Should we allow the novel Coronavirus to spread in a controlled way in the healthy population?

[Starmill]

But as article says:

And various other articles also put doubt on this strategy:
https://theconversation.com/coronav...ny-people-have-had-it-sweden-thinks-so-136893


Here is an interesting video about contact tracing in South Korea, but they acted very quickly and they gather information that I don't think would be possible in the UK:
https://www.bbc.co.uk/news/av/world-asia-52584494/coronavirus-how-south-korea-crushed-the-curve

I agree that it will be extremely difficult for this to be effective here, and at such a late stage, as so much ground is lost. But this does not change the objective: it is not for people to get infected!

 

[Bantamzen]

An excellent article (excerpt below) on why the current approach is flawed.

Get back to work, is Johnson's cry. But the economic hardship isn't over | Simon Jenkins

With the stakes this high, there has to be discussion of the data that guides the prime minister’s decisions, says the Guardian columnist Simon Jenkins

www.theguardian.com

This quote from that article struck me the most:

[But Britons are now more fearful of Covid-19 than any other people on earth.

So very true, it has been shockingly way too easy to use fear to drive compliance, and I am fearful that it will be much harder to undo. Last night some people on my social media feeds were going into meltdown after the PM's announcement, some even getting angry at the thought that some people need to get back to work to earn the money for them to live. And the memes, so many....

So should we allow spread? I've voted for yes, not because I necessarily think its the best way to deal with, but because we really have no choice. We cannot sit in our homes being fearful of every other person, despite what some people think we cannot tank the economy because this will cause more damage.

 

[6862]

No, simple maths and the experimentation we have already done suggest why allowing the virus to go through the population would be BAD.

I can see where you are coming from with this, especially your point about long term isolation of the elderly, but I think part of the hope with this approach would be that when (if) a vaccine comes along (say in 1 year - 18 months) the vulnerable can be vaccinated first because the young and healthy would already have natural immunity. So their isolation would not be for ever.

With either our current approach, or the approach being suggested here, the elderly will be isolated for a very long time. The difference is that in the 'controlled spread' approach the young and healthy are not also confined (like we are now).

 

[nedchester]

I would say yes but with the proviso that the vulnerable should be shielded and also there should be effective testing, tracking and tracing in place to nail down clusters of the virus.

 

[yorksrob]

I don't think it's a binary choice between lockdown and letting the virus run rampant. It will be about finding smarter ways to control infection.

 

[Bletchleyite]

I don't think it's a binary choice between lockdown and letting the virus run rampant. It will be about finding smarter ways to control infection.

Track, trace and test seems to be the only sensible way. Indeed, I'm slightly surprised there was any slackening before that app was rolled out, even though the slackening is more to take people to what the Government expected them to do in the lockdown in the first place.

 

[yorksrob]

Track, trace and test seems to be the only sensible way. Indeed, I'm slightly surprised there was any slackening before that app was rolled out, even though the slackening is more to take people to what the Government expected them to do in the lockdown in the first place.

Yes, there doesn't seem to be much in the way of de-facto slackening to be honest. The "return to work" (in speech marks because there was never a blanket requirement to suspend work) seems to have been a bit rushed.

 

[Jayden99]

I'd be likely to err on the side of caution on this one, as there's still too much that we don't know about the virus. I'm really concerned by reports coming out of the US of perfectly healthy young people getting infected with Covid 19 then suffering strokes despite having few/no risk factors. We've also seen that even in young kids who quite a fair few think are completely immune, doctors are being presented with strange symptoms like Kawasaki disease. Until we understand more some policy of control is imho for the best

 

[Bletchleyite]

I'd be likely to err on the side of caution on this one, as there's still too much that we don't know about the virus. I'm really concerned by reports coming out of the US of perfectly healthy young people getting infected with Covid 19 then suffering strokes despite having few/no risk factors.

That would alarm me if it was happening in large numbers but it's not. Risk = severity x likelihood. The latter must be taken into account (and traded against benefit, ideally - risk-benefit analysis is far better than simple risk assessment in any situation where you're not basically trying to eliminate risk - and this is not one of those situations).

 

[yorkie]

I agree that it will be extremely difficult for this to be effective here, and at such a late stage, as so much ground is lost. But this does not change the objective: it is not for people to get infected!

No-one is suggesting the objective is for people to get infected; it's perhaps more a question of how much we are prepared to sacrifice to avoid getting infected.

For example if the mental health and livelihoods of many people are severely impacted there is a possibility that the price of taking greater steps to avoid it may be a price that's too high to pay.

 

[najaB]

There’s a good argument for young, healthy people to be able to get on with things. The death rate is vanishingly small amongst this group so it’s difficult to see how it could lead to the NHS being overwhelmed and “herd immunity” will be achieved rapidly, especially in densely populated towns and cities.

Initially I agreed with this, but there are two reasons that I don't think it's a good idea. Firstly, it's become apparent that the "young healthy people are at no risk" line isn't always true. There appears to be a complication of Covid-19 infection which can develop in children/younger people that results something like toxic shock syndrome. There have only been a small number of cases (three deaths and 70-something cases in New York) but there may well have been more cases that were missed. The second reason is that it appears that mild infections might not confer lasting immunity - the jury is still out on this but there's disturbing evidence that people who only develop the mildest symptoms can catch it again.

 

[Huntergreed]

The answer to this question is that we need a balance to be struck. What needs to happen in my opinion is we need to stop scaremongering from the government and media leading people to fear “the big bad virus” and instead we need to promote well rounded discussions about how we can minimise all round damage from the current situation. Factors we need to consider include:

• We do to a certain degree still need to suppress the virus to ensure that the NHS is not overwhelmed, not to remain in lockdown to get the death rate down to 0 which would cause greater damage to other aspects of society
• We need to rescue the economy and get the country going again, the serious damage we are doing needs to stop sooner rather than later and the government need to open their eyes to how bad this is getting
• We must find a balance between encouraging people to act in a safe manner when out rather than trying to scare people into their homes
• We need to respect the prospects of the young as well as the health of the elderly, schools must be opened and we need to get the younger workforce back into work, as the virus won’t affect them as badly and this is seriously damaging their mental health and future career prospects

The most important thing is we need to find a balance. The current situation is putting everything else at risk to suppress the virus, after a few more weeks we really need to change our messaging. This virus is going to be a part of society perhaps permanently and we’re going to have to learn to simply return to a functional society and get the economy moving again whilst taking appropriate measures to ensure hospital capacity remains sufficient.

 

[najaB]

That would alarm me if it was happening in large numbers but it's not.

The problem is that we don't know how frequent it really is - how many cases have been missed? There's at least three deaths and 70-something cases that we know about in New York.

 

[yorkie]

Initially I agreed with this, but there are two reasons that I don't think it's a good idea. Firstly, it's become apparent that the "young healthy people are at no risk" line isn't always true.....

It's not that there is no risk; most activities in life have some risk.

We need to find a viable balance. If we continue as we are for too long, it's going to cause irreparable damage that would - for most people - potentally be a far worse outcome than getting the virus.

 

[najaB]

It's not that there is no risk; most activities in life have some risk.

You, I and anyone reasonable all know this, but I've heard many people saying things like "It only kills old people" - it's important to make sure that people know exactly what they're advocating.

 

[Peter Sarf]

The answer to this question is that we need a balance to be struck. What needs to happen in my opinion is we need to stop scaremongering from the government and media leading people to fear “the big bad virus” and instead we need to promote well rounded discussions about how we can minimise all round damage from the current situation. Factors we need to consider include:

• We do to a certain degree still need to suppress the virus to ensure that the NHS is not overwhelmed, not to remain in lockdown to get the death rate down to 0 which would cause greater damage to other aspects of society
• We need to rescue the economy and get the country going again, the serious damage we are doing needs to stop sooner rather than later and the government need to open their eyes to how bad this is getting
• We must find a balance between encouraging people to act in a safe manner when out rather than trying to scare people into their homes
• We need to respect the prospects of the young as well as the health of the elderly, schools must be opened and we need to get the younger workforce back into work, as the virus won’t affect them as badly and this is seriously damaging their mental health and future career prospects

The most important thing is we need to find a balance. The current situation is putting everything else at risk to suppress the virus, after a few more weeks we really need to change our messaging. This virus is going to be a part of society perhaps permanently and we’re going to have to learn to simply return to a functional society and get the economy moving again whilst taking appropriate measures to ensure hospital capacity remains sufficient.

Not sure/too early to say.

Yes the balance. I see cases of people flaunting the rules for no benefit but for themselves and they do it in the belief that it won't hurt them - selfish. I think we need to relax lock-down as much as we dare. i am horrified that advice is to avoid public transport as this will make the roads terrible. But the 2 meter distancing rule is the necessary culprit.

The government has said that a fully functioning rail system would only have capacity for 10% of its normal levels. Well we could cut commuting to 80% if people worked four longer days. then by changing peoples start and finish times we could get four different rush hours so down to 20%. This could be achieved either within companies Or varying start & finish times on a company-by-company basis. Halve the 20% because of home working and we arrive at 10%. Bit simplistic but I think, in the long run, we have to modify the way live and work anyway.

The elderly and otherwise vulnerable is a difficult one. Care home staff would still be mixing in the big bad world unless they 'live in' which assumes the staff have no other life.

We have to look forward to more testing, tracing and a vaccine. Then we can relax things a lot.

But do any of us want to go back to being packed into trains, trams and buses like sardines. It can never have been healthy regardless of COVID-19. I think there are rules to be made about the travelling conditions of so many. If we reduce the crowding on public transport by spreading the load I don't want to see that as an excuse for allowing more growth in public transport usage when this is over. We need to lead simpler less crowded lives. Perhaps there are too many people on the planet and nature is getting back at us because infections spread too easily.

I should say I am not suffering from lock-down as I am still at work. Nature of work has changed to be dominated by cleaning and we have extra temps in to help with that. My partner is a chef in a private hospital and now gets a lift from me in the morning but uses the bus to get back home. So my biggest risk is her bus use - I want her to work fewer but longer days to match my driving times. But in the long run I realise neither of us will have jobs if the economy implodes !.

Moderator note: discussion of the 2m social distancing guideline moved to https://www.railforums.co.uk/thread...al-distancing-rule-who-guidance-is-1m.204256/

 

[Belperpete]

The title of this thread is Should we allow the novel Coronavirus to spread in a controlled way in the healthy population?
But what exactly does "controlled" mean? If it means not overwhelming the NHS, how different is that to what we are doing now?

From the graphs shown on the Horizon programme awhile back, even fairly moderate controls (which would still result in the NHS being overwhelmed) would need to be maintained until well into 2021.

 

[43066]

Initially I agreed with this, but there are two reasons that I don't think it's a good idea. Firstly, it's become apparent that the "young healthy people are at no risk" line isn't always true. There appears to be a complication of Covid-19 infection which can develop in children/younger people that results something like toxic shock syndrome. There have only been a small number of cases (three deaths and 70-something cases in New York) but there may well have been more cases that were missed. The second reason is that it appears that mild infections might not confer lasting immunity - the jury is still out on this but there's disturbing evidence that people who only develop the mildest symptoms can catch it again.

Young people aren’t at “no risk”, but they are at vanishingly “low risk”. Three deaths from toxic shock is very small in the context of the overwhelming number of cases (even accepting there may be unknown cases).

The fact that the disease may not confer lasting immunity might reduce the effectiveness of herd immunity (and will presumably mean an effective vaccine is less likely). But at some stage we have to come out of lockdown and cases will start to climb at this point whatever happens. It’s a case of learning to live with the virus.

I’d be interested to know if there are figures out there for deaths being directly or indirectly caused by the lockdown measures - e.g. people dying due to cancelled operations, cancers being diagnosed late etc.

 

[Bletchleyite]

The problem is that we don't know how frequent it really is - how many cases have been missed?

I don't think any deaths of children are likely to be missed. If people don't die of it and it doesn't cause life changing issues, does it matter? There are plenty of nasty childhood illnesses, it's just adding another one.

 

[DaveTM]

No-one is suggesting the objective is for people to get infected; it's perhaps more a question of how much we are prepared to sacrifice to avoid getting infected.

Errm, isn't getting people infected the guaranteed outcome of a yes to "Should we allow the novel Coronavirus to spread in a controlled way in the healthy population?"?

In an earlier post regarding https://theconversation.com/coronav...ny-people-have-had-it-sweden-thinks-so-136893 , @yorkie, you asked of me:

That's what your "simple" modellers said about Sweden. But, as stated in the article linked to above, they were very wrong. Have you actually read the article?

...

I'm open to changing my opinion if you can explain to me why you are correct and Sir David Spiegelhalter and Dr Amitava Banerjee are wrong.

I have read the article. It was written on 22/4/20, and asserts that more people have been infected in Sweden, particularly Stockholm, than the modellers have previously considered. The article finishes by suggesting a good experimental test of this:

It is impossible to know for sure how many people have had COVID-19 – in Sweden and most other countries. But if the simulations conducted in Sweden are correct, and post-infection immunity is achieved in most people, we should soon expect infections and deaths in Stockholm to drop substantially in the coming weeks.

The article conveniently provides a link to the Swedish health services statistics page ( https://www.folkhalsomyndigheten.se...RLdcpKucJKuloBr5vWSjDRjZGQUPYoTazfGJ-vU9rFSrY ). Now, nearly two weeks after that article was written, the data is not conclusive in either direction, but is not yet suggestive of a rapid tailing off of cases due to a lack of new people to infect:


I suspect neither of us is likely to change our opinion on this until the Stockholm/Sweden experiment gives strong evidence one way or another.

 

[yorkie]

Errm, isn't getting people infected the guaranteed outcome of a yes to "Should we allow the novel Coronavirus to spread in a controlled way in the healthy population?"?

It is guaranteed that some people are going to be infected regardless of what we do.

The question is to what extent should we avoid it. Harsher measures will have a greater impact on the economy, mental health etc, but do they really get the R value down sufficiently to be worth all the pain? Are harsher measures sustainable in the longer term?

I’d be interested to know if there are figures out there for deaths being directly or indirectly caused by the lockdown measures ...

A forum member linked to an article in their local paper about someone they knew who committed suicide. A forum member who works in a school told me that their school had an attempted suicide. There will definitely be a huge impact but it will probably be difficult, if not impossible, to measure it. Some of the effects won't be known until a long time later (especially the effects on children at a crucial time in their lives).

 

[43066]

Errm, isn't getting people infected the guaranteed outcome of a yes to "Should we allow the novel Coronavirus to spread in a controlled way in the healthy population?"?

I think it’s a little more nuanced than that. I don’t think anyone on the thread is saying should be “business as usual”. Clearly proportionate and sensible measures need to be taken to minimise the spread, in particular so as not to overwhelm the NHS.

People are concerned that the wider costs of such a strict lockdown are going to outweigh the benefits.

 

[43066]

Yes but they won't be major news. A forum member linked to an article in their local paper about someone they knew who committed suicide. A forum member who works in a school told me that their school had an attempted suicide. But these won't make national news.

Quite. Especially as the media (quite rightly) minimises reporting of suicide so as to prevent copycat attempts. And of course poor mental health contributes to premature death in other ways - drug and alcohol abuse, smoking etc.

Mental health in this country was in deep, deep crisis even before the virus arrived, so goodness only knows what state it must be in now. I dread to think what might happen to the incidence of suicide on the railway over the next few months.

 

[Bantamzen]

Is the 2 meter rule a 'necessary' culprit ? I was reading that on the Paris metro, every other seat was marked out of use and floor markings had been laid out to show people where they can safely stand. It doesn't sound as though they are employing a 2m rule.

They are not, France has had a 1 metre rule all along. 2 metres was a UK government decision.

 

[yorksrob]

They are not, France has had a 1 metre rule all along. 2 metres was a UK government decision.

Thank you for confirming.

 

[DaveTM]

It is guaranteed that some people are going to be infected regardless of what we do.

The question is to what extent should we avoid it. Harsher measures will have a greater impact on the economy, mental health etc, but do they really get the R value down sufficiently to be worth all the pain? Are harsher measures sustainable in the longer term?

A forum member linked to an article in their local paper about someone they knew who committed suicide. A forum member who works in a school told me that their school had an attempted suicide. There will definitely be a huge impact but it will probably be difficult, if not impossible, to measure it. Some of the effects won't be known until a long time later (especially the effects on children at a crucial time in their lives).

Anecdotally, I know a radiographer whose specialism is brain imaging, who had to image a teenage boy on the day when lockdown was started after he had attempted to hang himself. As she put it, home was apparently not a safe space for that child.
The question to me though, is not quite as simple you put it. I think there is a scale of options from, the Swedish laissez-faire, option of "business as usual" , through our current middle of the road option of an extended semi-harsh lockdown, to the China/NZ/S.Kor/Taiwan/Aus/Cyp option of a harsher but shorter lockdown and then a relatively quick return to near normality. I suggest that of the three courses we could take here, our current option is the worst as it seems to guarantee as many deaths as the laissez-faire option while requiring a longer lockdown and worse economic effect than the short sharp shock option.

 

[Bletchleyite]

Anecdotally, I know a radiographer whose specialism is brain imaging, who had to image a teenage boy on the day when lockdown was started after he had attempted to hang himself. As she put it, home was apparently not a safe space for that child.
The question to me though, is not quite as simple you put it. I think there is a scale of options from, the Swedish laissez-faire, option of "business as usual" , through our current middle of the road option of an extended semi-harsh lockdown, to the China/NZ/S.Kor/Taiwan/Aus/Cyp option of a harsher but shorter lockdown and then a relatively quick return to near normality. I suggest that of the three courses we could take here, our current option is the worst as it seems to guarantee as many deaths as the laissez-faire option while requiring a longer lockdown and worse economic effect than the short sharp shock option.

But with that you assume there'd be considerable spread from exercising alone outdoors. There may well be none whatsoever.

I actually think our lockdown may have had exactly the same effect on the virus as the much stricter Italian one, as the things they banned that we didn't had barely any effect on it at all.

 

[yorksrob]

Anecdotally, I know a radiographer whose specialism is brain imaging, who had to image a teenage boy on the day when lockdown was started after he had attempted to hang himself. As she put it, home was apparently not a safe space for that child.
The question to me though, is not quite as simple you put it. I think there is a scale of options from, the Swedish laissez-faire, option of "business as usual" , through our current middle of the road option of an extended semi-harsh lockdown, to the China/NZ/S.Kor/Taiwan/Aus/Cyp option of a harsher but shorter lockdown and then a relatively quick return to near normality. I suggest that of the three courses we could take here, our current option is the worst as it seems to guarantee as many deaths as the laissez-faire option while requiring a longer lockdown and worse economic effect than the short sharp shock option.

I think the key point about NZ, Aus, S Korea, Taiwan wasn't that their lockdown was shorter and harsher. S Korea's was notably less intense than ours and continues to be. The difference was that they cut off imported cases at the beginning and tracked and traced.

 

[Bletchleyite]

I think the key point about NZ, Aus, S Korea, Taiwan wasn't that their lockdown was shorter and harsher. S Korea's was notably less intense than ours and continues to be. The difference was that they cut off imported cases at the beginning and tracked and traced.

Yes, I think a key difference is indeed that they got in earlier.

 

[yorksrob]

Yes, I think a key difference is indeed that they got in earlier.

It will be interesting if antibody testing does reveal that the virus was present in the country earlier than previously thought.