[ed25519FUUU]

Protect the vulnerable (no sending Covid positive patients into their living spaces!) while allowing low risk population to develop and overcome the virus.

This seems like the most logical way to combat issue, as opposed to hiding and hoping it goes away. Of course proposing it publicly means to be smeared by the media and politicians and twitter blue checks, who always have our best interests in mind.

Does this solution cause no pain and death? Of course not! It’s about causing the least amount of pain long term, including the externalities of our actions.

[ashtonkem]

The problem is that this is incredibly hard to do. It’s much easier to protect the vulnerable if the routes for community transmission are reduced or eliminated; if society is acting as normal it’s really hard to stop those specific transmission vectors. Given that we can’t convince people to wear masks, I’m dubious about any plan that requires more planning and communication.

We also have no idea if herd immunity will work, or for how long. Lots of coronaviruses confer either no immunity or a short term one; remember that a lot of common cold cases are coronaviruses too, and you can catch those repeatedly. Also, pursuing herd immunity involves infecting basically 20-50% of the population, a strategy that might kill 500k to 1.5mil Americans (assuming CFR stays at 1%, an optimistic assumption in this scenario)

We also have no idea what the health impacts for non-fatal cases are. Lots of patients are surviving with heart & lung damage; long term impacts TBD. Crippling an entire generation from the get go would both be tragic, and would put lie to the idea that not opening schools is “letting them fall behind”.

[phantom0308]

There isn't enough evidence of long term immunity to make herd immunity a sensible strategy. It's smeared by the media b/c it's way less preferable than the alternative of containing it like nearly every developed country in the world.

https://www.cnbc.com/2020/07/14/immunity-to-covid-19-uk-stud...

[ashtonkem]

“This strategy would kill over half a million Americans” isn’t even really a smear, it’s an accurate description of why the herd immunity strategy is bad.

[ed25519FUUU]

It's neither a smear nor an accurate description. It's fear mongering.

[ashtonkem]

They said the same about tens of thousands dying; we’re now at 141k dead Americans. If you want to dismiss it as “fear mongering” that’s your prerogative, just don’t be surprised that most people find this unconvincing.

[akamia]

The problem with this approach is it also assumes that overcoming the virus means a return to 100% health with no long term impact. We're already seeing that it can lead to other long term conditions. I have a friend who is being treated for heart damage after having COVID.

I'm in a low risk population but just because I'm not likely to die from it doesn't mean it's completely harmless to me.

[phantom0308]

Protecting the vulnerable has never actually worked. In theory it's possible, but it would require constantly testing nursing home workers that don't have the money to do this and an administration that hasn't shown the ability to support it. Every area that's had a significant level of spread has had issues where nursing home care workers brought in the virus from the community. The exception is Hong Kong where nursing home residents were quarantined in hospitals for significant periods. This presupposes the leadership to setup a system like this and the willingness of nursing home residents to be isolated for long periods of time. If we had either of those things we'd be able to contain the virus in the broader population.

[jkinudsjknds]

That's not how it works. If you had 100% immunity in the young, the old would still be at relatively similar risk because of homophily in social networks. That is, old people spend most of their time with old people. Herd immunity for the general population requires a homogenous mixture of social interactions across those infected.

Keeping the vulnerable protected sounds good and all, but in the case of, say, children, the vulnerable is the teaching staff.

[searine]

>This seems like the most logical way to combat issue, as opposed to hiding and hoping it goes away.

Logical if all that matters to you is numbers and money.

Lets not hide behind words. This logic mean death. You are conducting a blood sacrifice to ensure people don't have to alter their behavior.

If you're so gung-ho to get to herd immunity, how about you volunteer to be on the front lines?

[dexen]

The alternative - hiding people in homes until vaccine is widely available - means death.

From alcohol & substance abuse, from increased suicides, from domestic violence, and so on. Extended period of being prevented from running your business (or out of employment) without steady income, and bottled up at home is a major stresor and silent killer. The hospitals already reported significantly elevated suicides.

There is no magical strategy to stave off all the problems; balancing the risks and managing precautions as our knowledge expands is the correct, if hard to politically sell, way to go.

[ashtonkem]

Opening up without restrictions would kill somewhere between 500,000 and 1,300,000 Americans, assuming that the CFR doesn’t rise above 1% (an optimistic assumption). If you think lockdowns will kill that many Americans, then provide your sources.

[__blockcipher__]

I think you mean IFR not CFR.

The new estimates of HIT factoring in widespread t-cell cross-reactivity in humans that have NEVER been exposed to a SARS-like virus nor anyone who was themselves infected with one, implies that the true HIT is somewhere around 25%.

Do the math on the US with an IFR of .3% and an HIT of 25%. That’s what a likely scenario looks like. It means a few hundred thousand dead.

As an upper bound do the same math with .9% IFR and 25% HIT.

BTW you should also consider the risk that lockdown puts the body into a state where it is more susceptible to bad COVID-19 outcomes, due to vitamin d deficiency, lack of nitric oxide, lack of exercise, reduced sleep, social isolation, unemployment, and an unprecedented environment of widespread fear&hysteria. Also consider the lives we have already lost when calculating the delta between containment versus not practicing containment.

IMO containment is a foolish and infantile strategy which makes us perpetually at risk of an outbreak. Population immunity is the stable and logical solution. Banking on a vaccine is an awful idea, doubly so in a country where we can’t mandate a vaccine without plunging ourselves into civil war. Vaccine-attributable herd immunity only works if a bunch of people get vaccinated. Granted the t-cell reactivity findings alter the calculus there, but we would need to vaccinate people who do not demonstrate cross reactivity in order for that fact to change the number of required vaccines.

[ashtonkem]

> Do the math on the US with an IFR of .3% and an HIT of 25%. That’s what a likely scenario looks like. It means a few hundred thousand dead.

Let’s be precise. That’s a quarter of a million dead Americans. I’d consider that number to be deep in the “catastrophic failure” territory.

I also find the idea that the IFR would stay at 0.3% to be absurdly optimistic. We know that fatality rates scale with hospital load, any minor change to IFR could result in tens or hundreds of thousands of unnecessary deaths.

> BTW you should also consider the risk that lockdown puts the body into a state where it is more susceptible to bad COVID-19 outcomes, due to vitamin d deficiency, lack of nitric oxide, lack of exercise, reduced sleep, social isolation, unemployment, and an unprecedented environment of widespread fear&hysteria. Also consider the lives we have already lost when calculating the delta between containment versus not practicing containment.

Prove it.

> IMO containment is a foolish and infantile strategy which makes us perpetually at risk of an outbreak.

It’s worked elsewhere.

> Banking on a vaccine is an awful idea, doubly so in a country where we can’t mandate a vaccine without plunging ourselves into civil war.

This level of nihilism is genuinely baffling to me. What course of action are you recommending? Just ignore it?

[__blockcipher__]

> I also find the idea that the IFR would stay at 0.3% to be absurdly optimistic. We know that fatality rates scale with hospital load, any minor change to IFR could result in tens or hundreds of thousands of unnecessary deaths.

Hospitals being overwhelmed is not a serious concern at this point in time. Even at NY at the peak, one hospital would be past capacity while a nearby one would be nearly empty. Shuffling is not ideal but it works.

> This level of nihilism is genuinely baffling to me. What course of action are you recommending? Just ignore it?

It's not nihilism. I don't believe that practicing containment actually avoids mortality, except in the most optimistic scenario where lockdown-associated deaths are unreasonably low and a safe/effective vaccine is developed and deployed unreasonably fast.

My recommendation is not to employ any measures to slow the spread of SARS-2 in the general population, but instead to let the virus naturally pass through the general population. We can practice containment for elderly care facilities, although those individuals should be permitted to leave the facility and stay at home if they abject to the prison-like conditions required to avoid pre-symptomatic spread.

> Let’s be precise. That’s a quarter of a million dead Americans. I’d consider that number to be deep in the “catastrophic failure” territory.

Well, we already have 130,000 deaths, so that's about double where we're at now. So, we're talking about a delta of +120,000 if you want to be hyper-precise (I was not to account for uncertainty).

That's not a catastrophic failure at all; early (unrealistic, but that didn't stop our policy leaders from using them) estimates were forecasting 2.2 million dead, that's Ferguson's paper with a .9% IFR and 82% of pop. getting infected.

Please don't twist these words to portray me as callous, as you seem apt to do, but are you aware that ~500k americans die from cardiac disease every year? Smoking?

> Prove it.

You know that there will never be a RCT, so you must rely on good mental models and experimental results, such as ones showing the incredible role of vitamin D in the pathology of respiratory illness, the fact that nitric oxide lowers blood pressure and is currently being studied as a possible COVID-19 treatment, the obvious result that closing gyms = less exercise, the fact that unemployment is disruptive to one's life and tends to lead to a disregulation of sleep schedules, emotional states, etc.

> It’s worked elsewhere.

Where, exactly? Be specific.

New Zealand is the classic example held up here, and now New Zealand, which is a tourist economy, cannot allow any foreign entrants into their country without a 2+ week quarantine. I think that's a bad and unstable solution. BTW this is less of a concern but it makes them vulnerable to bioterrorism (intentionally spreading SARS-2).

OTOH Sweden followed a herd immunity strategy and has gotten there. Findings of t-cell cross-reactivity in the absence of having ever been exposed to a SARS-type virus indicates that a large swath of the population is not susceptible to COVID-19, period. Of those that are, the vast majority will either be asymptomatic, paucisymptomatic, or experience symptoms consistent with a mild cold. A small fraction will develop severe COVID-19 (which is dramatically worsened by vitamin d deficiency), culminating in the need for invasive ventilation and possible death.

---

In general, the risks of COVID-19 itself have been overblown, and somehow we never have enough information despite very well-defined risk categories and good bounds on what bad COVID-19 looks like (it looks like SARS-1, the original SARS). Whereas what we do not have bounds on are the results of an unprecedented global economic destabilization and lockdown, nor the socioemotional costs we're inflicting upon our children as well as ourselves.

[triceratops]

Or...what could have been done from the beginning. 3-week lockdown to get a grip, then mandatory mask laws (indoor and outdoor) and a reduction in indoor events and large social gatherings. Life and the economy goes on mostly as normal.

Even in the SF Bay Area, fewer than half the people I see outside actually wear masks. It's crazy how little people seem to care.

[clairity]

stop worrying about, and projecting unfounded motivations upon, maskless people outside. it's better for your health via stress reduction, at the very least.

[triceratops]

Other people's masks protect us, our masks protect other people.

Someone on Reddit gave the analogy of people peeing themselves with or without clothes on. If you're clothed and someone else pees in your direction, you're gonna get at least a little wet. If they're clothed, you don't get wet at all.

If someone developed a comfortable mask that gave the wearer near-100% protection and was widely available, I wouldn't worry about what others do.

[clairity]

the atmosphere is incomprehensably vast compared to viruses, making the chances of getting covid outside essentially zero. worry more sensibly about prolonged face-to-face conversation if you need to worry, but not maskless strangers outside.

[ashtonkem]

Worrying that someone might get me sick because they’re not wearing a mask isn’t “projection”.