As I understand it, the goal of "flattening the curve" was never to reduce the overall number of people that contract the virus. Which, to me, means that neither herd immunity nor hiding were ever really the plan for covid. Giving manufacturers the time to shift into overproducing PPE and researchers the time to develop/test short term treatments so the hospitals could shift into treating it as a part of routine coverage. I don't think you need herd immunity to be prepared.
I can't tell if that's what you meant by "manage the flow of bodies." As I understand it, lots of the deaths have been a result of timing and lack of preparedness, not necessarily overall lethality of the virus itself.
The virus has a reported 12-20% hospitalization rate. Once they overfill in any given region, the death rate and the hospitalization rate become the same.
We can argue about small percents for CFR, which only apply given healthcare resources, but if we do not stay under the hospital thresholds by some means, we get a catastrophic death rate that is comparable to the 1918 Spanish Flu, which had something in the neighborhood of a 10-20% fatality rate.
Unless we somehow find an astonishing number of people are true asymptomatic, this will hold. The Iceland survey does not yet count, as they surveyed and tested and found a goodly number of people positive, but we haven't seen the followup of how many develop symptoms where it can take 11.5 days in 97.5% of all cases to develop.
So, we are in a Class 5 pandemic, one of similar severity to the 1918 Spanish Flu. We just have oxygen and ventilators now for pneumonia. Once we run out of those resources, we get to "manage the flow of bodies". If we get the infection rate of the 2009 swine flu at 60.8 million cases, we stand to lose up to 7 million lives in the United States alone.
You're right that flattening the curve wasn't about reducing the overall number of people that are infected -- it was keeping the amount of people that needed treatment below the hospital capacity for the state/country/region. This necessarily means that the number of people that are exposed will be roughly the same as without exposure, but in a longer time-frame. The WaPo simulations do a good job of showing the effects of flattening the curve on the total number of infected at any one time.
And the point of keeping these total number of infected was to not overwhelm the hospitals. When the hospital systems are overloaded, then you start to see deaths from normally treatable causes where the system couldn't keep up with COVID, so couldn't treat an otherwise survivable condition. These numbers aren't being readily reported, but the absolute death rate in places has gone up. Italy has reported some of these numbers and while the COVID death rate is fairly low (but still substantial enough to try to avoid), the impact it has had on the overall death rate of the population is striking.
But, if you extrapolate out the WaPo simulations, there are three possibilities: 1) Total burn where the virus does what it's going to do and whoever survives is (hopefully) immune. Thankfully we didn't go this route. 2) A moderate degree of infection where most of the population has been exposed by the end. This will take a long time to achieve this level of herd immunity and you still have to deal with the death rate of the virus itself. 3) Slowing the infection rate so much that the outbreak burns itself out. This takes time as well, and a lot of discipline. And at the end, there is still a large percentage of the population that is potentially at risk when the virus flares up again. This is likely the scenario we are headed towards.
If we are going to start to remove restrictions before we have a vaccine (which is all but a given), then I interpret "managing the flow of bodies" as controlling where people can travel. Or more likely, contact tracing where we monitor where people travel in near-real time so that if they end up getting infected, then we can retrospectively contact-trace who they may have been in contact with so that they could also be tested and/or quarantined.
Yes, I agree with everything you just said. I took "Managing the flow of bodies" as a facetious comment implying the path we're on meant catastrophic death, which is why I attempted to clarify.
So ..., if widespread testing is not available, we don't have a choice, and have to manage the flow of bodies as we reopen society in stages.