection, but there is currently no commercially available vaccine that is protective against genital herpes infection. One vaccine trial showed efficacy among women whose partners were HSV-2 infected, but only among women who were not infected with HSV-1. No efficacy was observed among men whose partners were HSV-2 infected. A subsequent trial testing the same vaccine showed some protection from genital HSV-1 infection, but no protection from HSV-2 infection.

Ebola:

https://www.cdc.gov/vhf/ebola/treatment/index.html

Antiviral Drugs There is currently no antiviral drug licensed by the U.S. Food and Drug Administration (FDA) to treat EVD in people.

During the 2018 eastern Democratic Republic of the Congo outbreak, four investigational treatments were initially available to treat patients with confirmed Ebola. For two of those treatments, called regeneron (REGN-EB3) and mAb114, overall survival was much higher. These two antiviral drugs currently remain in use for patients with confirmed Ebola.

Drugs that are being developed to treat EVD work by stopping the virus from making copies of itself.

TL;DR; at best we can manage.

[velosol]

Isn't this similar to a typical antibiotics regimen? The abx kill a lot of bacteria with an X-log reduction and the immune system takes out what's left?

I'm not an expert on this, just curious.

[notyourday]

Antibiotics target bacteria. We have been successfully killing bacteria ever since the invention of penicillin.

The rule of the thumb is "prevent viral infections via vaccinations because they cannot be treated" and "treat bacterial infections using antibiotics because they cannot be prevented"

[Zaskoda]

If tensions ease too quickly and we release everyone into the wild, it could cause another outbreak. I don't personally know the parameters of that risk, I just know it is a risk.

But on the bold assumption that we somehow contain the virus, we have a global economic collapse to tend to.

[ChuckMcM]

It's a good question. I've been thinking of it this way;

If we have an "unlimited" (by which I mean we manufacture them faster than we consume them) number of test kits with a turnaround time of < 24 hrs, then everyone on lock down for 14 days. Medical/Drive through facilities set up to process everyone for a test. Get a test, and then within 24 hours get a text on what their status is (infected, uninfected, immune (post infection)).

People who test positive go into quarantine to be re-tested weekly until they are immune.

People who test immune are allowed to resume work movement while keeping good practice (washing hands, coughing into elbow, Etc.)

People who test as non-infected are required to come back for re-testing every week, can move around with social distancing.

I don't know if it would work (I'm not a public health professional) but from a systems perspective surveillance of the infection seems to be the best strategy for staying on top of outbreaks.

Once a vaccine is available it becomes one of the things you get every year like a flu shot.

[pmoriarty]

Regarding immunity, there is evidence that such immunity (if it exists) is short-lived, and after a little while recovered individuals are susceptible to being infected again.

[tonyedgecombe]

Do you have a reference for that as I keep hearing it repeated but I'm yet to see any real evidence for it.

[pmoriarty]

Here's what Ralph Baric, an epidemiologist from the University of North Carolina Chapel Hill, had this to say on episode 591 of This Week in Virology[1] a couple of days ago:

Ralph Baric: "I saw some very interesting data from Stan Perlman the other day, who has been looking at serum neutralization titers of MERS patients from the Middle East kingdom of Saudi Arabia area and it's quite intersting that people peak fairly quickly with high neutralization titers but then they wane over the next year to almost background levels or just slightly above background levels by the second year, and with MERS there have been several reports of people who have seroconverted. They were rtPCR positive and their serum neutralizing titers and even ELISA titers went to almost zero within a few months."

Baric: "And it has not been studied and it should be studied, and this is the contemporary human Coronaviruses -- nobody knows how they maintain themselves in human populations. They don't undergo rapid antigenic variation like influenza. There's not 115 common cold or corona virus type genotypes or whatever they're called, serotypes. Sorry Vincent, I just butchered the coronaviruses."

Vincent Racaniello: "That's ok." <laughter>

Baric: "So one hypothesis is that they cause a transient protective immune response that wanes quickly and then they can reinfect and cause mild upper-respiratory tract infections and that's how they maintain themselves. So it is quite possible.. there's been a number now of reported cases in China of SARS2 infections where people were documented to be infected and recovered. They were rtPCR negative. They went home and they became reinfected a month later or so."

Baric: "In this case the United States has sufficient cases that we can actually track the serologic responses of the individuals and their general immune.. both B- and T-cell responses after infection and we can get a handle on the long term immunity that may be elicited after infection."

[1] - http://www.microbe.tv/twiv/twiv-591/

[2] - about 15 minutes and 50 seconds in to the program

[gomox]

Could you clarify this for laymen?

[dijit]

"The Immune response for MERS tapers off over a year; but we don't know what the immune response is of SARS2, it looks very different, it might be very short lived, we need more evidence"

[pmoriarty]

I don't have medical training myself, so my own understanding is only that of an interested layman who's been following this closely. So please take what I say with a grain of salt, but here's my understanding of what Dr Baric said:

In the first paragraph he speaks of evidence that immunity waned over time in the case of a closely related disease called MERS.

In the second paragraph he talks about the mystery of how all human coronaviruses (including some of the viruses that cause the "common cold", the virus that causes MERS, and SARS-Cov-2: the virus that causes COVID-19, aka "The Coronavirus") keep themselves alive in the human population. He didn't say so explicitly, but the implication is that we should expect these coronaviruses to die out as humans get sick, recover, and acquire immunity to them.. but that's not what happens. People get sick with these same viruses again and again and again.

In the case of the flu (which is not a coronavirus), the way it keeps reinfecting people is that it mutates a lot in ways that will evade acquired immunity, so any immunity a person had from having had and recovered from the flu will not keep them from getting sick with another, mutated variation of the flu.

But that doesn't happen with human coronaviruses. People keep getting infected with the same strain. So the educated guess (the hypothesis) is that being infected and recovering from the coronavirus does grant some immunity, but that immunity quickly fades and then people get reinfected with the same strain because they no longer have that immunity (or have too little of it to keep from getting infected).

Then he mentions reports from China of people getting infected with the coronavirus, recovering, and then getting reinfected (which should support the above hypothesis, but we can't be sure because China has not been actually monitoring the levels of antibodies in infected and recovered people in their population).

In the final paragraph, Baric says he expects the US health care system to closely track the level of antibodies in infected and recovered people over time, which should give us some insight in to whether this hypothetical reduction in immune response really does happen.

[Johnjonjoan]

There's precedent, it makes sense with our knowledge, we have seen people who are apparently reinfected, we can likely soon find evidence for or against the idea

[hluska]

I’m not OP, just a concerned parent who is trying to figure things out. I have not been able to locate a single scientific study about this. Rather, the evidence all seems to be news reports of people testing positive, then negative and then positive again. Since it isn’t scientific, all the usual caveats apply - we don’t know much about how effective those tests were and again, these are news reports.

If you’re interested, I can post some news reports. Forbes actually has a pretty good rundown of the various news articles, but Forbes isn’t always the best place for facts or safe browsing, so I’ll avoid posting that one. In the interest of fairness, I can also post (much older) news reports that called HIV/AIDS “Gay Related Immuno-deficiency” and we know how good that science was.

[timhigins]

The truth is that these current tests (rt RT-PCR) are not completely accurate and may only have a true positive rate of 60-70%. See Discussion section of: https://pubs.rsna.org/doi/10.1148/radiol.2020200642

Additionally, people who are asymptomatic can test negative on all of their tests and only be diagnosed via other means. See Figure 1 here: https://link.springer.com/content/pdf/10.1007/s11427-020-166...

[projektfu]

You have that a little backwards. The positive predictive value in the discussion is for CT. rtPCR is being used as the definitive test but it lacks sensitivity so it has false negatives. The 59% rate for rtPCR positive suggests that they are missing cases that CT might catch. However, the CT findings are not “pathognomonic” meaning that other conditions can cause the appearance of viral pneumonia (such as influenza).

[jredwards]

I anticipate that sooner or later the economic costs of staying on lockdown will overwhelm the benefits. We will probably begin to loosen restrictions and we will probably see periodic outbreaks in various places.

I don't know if that simply continues until a vaccine is viable or some other factor intervenes.

But this new reality won't be short-lived.

[hfufigivknog]

No actually it will be. It will be gone from the planet more or less within months. Corona viruses don’t mutate in a way that invalidates immunity gained from exposure to its ancestors. The flu does that but corona viruses do not. And there is no evidence that this one is an exception. Herd immunity will be achieved and it will stop spreading.

[zw123456]

I don't know if anyone is still following this post but does anyone know if there are studies around the cost in lives of the shutdown itself? I recall reading somewhere that every 1% of unemployment equaled some number of additional deaths per year. Does anyone know of a study of the human cost of a shutdown vs. the virus itself ?

[SpinyNormal61]

The commonly stated goal of lockdowns is to slow the spread, flatten the (new cases vs time) curve, and thereby try to manage the rate of new cases so hospital resources (ICU beds, respirators, nursing staff) arn't overwhelmed.

Once (whenever that may be) the curve is shown to be flattening and hostpitals are in control, it'd be logical to see some gradual loosening of the restrictions that are currently being ramped up.

I personally doubt that loosening of restrictions, once above conditions are met, will be contingent on a proven and widely available vaccine having been developed (not least because there's no guarantee that one ever will be).

At this point it's anyone's guess how long it'll be in any given country until things appear to be more under control... Even in South Korea, who seem to have done best job in containing this, I've yet to see any estimates of how long it'll take at current rates on infection for the majority of the population to get it and/or get to "herd immunity" point.

In the US all bets are off.. it seems we were (and still are) extraordinarily slow to recognize the severity of this and take appropriate actions (severe lockdowns, widespread testing and resulting case tracking), so a reasonable expectation is that we may be following the case trajectories of the harder hit countries, with similar measures as they have in place coming to the US.

[jamesdmiller]

The endgame is to figure out the least cost sustainable measures of getting R0<1 until we have a vaccine or treatment safe enough for people in high risk groups to take.

[pdonis]

> The endgame is to figure out the least cost sustainable measures of getting R0<1

The question assumes this has already been done: "single cases here and there, maybe even 0 cases".

It seems to me that the key question at that point is, if there are no active cases--everyone exposed to the virus who is still alive has either never developed symptoms in the first place, or has recovered from whatever symptoms they had and is now asymptomatic--is there still a risk of spreading the virus further?

[PeterisP]

It does not assume that - Wuhan currently has R0<1 and it did not and still does not have "single cases here and there, maybe even 0 cases"; R0<1 through a lockdown is a tested (in Wuhan) way to get from tens of thousands of cases to just tens of new cases per day and probably eventually to single isolated cases here and there. But we'd really like to find a less invasive, more sustainable set measures than what was done in Wuhan.

[pdonis]

> Wuhan currently has R0<1 and it did not and still does not have "single cases here and there, maybe even 0 cases"

You're missing my point. I'm not saying that R0<1 implies "single cases here and there, maybe even 0 cases". I'm saying the converse: that "single cases here and there, maybe 0 cases" implies R0<1. Which is obviously true. And the scenario posed in this "Ask HN" question assumed "single cases here and there, maybe 0 cases", so if that implies R0<1, and it does, then the OP's scenario does assume R0<1, even though it doesn't say so explicitly.

[blamarvt]

Isn't it about flattening the curve instead of eliminating the curve?

[olliej]

The purpose of the lockdown is solely to prevent emergency services from being completely overwhelmed. Not make it go away.

[projektfu]

A country like Colombia could implement a lockdown and stop transmission entirely. The virus would naturally die out there in a few weeks. All foreign travel would have to be quarantined but life could go on after that internally without disruption. Eventually vaccination could bring herd immunity.

[pmoriarty]

I've heard an epidemiologist say that if a vaccine becomes available in 18 months it'll be a record.

Experimental treatments are being researched, but with only very small numbers of patients. It'll take quite some time for those treatments to become widely available.

It's unlikely that we're going to even begin to see things return to normal in a month or even three of isolation, especially if that isolation isn't as effectively and universally enforced as in China.

Afterwards there has to be extremely aggressive testing, tracking, and monitoring, or the outbreak has a very good chance of starting all over again.

In addition, the health care system itself has to have time to recover and replenish its equipment, ICU capacity, and healthy and able medical personnel.

[scottlocklin]

> I've heard an epidemiologist say that if a vaccine becomes available in 18 months it'll be a record.

Your epidemiologist should talk to a chemist or look at a wikipedia entry. In 1957, the H2N2 pandemic vaccine was available in 3 months. Still managed to kill a few million people.

https://www.globalsecurity.org/security/ops/hsc-scen-3_pande...

https://www.city-journal.org/1957-asian-flu-pandemic

[etrabroline]

I think you are nitpicking this doctor's words instead of listening to what he's saying. 18 years and no SARS vaccine. 18 months for SARS 2 would be miraculous.

[scottlocklin]

He's an epidemiologist, and I think people aren't listening to what history is saying about the possibility of things. People accept 18 years or 18 months because they're trained to live in a sclerotic bureaucratic hellscape not because those are actual limitations involving long periods of time.

There was a thread last night about people worrying that improvised ventilators aren't FDA tested or whatever. That's a great thing to worry about in soft times. If I (or a member of my family) am facing death while waiting for a ventilator to save my life, I'll take my chances on the doodad cobbled together from a CPAP machine without FDA approval. Same story with vaccinations.

[scotty79]

I think you just gradually make lockdown less strict to throttle number of cases so that it's on the level your healthcare can handle and do that till most of your population already had the virus. And hope for new treatments, vaccines and that immunity from already having the virus lasts at least a year or two.

[forkexec]

A rational move would be to lock everyone down until a vaccine is proven safe and efficacious can be delivered to enough people. Since no one other than indigenous people living near bats have any immunity to beta-coronaviruses, it doesn't make sense to expose billions of people to unnecessary risks when we can pause nearly all social- economic activity until immune defense is possible or supplies run low.

The vaccine, once developed, should be free for everyone to encourage high uptake herd immunity.

[kelseydh]

Do you think the world could handle two years of two supply chains being disrupted and shut down?

[aaron695]

How long did the HIV vaccine take?

Use that as a yard stuck.

A lockdown isn't 'successful' it does little, except drag society into the dirt while a little time is bought to work things out.

Time China bought us but we squandered.

If you're lucky it's a winter desease so it'll become summer and it'll die off. But that's coin flipping a little.

Treatments might be found but it's hard to know how fast, especially while everyone is on lockdown.

[dgb23]

> A lockdown isn't 'successful' it does little, except drag society into the dirt while a little time is bought to work things out.

Slowing down the spread is useful to soften the blow on medicinal infrastructure.

[aaron695]

The flatten the curve meme has become toxic. Maybe it always was.

Have a look at a flatten the curve with actual numbers not cartoons.

Make sure the hospital capacity is seasonal and accounts for the fact nurses and doctors will wear out and supply's will dwindle.

Then say it softens the blow.

[gus_massa]

Each virus is different, and apparently it is easier to find a vaccine against covid19 than HIV. Covid19 is similar to SARS and other cororavirus, so virologist have a good guess about how much time it will take. Probably not less than a year, don't expect to see it next month magically as other people. Here says 18 months approximately https://www.theguardian.com/world/2020/mar/16/when-will-a-co... I guess it will take longer, like 2 years.

[totaldude87]

One word...

Summer..

once the summer starts and we see 30c or above , i think the spread will be limited and the quarantine might end.

But, worrying part is what comes next, without a Vaccine, coming Winter might be lethal, and we may end up with same cycle..

https://www.scmp.com/news/china/science/article/3074131/coro...

[dhosek]

It's summer in Australia and South Africa. They're still seeing spread. I wouldn't count on that.

[adventured]

Is there any information on how many of the ~377 Australian cases originated outside versus inside their borders? I can't find much on that figure.

South Africa only has 62 cases and New Zealand only has 8 cases. Not much there yet.

[dhosek]

I haven't seen any statistics, but it appears that Rita Wilson and her husband contracted it in Australia from what I've read. That was the more worrying thing to me about that news than the celebrity connection.

[kevin_thibedeau]

Two global travelers with frequent contact to other global travelers doesn't prove much.

[dhosek]

It's anecdata for sure. Apparently though, at least one TV reporter contracted the virus after being in contact with Rita Wilson. Again, anecdata, but it points towards the idea that there is local transmission.

[marcosdumay]

Well, in Brazil it's officially known that there has been domestic transmission in both São Paulo (that has been cold, much like a summer in North Europe) and Rio de Janeiro (that has been quite hot on the last few days).

[ta999999171]

More humid there, easier for microorganism travel.

[IpV8]

Fist off, its a virus not a microorganism. Second, high humidity reduces the spread of viruses. That is why you get the common cold more often in winter, when it is very dry.

[m4rtink]

Summer might help, but there have been cases in the tropics, so it's not completely killed by higher temperature.

[jlgaddis]

The President of the U.S. has said this, but pretty much any medical expert I've seen on television has said there's zero evidence to support that assertion at this point.

In other words, don't count on it (additionally, ignoring any "medical information" that comes out of POTUS' mouth is likely a good idea, too).

[hfufigivknog]

The virus isn’t serious enough to warrant or motivate total quarantine so a ton of people are going to get it. Then we’ll have collective immunity and things will go back to normal. 3 to 6 months from now.

[ztjio]

It's not that simple. First of all, most people do not develop permanent immunity to the cold which is usually one of the first 4 known human transmissible corona viruses. So there is no reason to think we'll develop long term immunity to this one either.

Second, our reaction has be abysmal which, similar to the 1918 Spanish Flu pandemic, massively increases the chance of a second or even third wave of massive infection spread. That will be on many peoples's minds.

And one more thing I want to touch on so people here can get it through their thick heads: just because the death rate is supposedly "low" and "only" impacts old people mostly, that doesn't mean it doesn't impact YOU. If YOU have an emergency and the hospital is packed with COVID-19 patients, it doesn't really matter what you have, you are affected.

Even ignoring the ethical implications of just letting people die from this, I think most people who would do that are unlikely to ignore implications to themselves so figure out where you land or not, it doesn't matter, the goal of keeping hospitals from being overloaded affects everyone.

[hfufigivknog]

Corona viruses are not “the cold.” Rhinovirus causes the common cold and corona viruses cause 10% of cold cases. Just like other corona viruses, they make a recurring appearance. But this is not because they mutate in the way the flu does. No corona viruses mutate in the way that the flu does. If you have some evidence to prove me wrong then produce it.

You definitely develop immunity to viruses that sicken you. For the average person who is healthy.

If there is a second wave it will only be because of overly aggressive quarantining. This is why I said it won’t happen. For it to work, it would have to be air tight. All these young kids staying home are just saving fuel for a second wave. Old people ought to stay home and let younger people gain herd immunity as quickly as possible.

[azhawkes]

That's my inclination as well. Isolate and protect the high-risk people, and let the rest of us get herd immunity quickly. Especially the kids, who are apparently unaffected by this thing. That's the silver lining here.

On the other hand, if you prevent the kids and young healthy people from getting it, you pretty much guarantee a large vector for continuous outbreaks well into the future, which may end up killing far more people in the long run and at a much higher economic cost.

I'm not an epidemiologist, so if anyone here is, please share why this approach isn't getting more consideration.

[chengangcs]

Singapore scientist just published a result on bioRxiv. They have found a 382-nt deletion during the evolution of this coronavirus. https://www.biorxiv.org/content/10.1101/2020.03.11.987222v1

[scotty79]

> If there is a second wave it will only be because of overly aggressive quarantining.

Common cold causing coronaviruses have recurring waves every 2-4 years. If they don't mutate like flu it means that immunity is not that long lasting.

[hfufigivknog]

No, it doesn’t necessarily mean that. If you find a paper or expert testimony that totally unambiguously shows that I’m wrong, I will totally retract what I’ve said.

[chrisked]

Do you assume full recovery?

[tuna-piano]

The economic loss of a lockdown is just extraordinary. Just think about how many people and resources are idle... Literally trillions of dollars in lost economic potential (let alone the harder to quantify human+health consequences).

So it's crazy to me how little, relative to the hard economic costs of the virus, is being spent on mitigation.

I'm a totally uninformed lay-person, but the below seems reasonable:

Huge testing effort, something like 5% of the country's population gets tested every day (once every 20 days per person). Manage electronically. If positive, quarantine that person and known contacts.

Huge contact tracing and small lockdown strategy (found 10 cases in Omaha, Omaha lockdown for 2 weeks).

Seems that would be doable, cost billions and billions, but enable economic activity and minimize health+human consequences. Would be a great RoI.