How To Break the Covid Doom Loop

Yves here. While this proposal sounds more realistic than other schemes on offer, I still wonder if it would work all that much better than the shambolic approaches in countries and communities where Covid has settled in. And on top of that, we have the sobering spectacle of countries in Europe that had gotten infection rates down now seeing troubling upsurges.

In other words, I keep coming back to the notion that the disease is in control and it takes pretty stringent measures to lower contagion rates. This proposal does have the appeal of reducing uncertainty, since the populace would know in advance when restrictions would be in place.

However, I regard the authors as way too optimistic about the effect of short stringent lockdowns (two weeks??). And even if the weight of the law were put behind these two week lockdowns, it seems likely that the effect of “off-on” lockdowns is that people will simply crowd dangerous activities in “on” period, rather than spreading them out more over time. Is that really any sort of gain? I also see the authors as way too optimistic about contact tracing, which seems to work only when you have free, fast, and readily available tests, a citizenry is willing to respond quickly to tracing inquiries, and a pretty low baseline of infections.

And where is the income support?

The big problem, particularly in the Anglosphere, is not enough people are willing to follow rules. Too many people equate putting others at risk and being a scofflaw as an inalienable personal right. The authors acknowledge that “compliance is key” but don’t have new ideas here.

By Anne Williamson, a health economist working with COVID-19 Statistics, Policy Modelling, and Epidemiology Collective, Scott Sheffield, Professor of Mathematics at MIT, specializing in the theory of probability, and Anna York, a Postdoctoral Associate at Yale School of Public Health. Originally published at openDemocracy

What we are doing simply isn’t working. There have been countless individual sacrifices; relatives not seen since Christmas and restaurants shuttered forever. As cases spiral alarmingly again, we are moving back towards economically devastating restrictions or, worse, thousands more patients struggling to breathe in intensive care units.

Can we take hope from the new strategy of ‘circuit breaker’ lockdown? Yes – but only if done correctly.

From our vantage points by the bedside on COVID wards, and as part of the COVID-19 Statistics, Policy Modelling, and Epidemiology Collective, we saw firsthand how we failed before. We argue that a coordinated circuit breaker followed by intermittent and contingent ‘reset’ periods could avoid a longer lockdown, help the economy, keep a handle on COVID, and save lives.

This would mean imminent strict regulations for two or more weeks to reduce the disease reproduction rate, R, below 1. Then in the subsequent months, intermittent repeated resets would allow increased activity overall whilst remaining below this safe threshold.

A Failed Approach

It is pivotal we understand how we arrived back at this precipice. The current ‘moderate distancing’ approach walks a dangerous tightrope, aiming for social and economic activity up to just before the point where disease rates would explode. It then resorts to disordered de-facto lockdowns, like we are currently seeing, but only as a reaction to a situation that is already out of control. It is doomed to fail for multiple reasons.

First, moderate regulations are prone to behavioural slippage. Early on, people largely followed the rules. However, when one or two friends push the boundaries and squeeze seven onto a table, or a high profile figure is compelled to explore Barnard Castle, others relax their internal standards in unravelling policy chaos. If we don’t change course we thus face an interminable loop of moderate restrictions punctuated by kneejerk lockdowns that fail to effectively suppress the disease.

Second, it requires excellent testing to stay on the tightrope, and constant policy tinkering as disease rates evolve. If recent weeks have revealed anything, it is the inability of current Test and Trace to cope with higher rates of disease.

Third, it leads to disparities in infection rates, which make sacrifice inefficient. Many towns and subpopulations have already sacrificed more than enough to eliminate internal spread, but a constant threat of outside reinfection prevents them from relaxing and enjoying their triumph.

Finally, this approach still requires months of major adjustments to everyday life, and rather than minimising cases, it simply spreads them out. Even with all this sacrifice, there is no clear point of ‘success’ or increased freedom until a vaccine is found.

Breaking the Doom Loop

In recent weeks, discussion of ‘circuit breakers’ lockdowns have made the headlines, with everyone from Keir Starmer to SAGEcalling for a snap policy to regain control. Yet there is little discussion about what a good circuit breaker would look like and even less about what must happen afterwards.

In a recent paper, we considered exactly this question. Suppose a town wishes to allow 1,000 small but risky activities like essential workplace meetings, haircuts, and small social gatherings over the course of a month. Is it better to put all the activities in the same fortnight or space them out evenly? The mathematical answer is clear: we should take the former strategy. Temporally concentrated sacrifice beats temporally spread out sacrifice.

The exact optimal way to cluster these activities in time then becomes a policy question, not just a mathematical one. In practice, business and social activities could be permitted during the second fortnight of each month from November to January, but curtailed during the first fortnight. This would immediately lead to better disease control and more economic activity than the present approach. The resets might mimic what we had in early June: multiple households only meeting outdoors, with financial support for businesses that suspend trading. We emphasise that some economic activity could continue even during these periods: thanks to contactless supply chains, PPE, and other innovations, many businesses could safely remain open. But safety would be paramount. The goal is to drive the as low as possible over two strict weeks; the lower the disease rate, the less costly and more feasible a Track and Trace system becomes.

After this circuit breaker, relaxed periods could resemble current rules where masks and sensible caution coexist with increased social freedom. The advantage of intermittency is that it is flexible but effective: at first resets would be scheduled in advance, but as the situation improves the resets may become less strict. A highly effective circuit breaker could even eliminate the need for subsequent resets (as demonstrated in New Zealand), though this would most likely require a larger initial sacrifice than the UK is prepared to make.

So, would an intermittent strategy work? The maths shows better outcomes, but more importantly, it makes sense. Disease spread comes from total cases multiplied by the growth rate. A circuit breaker means many infected people will recover, suppressing total cases, so we can then enjoy several weeks of careful socialising and work activity. Intermittency also matters, because just when transmission starts to rise, we would have a preorganised reset to reduce disease prevalence before it gets out of hand again.

Over several months, rates could be driven towards zero without a continuous and interminable moderate lockdown. After cutting oxygen off from a fire to reduce it to embers, restoring airflow intermittently doesn’t allow large flames. Compare this to a steady continuous oxygen supply, and the blaze quickly rages out of control.

Compliance Is Key

Of course, there are caveats. Not all activities can be shifted in time, so inflexible activities like urgent medical care must continue. Since a month’s worth of flexible activity will be compressed into two weeks, businesses may have to extend opening hours to maintain appropriate social distancing. Still, the benefits of policy fluctuation remain even after the model is tweaked to allow for this.

However, one tweak causes particular trouble. If the model involves multiple subpopulations, and one of these refuses to follow the initial circuit breaker or subsequent resets, it will export infection and make it impossible for its neighbours to cut off the oxygen from the fire. This could occur between geographic areas, or between groups in society – precisely the concern about university students returning to their hometowns. The worst case is a lockdown in which groups with low disease prevalence must take even more precautions, while those unwilling or unable to lock down continue as before. It is critical that the highest prevalence populations have both the rules and resources to drive down and nearly eliminate the disease. Once we’ve decided upon circuit breakers, coordinated sacrifice beats uncoordinated sacrifice.

Thus the final key question is a behavioural one. Will the public comply? We would have to be crystal clear, with effective early enforcement, to avoid people carrying the freedom of the relaxed weeks into the reset periods. Nonetheless, it isn’t hard to explain: if you’re born in November, you can have your small birthday event – but only after the 14th. This may actually increase compliance, because of the psychological appeal of regular social “rewards” for committing to strict measures. It also allows affected businesses to plan for these intermittent cycles, coordinating staffing and stock far more effectively than the current unpredictable parade of rule changes.

The hope is that a vaccine will emerge soon, and we can return to the safety and freedom that we value more now than we ever realised. In the meantime, with proper compliance and coordination, we can at least reduce the amount of sacrifice required. That will be a win for everyone.

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62 comments

  1. PlutoniumKun

    Its tempting to see something like this as a way forward, but one problem thats repeatedly been found when there has been a deadline for greater restrictions, is that people shove everything – shopping, partying, etc., in to the last day or two. Its just human nature that if you know all your hairdressers and cafes and bars are going to shut on the 15th, that you try to do everything you can on the 14th, and throw in a few beers with friends and family that evening. Human behaviour is generally stochastic, not linear. This is something traffic modellers have long recognised. So unfortunately I think this element of human behaviour would strongly undermine the efficacy of this type of shutdown.

    Reply
  2. Maritimer

    “The big problem, particularly in the Anglosphere, is not enough people are willing to follow rules. Too many people equate putting others at risk and being a scofflaw as an inalienable personal right. ”

    Isn’t it time for science, government, Big Pharma and those involved in Covid management to consider that many citizens no longer have any trust in them? Possibly for them to consider that years of abusing, looting and manipulating citizens are reaping an unwanted harvest. Mine and destroy trust for decades and you have none left when you need it in an emergency.

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    1. GramSci

      The problem isn’t just “science, government [at least the bureaucrats], Big Pharma and those involved in Covid management”. It’s all of the generations of “little Eichmanns” after WWII , drunk on the power and perqs of empire.

      The party’s over and the hangover’s a bitch, but the resolve to quit drinking is still riddled with denial.

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    2. Clive

      Yes, The Powers That Be can’t even keep a story straight on how deadly, exactly, is the deadly virus, how full hospitals are (or aren’t), how effective countermeasures are and so on. It’s like they’re trying to pull this stunt in a world where no-one has any access to the internet. Saying anyone who disagrees or challenges the narrative is a refugee from QAnon is an evasion which isn’t going to wash.

      And the laws being scoffed at are passed under emergency legislation. So there’s little if any democratic mandate. And even under emergency powers, courts are perfectly entitled to strike out executive over-reach https://www.dw.com/en/court-overturns-berlins-nightlife-restrictions/av-55300040 where the measures are disproportionate or aren’t established in evidence. Plus, human rights are a balancing act — there’s nothing in COVID-19 which should preclude a balancing exercise being undertaken.

      And the public questioning “the scientists” and politicians proffering either “the science” or their interpretations of it aren’t some unwashable cadre of despicables — they’re the people, exercising a legitimate right to challenge officials, be they elected or unelected.

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      1. cocomaan

        The author uses the word “control” and “precipice” and “explosion” to talk about the disease, but doesn’t quantify it.

        When we started with the original lockdown, the bugaboo was “15 days to slow the spread”. Flatten the curve. We don’t understand the nature of the virus, so help each other out.

        And the amazing thing is that for two weeks, people were pretty damn compliant. Almost no cars were on the roads. I was out, getting things from an empty building, and saw it all firsthand. Few hospitals had the overcrowding feared.

        Now we understand the virus, we have supply chains to deal with needed equipment (ventilators, medication), so what exactly is control? What precipice are we teetering on? There’s no numbers in this article.

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        1. GramSci

          I think the author presumes the precipice is this:

          While deaths are flat, winter is coming. Hospitalizations and COVID-19 cases have, as predicted, begun to increase. Add to this the likelihood of seasonal flu and the uncertainty of an effective vaccine, and there is a significant danger of healthcare systems failing.

          Of course this isn’t all that dangerous if one is rich.

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          1. JohnMc

            ‘likelihood of seasonal flu’

            you haven’t been paying attention to what didn’t happen in the southern hemisphere this past summer. no flu season. and it appears, two months into the northern hemisphere flu season, we will experience the same.

            here is a discussion: https://twitter.com/kylamb8/status/1317186379483406337

            i’ll also add what should be obvious at this point: there is less dry tinder, many of the vulnerable have already been taken.

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            1. Cap'n Mainwaring

              Apart from the theories advanced in your twitter link, there’s also the probability that in some southern hemisphere countries the mitigation measures taken for covid19 have lowered the degree of contagion pertaining to the flu, which is significantly less infectious than covid19. Additionally, in Australia, there were numerous public statements during early autumn, exhorting people to have the flu vaccine. We know it’s far from 100% effective, but it’s likely that far more people than usual had the jabs, adding to the effect of the covid19 restrictions, which were pretty harsh in March/April when the flu shots became available.

              Sadly, I agree with the observation in your last sentence.

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            2. Late Introvert

              n+1 here but my daughter is 15, and she has gotten sick on average every 6-8 weeks since her early grade school years.

              Since early in February when she was very sick with unusual symptoms for her, along with many others at her school, shortly before the schools closed, she has not been sick even once. She talks about it regularly, how great it is.

              One of the few bright spots in this for her. And I think it may well portend a very mild flu season, if only people wear masks and social distance.

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        2. Phillip Cross

          Take a look at the usual number of deaths from respiratory illness on a given year. You will find there are relatively few in March and April, and a great many more in December and January, specifically peaking in the first week of January. Probably something to do with the cold, wet and dark conditions, but also ‘the holidays’ where everyone gets together indoors and shares stale air.

          I supposed the fear is that an uncontrolled community spread of a serious respiratory illness during these ‘peak months’ will hospitalize and kill a lot of our loved ones and neighbors. Understandably, concerned citizens and public health officials want to minimize this toll by bringing that spread under control.

          Unfortunately, there has been an intense propaganda campaign to get us out spending money by gaslighting us into believing we were silly to worry about it, its not dangerous, its not our problem, but only a problem for very feeble people. I worry that this will make matters worse this time around. People will be less inclined to take precautions before its too late.

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      2. Count Zero

        It’s not a matter of “keeping the story straight.” Our knowledge about this virus and about how people respond to it — physically and socially — has been constantly changing over the last 8 months. So policy has had to be flexible, adapting to new information. And different scientists and doctors are not in entire agreement. There are differences and debates and areas of uncertainty — so knowledge progresses.

        There is no “stunt” by the powers that be, whoever they are supposed to be.

        And of course citizens have a right to question what their governors do. But science isn’t a matter of opinion. If you want to challenge specific aspects of what medical experts are telling us about covid19 then do so. What exactly are they getting wrong? You better frame your criticisms on the basis of knowledge and not some idle trawling of the utter crap that fills the internet. The world is currently full of amateur epidemiologists and virologists who unfortunately know very little or nothing at all. They appeal to fearful people suffering from different degrees of paranoia.

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        1. Clive

          You started off explaining that the knowledge — the science — is constantly evolving. Which is fair enough, this is a new virus. This is what you’d expect.

          Then in the very next paragraph you say that science isn’t a matter of opinion and demand I say what the experts are getting wrong. But those self-same experts by your own argument got things wrong, based on an immature and partial understanding up until now — adapted to new information, as you put it. This isn’t to apportion blame on the experts, they could only be expected to know as much as their knowledge extended to at the time. And, crucially, understanding remains somewhat sketchy.

          And yet, none of the countermeasures which are proffered come with any small print along the lines of “this may work, but it may not, it’s all just our best guess”. If, when these public health policies are introduced, they come with — pardon the pun — health warnings, these are stripped from the announcements. The experts also are slow in reiterating and ramming home the point about the uncertainty. It deserves equal prominence to anything else in the messaging. It certainly does not get it. Yves rightly introduced a note of caution — but the need for this did not permeate the psyche of the original author. It seldom does in these things.

          Even in the openDemocracy post above, it should, if you’re correct (and I think you are) be topped and tailed with a version of “but of course, this is all somewhat speculative, we might be completely wrong, it’s maybe something to consider, we offer it for your perusal and evaluation as a form of peer review” (or something like that).

          And elsewhere in this comments thread, there are similarly implacable assertions about countermeasures, disease severity and what people should or shouldn’t be doing. Few, if any, express any residual doubts. Interestingly enough, you chose not to critique them for their potentially unsubstantiated sureties. Rather, you chose to apply criticism to me for questioning “the science”.

          I’ll conclude on the topic of questioning the science by suggesting that readers who want to see how that works out could look at the pixels-at-dawn dingdong currently underway between OffGuardian and Moon of Alabama. I won’t dignify this rather unseemly hoo-haa with links, readers can find these two scurrilous vagabonds for themselves if they like (short version — the original OffGuardian piece was thought-provoking but, as is often the case with OffGuardian, a little flaky, Moon of Alabama did a bit of knocking copy which was lazy, just some cut ‘n paste from less-than-convincing mainstream sources to which OffGuardian responded with a linkfest that certainly left me none the wiser in terms of being able to establish absolute accuracy and definitive conclusions). This all is sadly typical, I cite this slanging match not because it is edifying or particularly useful, but because that is the typical level into which these sorts of exchanges descend.

          You rightly rebuke the “utter crap that fills the internet”. But if you can tell me where I can find robust, knowledgeable and independent evaluations of COVID-19 and effective honest debate, I’m all ears. The fact that it’s not happening (not as far as I can see anyway) doesn’t mean it shouldn’t happen and doesn’t mean that imperfect, often lamentable attempts at it — like OffGuardian and Moon of Alabama‘s — aren’t at least a start. If they are hopeless, at least we can see where they are going wrong and try to make a better job of it in future.

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          1. Waking Up

            “But if you can tell me where I can find robust, knowledgeable and independent evaluations of COVID-19 and effective honest debate, I’m all ears.”

            For decades, many people around the world have thought the United States was “exceptional” in everything. COVID-19 has shown that not only is our country not exceptional in regards to healthcare, it is rather chaotic. I am hoping, but not expecting, that enough people in the U.S. will recognize that politics and financialization of our healthcare system has been detrimental for the majority of people.

            In a country which puts a “price” on everything, the very institutions which should have been neutral are instead now suspect. As you stated, what we need is a robust, knowledgeable and independent evaluation of COVID-19 and effective debate. Sadly, I don’t believe that can originate from the U.S. It must come from doctors, epidemiologists, healthcare workers, etc. that care about everyone’s basic humanity in the world. They can’t allow themselves to be “politicized” or bullied by any one or more nation states. If you do happen to find that independent evaluation on not just COVID-19, but healthcare in general, I would really appreciate the information.

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            1. Synoia

              “Exceptional” has two meanings, and the US claims raise the question of which definition applies:

              1. Better than others
              2. Subject to exceptions

              The US appears to practice both, in varying amounts and at varying times. The duplicity appears to extend way into history, and includes Nagasaki, Hiroshima, and the treatment of Native people in the US.

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          2. Aumua

            If you are a scientist or a community of scientists who want to try and get public policy implemented based on your findings, the problem is you’re kind of damned if you and damned if you don’t when it comes to adding qualifiers, disclaimers and other honest indications of uncertainty. It’s the same problem that climate science faces, which is that your opponents have no scruples at all about being honest, truthful or forthright about anything they say. They are perfectly fine with manipulating, lying and claiming all kinds of things with a flimsy basis or no basis whatsoever that appeal to people’s paranoia, distrust of authority and all kinds of other strong emotions. Any expression of honest doubt is going to be pounced upon by them like a pack of hyenas, and failure to express doubt when it exists will also be used in arguments against you.

            So when it comes to public policy, where money is almost always involved, you get the clusterfack we see today. You get everything but the truth from all sides.

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          3. Count Zero

            Ok Clive, there’s nothing in your response which I don’t, more or less, agree with. The ill-informed opinions of conspiracy nutters – from “it’s just flu” to “Bill Gates is engaging in mind-control by vaccinations” — is one extreme. But the certainties of others about what we should all do is the opposite extreme. You are right I fired off at the former and not the latter. I do happen to think the former are more dangerous and verging on the psychotic. But the latter can be annoying.

            As to where we can find “robust, knowledgeable and independent evaluations of COVID-19 and effective honest debate.” I have to confess I do trawl the Internet. I listen to interviews with serious and senior medical experts around the world. Ivor Cummins is also worth listening to. “Unherd” has had some excellent interviews and discussions. NC and Marginal Revolution are my go-to blogs and have links to excellent material every day. NC has the best comments section, from which I also learn.

            I try to cultivate a healthy scepticism about “experts” but keep an eagle eye on my own profound ignorance. I try to remember that some of these people are not firing off casual opinions while leaning against the bar but are sharing provisional results and interpretations based on long hours of hard work over many months. I respect expertise but value reasoned debate too. So thanks for your response.

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      3. Tom Bradford

        “The big problem, particularly in the Anglosphere, is not enough people are willing to follow rules. Too many people equate putting others at risk and being a scofflaw as an inalienable personal right. “

        I concur with Clive. This is not a problem with public attitudes in the Anglosphere. In New Zealand, Australia and the UK at least, initial lockdowns were widely respected and people generally did follow the rules. The ‘problem’, at least in the UK and Australia, was that ‘the rules’ didn’t go far enough as the Governments equivocated, not going far enough to suppress the virus in an effort to protect economies, and in the UK the patent ‘rules for you but not for us’ arrogance and utterly inept administrative response to the situation from above to give value to that commitment elicited a ‘sod you, why should we bother with the rules’ response from the public after that initial compliance.

        New Zealand is firmly within the Anglosphere yet its population’s willingness to follow the rules for the greater good could have been emulated anywhere the administration did not betray or waste that commitment.

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        1. Yves Smith Post author

          You aren’t in the part of the Anglosphere I am in.

          New York City is all masked up due since they saw at very close range how bad Covid-19 is. Maine is well masked up despite being pretty rural, maybe because its population skews old. Here in Birmingham, with the medical industry the biggest employer? All sorts of mask non-compliance, including regular defiance of a local order to wear a mask in a business establishment. My middle aged brother in Florida doesn’t seem to be taking any of this seriously either. Etc.

          And perhaps I am hallucinating but I believe some readers have reported distressing incidents of non-compliance in the UK as well.

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      4. d

        at least in Texas (probably true in most states), the health system is so devolved that each counties (if it even has one) is the source of all the health care data for the state (basically the state is just the aggregator for it….)…this means if the county doesnt have a health department (and by law only counties that have populations over 1 million are mandated to have one…). and in my state there is a lot of them that have no health department, some dont have more than a few doctors even, and they may not have one, and no hospital either. with no health department, there is no date for many counties at all, never mind if the state government decides to ‘clean’ the data up (but applying rules that ignore if there is a problem to begin with…till its gets to be to obvious there is one). while i can see that restricting rights should be examined…but then how do we balance the right to live that some exercising their ‘right’ to do what they want inflict on others. maybe we would have to just restrict how those who dont care about the impacts of their actions on others….by separating them? and the virus wont care…it will take advantage of those who dont care how their actions impact others…to infect more…since this virus is relatively new (basically seems to have become visible some time last year (and since this isnt star trek episode….we dont have the ability to determine how a new virus acts….with in the first 30mins of encountering it….so a lot of the initial information we got was based on virus like x act in general….but as more is known that changes….which is basically how science really works…hypothesize how some thing works…test that to see if its correct..or not….change needed based on the data supports…if it doesnt change the hypothesis and test again…repeat till we the hypothesis reflects realty…or as close as we can..testing continues to improve it based new information as needed

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    3. Ian Ollmann

      Big Pharma And government has a lot to answer for. However, if you think science has been abusing looting and manipulating citizens, you are living on a different planet than I am.

      The fact of the matter is that few listen to scientists because few understand them well. They certainly aren’t trying to manipulate you, just each other, in pursuit of grant money and recognition

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      1. Late Introvert

        OK, keep telling yourself that. It has to be true, otherwise you would have to question the very foundations of your career. Must not let those doubts creep in now, right?

        It’s all fine there in science academic land, with all you in-fighters that are totally blameless.

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        1. tegnost

          “They certainly aren’t trying to manipulate you, just each other, in pursuit of grant money and recognition”

          …yeesh

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    4. TimR

      And why exactly do YOU trust these control freaks, Maritimer?

      As you say, they don’t have much of a track record. To read a paper like this one, it looks like nothing so much as “boiling the frog.” The wet dreams of technocratic tyrants spelled out in black and white, behind a thin veneer of concern for Safety & Security, uber alles…

      Reading through the comments, is like some Orwellian satire of true believers in government propaganda. You all are so far gone someday you’ll be on the rack being flayed alive, and still convinced by some academic’s paper that it’s being done for your own good. Probably complaining that your fellow citizens aren’t bright enough to understand how helpful torture is to driving out viral demons, counterintuitive though it may seem on the surface. That’s how advanced you’ve become, and what good pupils.

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      1. d

        well who should we trust? the person is just saying just go back ‘normal’ just because they want to? with no data or reasoning…other just because i want too?…and who also basically says i dont care if you live or die…i just want my way of life back..no matter the cost? is that who we should trust with our lives with?
        even with all of that, shouldnt we be able to at least question what they advocate for?
        now maybe we should question the goverments policies..but lets do that with real data not just with i heard that this happened..with no data to back it up? maybe we need the government to back up their data too….but considering how some states governments have corrupted the data so badly…because that supports their view…and since the feds get their data from the states…has that corrupted policies to adddress the threat?

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        1. TimR

          If the government, media, or scientists from big global agencies say it… You can trust that it’s 180 degrees from the truth, as a first assumption.

          You can also trust your own eyes and experiences. If you didn’t have the TV to tell you there was a pandemic— would you even know it?

          In the state where I live, it’s about 2600 alleged Covid deaths, in a population of 5 million. And there’s been plenty of opportunity for a contagious, lethal virus to wreak havoc, if there really was one.

          It seems transparently obvious to me that some kind of lightly veiled fascism is being rolled out, under cover of almighty Science, and playing on the trust and gullibility of the public at large.

          The highest actual deaths seem to be iatrogenic, from unnecessary use of ventilators. And neglecting the elderly in nursing homes, due to staff being fearful for their own safety.

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          1. Aumua

            Who says ventilators were unnecessary, you? Are you some kind of expert? I’m no expert but I would suggest that the vast majority of those who died on ventilators would have died anyway without them, and that ventilation was a last ditch effort to save them. That seems ‘transparently obvious’ to me, but then what do I know?

            Do you also believe the Earth is flat because you can’t see the curvature from ‘your state’? If we didn’t have worldwide communications networks and no one ever talked to anyone else outside their families or whatever then I suppose you wouldn’t know about the pandemic until you or your loved ones got it. Has it occurred to you that the spread of it has been significantly slowed by the very same communications networks? I admit I don’t really know where we would be today if we as a species had no science, communication tools or ability to look beyond the tips of our noses in that regard. But I don’t think you know either.

            I see so many people reject the mainstream narrative and rightly so, but then they turn to some alt-stream narrative and just eat it up like candy, because it sounds true, and reflects some suspicion or another they have held. It’s like their critical thinking ability shuts off after the top level of skepticism. I personally always ask myself of any conspiracy theory: how many people from different walks of life would have to be in on it and keep it secret for the rest of their lives for it work? Just because there are powers that want to take advantage of this or any other crisis for various nefarious ends does not mean the crisis isn’t real.

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            1. TimR

              It doesn’t take a “conspiracy”, at least not for the vast number of low level people involved… Just a flawed paradigm, plus hierarchical structures that operate with carrot and stick to reward obedience and punish asking questions.

              Read eg “Good Calories, Bad Calories”, a mainstream book that documents decades of misguided nutrition policy and advice.

              Same for Covid. At the top, Big Pharma and some of the oligarchic elites, planners and think tanks may be consciously “conspiring” to advance their own agendas. But everyone else below is some combo of true believer, needs a paycheck, clueless, etc.

              Or is that flat earth talk.

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  3. The Rev Kev

    At this point in time, it is hard to see a way forward for places like the US, the UK, Europe, Brazil, etc. When you come down to it, the best way to cope with this pandemic is using a solid basis of trust between the State and the people. But as Maritimer has pointed out, that option is no longer there. Fauci may now think that it was no big deal when he lied to the general public by saying that masks were no good but how does he expect people to believe anything that he has to say now? Places like New Zealand and South Korea pointed the way forward but were ignored as most countries went for saving their economies rather than their people – and ended up losing both.

    I am not sure the approach talked about here would ever work without taking care to ensure that there are no further reinfections from outside. Supposing that in the US, that the State of Vermont went for eradication using a series of targeted circuit breakers. Could they do it? How about the sheer number of trucks going in and out that State with pickups and deliveries? How about military personnel also going in and out that State as well? Would they stay on base? Would base commanders even say that they had an infection on that base at all? What about people sneaking into that State? How about people suing that State because the Constitution says that they have the right of free travel? Modern States are like sieves.

    I guess that this is why the emphasis on a vaccine to get these countries out of their doom loops but even that may be hindered in places due to ‘reasons’. Suppose that a successful vaccine was finally developed but that it came out of Russia or China. I seriously doubt that countries like the US or Australia would take it up because of not only geopolitical reasons but that there would be a huge amount of push-back from the big pharma corporations as they would see trillions in potential dollars going up in smoke to a cheap alternative. We saw a preview of this with HCQ. No happy answers here.

    Reply
    1. cocomaan

      Wouldn’t it be great if someone released a vaccine and released the patent to the public domain?

      A man can dream.

      Reply
      1. Carla

        Apparently, we broke the mold after Jonas Salk, who declined to patent his polio vaccine.

        “When [Ed] Murrow asked him, ‘Who owns this patent?’, Salk replied, ‘Well, the people I would say. There is no patent. Could you patent the sun?’ The vaccine is calculated to be worth $7 billion had it been patented.”

        Salk appears to have lived his life according to a plan and moral code. When explaining why he chose a career in medical research, as opposed to practicing medicine, he explained: “my original ambition, or desire, … was to be of some help to humankind, so to speak, in a larger sense than just on a one-to-one basis.”

        (All quoted material from Wikipedia.)

        P.S. You may not be able to patent the sun, but somebody patented peanut-butter pop tarts.

        Reply
    2. Jan Løth

      Re.: Trust in institutions (Sweden !)

      BBC has a good point here … unusually nuanced.
      https://www.bbc.com/news/av/world-europe-54561201

      “We in Sweden trust the authorities and if the authorities say stay at home please and work from home – we do that.” That’s what i hear from swedish friends too – I can assure you, that is not the case in Denmark ! Or in the USA, it would seem.

      The numbers today indicate, that Sweden has actually done the right thing – except and admittedly for the elderly in care homes etc. ! Sweden has 10 times the number of “corona-deaths” as Denmark (should be appr. twice), but most if not all of the difference can be attributed to institutional differences regarding the care for elderly, unable to take care om themselves … and maybe some “belatedness”.

      In both countries 90% of “Corona-deaths” are people over 70 and most of them over 80. Most of them were already hospitalized or in care homes for other reasons. (We count anyone who dies within a month after a positive test as “corona-dead”). It looks – right now – as if our lockdowns, closing of borders etc. have had only marginal influence on the number of deaths in Denmark. Protecting the elderly in care homes and hospitals (and in general), however, and having a health care system able to provide lifesaving treatment when needed has made all the difference.

      Since july the daily number of “corona-deaths” in Sweden has been 1-4. In Denmark it has been 0-2 since early may and 90% of the deaths occurred in march and early april – it took some time to adapt the hospitals and care-systems.

      The number of infections rises as more people are tested, but in Denmark the number of hospitalized people and people in intensive care/respirator have only risen marginally. Except in the media ;)

      Reply
      1. Cuibono

        “The numbers today indicate, that Sweden has actually done the right thing – except”
        That word except seems to always come up with regards to Sweden.
        “Except” they suffered 10x the mortality of Finland and Norway and gained no stronger an economy.

        10X. Not a small amount that, 10X

        Reply
          1. skippy

            I thought the “unusually nuanced” dialectal lead in proposition was a heads up to where the conservation was going – bit over egged as it were.

            Reply
      2. fajensen

        Which Numbers? Sweden’s experts decided sometimes in March that:
        1) This is a kind of flu
        2) Only the weak and impure will die from this
        3) Thus, Heard immunity is the way to go … (with hidden clause:
        4) … To protect the wealthy, because those are the ones “we” care about!)

        A Swedish expert never change their opinion once it has been announced. They may shut up about it for a while, but this is only a strategy to avoid resistance. Therefore they are still following The Swedish Model announced back then:

        Everyone earning less than 33000 SEK/Month has had their supplemental unemployment insurance cancelled, cutting them back to about 6000 SEK per month instead of 80% of previous salary. The message here is: “Go forth and get this flu to protect those better people, who can work from home” (people who all earns more than 33kSEK/Month. Or go bankrupt.

        can be attributed to institutional differences regarding the care

        Oh, boy, that’s putting it mildly.

        A big reason for the many elderly dead was (and is!) Euthanasia. Someone, somewhere “in the system”, issued instructions that were interpreted as only palliative care should be given to all people in care homes (whatever put them there, more than the elderly are in care). The sick didn’t get oxygen, they never even used the emergency hospitals where they had oxygen, for them. They just got morphine instead. “They were supposed to die anyway”, is the attitude. Even my neighbours will say this. True to Swedish Form, nobody can figure out who gave these orders. They just “happened”. Swedish journalists are of course digging into it, with limited success.

        Also, Sweden came into the pandemic really poorly prepared; Having awarded the procurement of medication and single-use items for the health services to a company who previously was in the business of renting slush-ice machines to parties … with such keen expertise on the job, of course medical supplies ran into serious problems already in August-September 2019!

        One notices the Total absence of *anyone* from the government in these matters, nobody wants to even go near this thing, deferring at most to “The Experts” – who will be disposed off quietly later, with a better job contingent upon an NDA, no doubt about it.

        In Denmark, the government acted fast and got in front of the thing. Maybe not everything worked out as well as planned, but the government did have the honesty to say that these were political decisions. They were still based on the expert advice, but with margin for error, and at least decisions were made relatively fast. Which made a lot of difference compared to the dithering of the US and the UK.

        IMO, A thing Sweden did do right right, even though one disagrees very much with the Swedish Value System on display here, was to come up with a set of rules that doesn’t have to change every five days.

        The problem with Covid-19 being that there is a response time between Infection and ICU of 10-30 days so the numbers decision makers see Today are already ‘baked in’ and cannot be changed by any actions until “the pipeline” has emptied, which will happen 20-60 days after a change. (2x the system delay). The UK especially seems to be totally perplexed by this basic digital control system property.

        PS,
        I know some trauma-nurses in Denmark. The people coming in now are mostly in their 30’ies. Many of those patients will end up having lasting problems. In My Experience, this disease is not something one wants to get: I never got ill enough for hospital but I was off work for 7 weeks and almost symptom free after only 6 months. I still can’t run as fast as I used to.

        Reply
    3. d

      i can see the reaction to the vaccine from china/russia going down in flames….we have enough trouble getting people (some n=any way) to vaccinate any way….so short of just forcing that if you dont vaccinate you have to be kept separate from others…and maybe you could be charged with crimes…because you didnt…and you didnt take any precautions….and you infected others by your actions…..and some of thse died (maybe manslaughter?…or you caused major harm (some didnt die…but their lives are nothing like they were before….they have trouble breathing etc…now they go to prison…where no one else was vaccinated…and the prison staff are protected …extremely well….but you arent

      Reply
  4. Larry

    I thought our biggest problem in the US was a lack of a national, coordinated response in conjunction with the governors. The US was a total disaster on this front with the federal government intercepting PPE supplies after Trump telling states they were on their own. The governor of Massachusetts enlisted billionaire owner of the Patriots, Robert Kraft, to fly his own private jets to China to get our healthcare workers supplies at the depth of the outbreak in metro Boston while we were setting up emergency hospital beds in convention centers. What an indictment of Trump’s response, and what an untenable situation state governments were and have been thrown into. And that’s from a government that while initially slow to respond to reality, did not deny reality.

    And yet, when I look at European countries that had stringent national lock downs and coordinated national responses I see the same troubling upswings. Is France controlling things any better than Massachusetts, which in reality has no control over it’s borders and is using minimal enforcement mechanisms to control social behavior? No, France is not. And that speaks to how people will continue back to pre-COVID behavior as soon as restrictions are lifted.

    I was recently in western Massachusetts to help my mother prepare for a long winter. She’s not much of a TV watcher, but without her volunteer work she found there’s only so many hours in the day she can read books. My mom lives in Northampton, where many establishments still have not re-opened to the public despite restrictions being lifted. I stopped in Easthampton (bordering Northampton) on my way out of town to get my daughter ice cream where I ran into my cousins who were dining indoors at a bar on the main drag. They invited us in, which I politely declined, deflecting that my daughter could hardly sit at a bar and it would be a bother to re-seat us at a table. Now they can get away with this because community transmission in much of Western Massachusetts is incredibly low. Some hilltowns still have 0 reported cases. But this return to normalcy, of extending social circles and casual indoor dining will lead to increased rates. But how do you stop people outside of incredibly stringent penalites?

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  5. Another Scott

    The other problem is the government is unwilling to enforce basically anything. For example, we’re only now seeing headlines of Boston Mayor Marty Walsh might fine hosts of large parties with unmasked party goers. He might do it, no guarantees and why is it taking so long? The MBTA has refused to enforce its mask ban. When I take the T, the vast majority have masks on, however, a few don’t, but each and every person who isn’t wearing a mask has one hanging from their neck. Simply enforce the ban.

    Reply
    1. d

      i suppose if you enforce a masks ban…ridership might collapse..as many would consider unsafe..sort of like how some might consider that travelling to a state that edits their data as being unsafe to travel too…

      Reply
  6. Bob Hertz

    Americans are rebels, Americans are line-breakers, America has a Federalist system that resists national mandates, America is a vast country where some rural counties have had less than ten deaths from Covid so far……….

    All these facts would seem to predict that we will have a disorderly response to contagious diseases….and that this response would be disorderly under any President.

    The natural response of public health officials seems to be “how can we get this disease down to zero cases?” I do not think that is a realistic goal in America.

    Reply
    1. Shiloh1

      “Follow the money”, is very American, and in America, Money = Politics.

      That’s the reason why there is little trust in institutions, deservedly so.

      I don’t think I’ll see Governor Pritzker on my trail run in the woods today, so that’s good for both of us.

      Reply
  7. Mark

    Forget looking at New Zealand. That horse has long bolted for most places in the world.

    A better example is Melbourne, Australia. But that comes with it’s own costs. Melbourne has been in a 3month lockdown off the back of what was a small number of cases compared to most countries. Lockdown hasn’t been complete, plenty of ‘essential’ economic activity has continue. It has been a long hard grind but largely successful. (Even with plenty of scofflaws that have probably meant things taking longer than needed.)

    An alternative choice is Sweden. It really isn’t clearly wrong path. Though it is clearly not desirable for those at risk.

    See this article for a reasonable coverage:
    Do Sweden or Melbourne, just not America

    Reply
    1. Grumpy Engineer

      New Zealand also closed their borders. Only NZ residents who’ve been traveling out-of-country may re-enter, and they may do so only after enduring a 2-week quarantine. The US has no hope of closing its borders. We’re unwilling to do so for the legal border crossings (much less with a strictly enforced quarantine after arrival), and unable to do so for the illegal border crossings.

      Reply
  8. Susan the other

    Two weeks on and two weeks off sounds feasible to me. But it will take more coordination and enforcement that we can provide. If society could get used to a schedule like this it might prove useful in other ways too, like energy conservation, more sleep, gardening, whatever. It’s just a change from five days on and two off – really no big deal. But it should be a long term change, not one based on an emergency which might be over in less than a year. Or might not. Once people settle into a schedule they tend to stick with it. Two weeks on and two off would be an efficient way to live permanently. In terms of any future pandemics/emergencies it would be good to already be living that way. And the 5-day work week with only one absurdly short vacation a year is a throwback to pre-industrial times.

    Reply
  9. JEHR

    There is one thing that we learn during a pandemic and that is where all the weak points are in our civilized country. For example, free health care helps patients cope with the virus better; and lax care at long-term homes means more deaths. Both public and private institutions reveal their weaknesses: where one may be regulated but the regulations are over time not followed meticulously; or where the other is profit-oriented so that the human connection becomes secondary. These two examples may show that the citizens of a country work together better when all of them gain a benefit equally and don’t work so well when there is wide disparity between them. A country without poverty, for example, would work more in unison under pandemic conditions than a country that suffers widespread and ugly poverty which means some citizens do not even have access to communications that would assist them in what needs to be done.

    For me the the big lesson to learn, and the best reason to hope, is for a re-organization in order to achieve equality for all. Climate change will be the next big thing that makes this change absolutely necessary.

    We need to feel empathy for others or our feelings for fully realized existence is not achievable.

    Reply
  10. sd

    Actions have consequences.

    There’s a great story by the journalist Colin Freeman in his book, Curse of the Al Dulaimi Hotel. He has a local driver, driving is absolute mayhem, so he asks ‘why do the Iraqis drive on both side she of the road?’ The answer: while Sadaam Hussein was in power, his motorcade would drive on the opposite side of the road to bypass traffic. So once Hussein fell, everyone wanted to try driving on the other side of the road.

    The lesson there is that rules are for little people, so whatever example is set by the big people is what the little people will follow. Influencers influence.

    Reply
  11. Synoia

    “After this circuit breaker”

    I wish we had explicit descriptions, and not a metaphor from the Electrical Industry, which appears meaningless in management of a pandemic.

    After a circuit breaker is flipped or triggered, everything is dead, that is “off’.”

    Such a metaphor is inaccurate, irrelevant and meaningless in pandemic management, because for everything would be “off,” which would be the end of all life.

    Please write clearly as to a pandemic action or set of actions, or remain silent.

    Reply
  12. chris

    Posting this from the discussion in the links thread because it seems much more appropriate here. Chris Hayes opining on re-opening schools.

    I’m pretty sure more teachers would be open to making commitments about returning to in person school if they felt the resources would be provided to help them do that. It’s unconscionable to assume they should do this while having to buy their own PPE. It’s also interesting to see the assumed “they’ll just have to deal with it” in Chris Hayes responses. So, when a parent doses up their kid and sends them to school with hidden symptoms, and then can’t come to pick up their kid, what is the school supposed to do? What’s the teacher supposed to do? How do we keep kids wearing PPE during the school day? How do we pay for all the biowaste created by teachers and students disposing of used PPE at school? So many questions.

    Electing Biden isn’t going to answer any of them.

    Reply
    1. Shiloh1

      Where are these teachers (Our Heroes!) buying their food? A few weeks ago those in the Hinsdale 181 public school district, making high 5 figure and low 6 figure salaries and super benefits were protesting going back to the schools while stationed coincidentally across the street from a Jewel grocery store full of near minimum wage/no benefits workers going about their business as cashiers, baggers, stockers, deli, butchers and cart chasers. For whatever reason the store workers can’t work from home with full pay(?) The sooner this corrupt system collapses, the better.

      Reply
  13. Code Name D

    When a flat-earther is approached with a problem, they often conceive of an add-hock solution for that problem that is inconsistent with other problem/solutions they have presented in the past. They pat themselves on the back for defeating that one “gatcha” question without realizing they made there total argument just that much worse.

    For example, Williamson says, “thanks to contactless supply chains, PPE, and other innovations, many businesses could safely remain open.” But its been argued here at NC that contactless supply chains don’t reduce COVID transmission, it just shifts the risk to invisible Amazon workers. And let’s not forget that its certain business that are remaining open (bars & restraints) that prove to be the major transmission events. In other words, Williamson sees a change in market behavior and assumes these and other “market innovations” work. When you have markets, who need science?

    Williamson also makes another common mistake, blaming the individual while letting corporations off the hook. It’s corporate practices that enable the super-spreader events. Practices such as no sick-time, not providing basic PPE to workers or enabling social distancing practices make super spreader events inevitable. And because of government capture, there is little that can be done to investigated these deficiencies, let alone mitigate them. They do far more damage than the anti-vexers and massless Karren’s.

    First is the observation that our modern world has simply grown too complacent over the decades. A viral pandemic was always a real risk, but society and culture kept further social integration. Be it the air-line industry or mass school consolidation, more and more transman paths for an inevitable pandemic opened up until it was too late. Hindsight is 20/20 of course, never the less there is a profound unwillingness to review those changes because – markets.

    Second, we live in a free-market economy, which means the government is controlled by the markets. Normally, the government would step in and take control of the situation, much like how FDR took control over the economy for WWII, converting nearly all of the US production capacity to war materials, and intense rationing of everything else. Individuals were able to anticipate problems and adapt quickly and intelligently to new developments. Such a transition is simply not possible in a free market. If a free market had existed in the 1940s, the government would simply have to put up with US bankers handling Nasi financing, and US production continuing to make more lucrative consumer products or even making Nasi weapons; you know, because markets.

    How would FDR respond to COVID? He would probably start by nationalizing the hospital system. On day one, he would begin moving material and manpower around where they are most needed. Day two, he would take steps to expand medical capacity as much as possible, including requestioning domestic production to meet the new needs. Any production displaced would then be placed under strict rationing. Day three, he would make direct appeals to Americans to begin making masks, and then ask that they be delivered to the post office so they could be sent to the sent and distributed to the front lines of New York City and other outbreak areas. He wouldn’t just ask Americans to stay home, he would ask them to stay home and get busy. He would lean on the average American to come through. And if FDR was confronted with Amazon, he would probably send in the national guard to arrest the supervisors under charges of treason. I am sure their replacements wouldn’t be as caveolar about worker safety after that. I think you get the idea.

    Reply
  14. Ignacio

    We would have better idea if contagion events would have been identified with precision and if airborne transmission was admitted in the first place. Following with the metaphor here we are leaving the embers unattended and these cause fires here and there mostly in superspreading events that in many cases have nothing to do with essential activities. Last cases I know appeared in a wedding, and in another large familiar meeting where social distancing was relaxed to say the least. I think that most contagions occur in closed places where people drink or eat and masks are removed.

    Months have gone by and we still don’t know, or act as if we don’t know, which are the circumstances that favour disease spread. Nearly every day, when my wife, son or dougther tell me they are leaving I ask: where, with how many, for how long, avoid bars and restaurants… it has to be a constant effort. From time to time I identify some event I dislike and tell them to avoid it. It has to be constant.

    Reply
  15. marku52

    So here is a question. It seems that even tho the case counts are rising, so far, at least, death are not rising as they did in the “first wave”.

    Did the virus become less lethal? I haven’t read any genetics that says it has changed.
    We are infecting more younger folks, our treatments have gotten better (dex, proning, avoiding ventilation, etc). And maybe the first wave simply carried off most everyone that was terribly susceptible.

    It is also possible that due to only testing sick people in the first wave, we missed huge numbers of asymptomatic infections (In fact we surely must have). This makes IFR numbers useless. CFR as well.

    So there is no way to look at the first wave, and make any estimate of how the second or third one might go. I’ve seen arguments that looked reasonable claiming that due to T cell immunity and carryover immunity to common cold exposure, we are much closer to a limited herd immunity than we thought. (maybe some suppression of R0 even at exposures of 20-30% of population)

    The current rocketing case numbers make this seem unikely. R0 in the population is clearly still high.

    But the failure of deaths to rise with cases seems hopeful. At least so far. YMMV

    Reply
  16. Palaver

    Lockdowns are meant to reduce the demand for/on health care, but it is killing GDP.

    Expanding health care capacity and embracing the inevitable is the “wise man doing at once what the fool does at last”.

    Herd immunity is fragile if not nonexistent. A vaccine may not cover all strains. The virus is endemic. The human race could not form a coherent strategy to save itself. Plan to fail accordingly.

    Reply
  17. anon in so cal

    Right at the outset, the authors are illustrating the point made in the Atlantic article posted a while back: Western medicine is overly focused on R0 and thus misinterprets this virus:

    “This kind of behavior, alternating between being super infectious and fairly noninfectious, is exactly what k captures, and what focusing solely on R hides. Samuel Scarpino, an assistant professor of epidemiology and complex systems at Northeastern, told me that this has been a huge challenge, especially for health authorities in Western societies, where the pandemic playbook was geared toward the flu—and not without reason, because pandemic flu is a genuine threat. However, influenza does not have the same level of clustering behavior.

    We can think of disease patterns as leaning deterministic or stochastic: In the former, an outbreak’s distribution is more linear and predictable; in the latter, randomness plays a much larger role and predictions are hard, if not impossible, to make. In deterministic trajectories, we expect what happened yesterday to give us a good sense of what to expect tomorrow. Stochastic phenomena, however, don’t operate like that—the same inputs don’t always produce the same outputs, and things can tip over quickly from one state to the other. As Scarpino told me, “Diseases like the flu are pretty nearly deterministic and R0 (while flawed) paints about the right picture (nearly impossible to stop until there’s a vaccine).” That’s not necessarily the case with super-spreading diseases….”

    https://www.theatlantic.com/health/archive/2020/09/k-overlooked-variable-driving-pandemic/616548/

    Reply
  18. Cap'n Mainwaring

    Mark, at the time Melbourne recorded mid-700s daily cases, its infection rate per capita was about the highest in the world. On the 30th July Melbourne had 723 cases, while the UK had 846. This would mean nearly 11,000 cases in Melbourne if the population were that of the UK. I don’t think that at the time it was a ‘small number of cases compared to most countries’. Thanks for the link in your comment; an interesting read!

    Reply
  19. VietnamVet

    On purpose, the political economy was monetarized in the West and democracies dismantled to promote global trade and transfer wealth from the lower classes to the top. As a natural outcome of this, the Trump Administration is unable to grasp the consequences or control the coronavirus pandemic and is quite unwilling to spend the funds necessary to fight the virus. The public health response was dumped onto 50 States. As a result, the White House is a super-spreader site.

    With the current status quo, the pandemic will never be controlled unless the coronavirus mutates to be less virulent form or vaccines/treatments are eventually developed. Around a million elderly Americans are projected to die early. Two hundred thousand are already dead. To save the remaining 800,000, roughly twice the causalities of WWII, the USA must restore democracy and go on a war footing.

    It is simple to eradicate the virus. Stop transmission from the infected to the uninfected. There is roughly a two-week period when the virus is virulent. The first step is to have universal daily paper antigen testing for everybody. If negative, the person can go to their work, school or social bubble (equivalent to a platoon/company in the military hierarchy). If positive, stay home or paid to stay in safe quarantine facilities, if needed, and require reporting of your status to your bubble Sergeant. If you get sick, you go to the county hospital to be treated for free. Bubble sergeants report directly to district public health officers, who report to county and state chains of command up to the reformed National Public Health Service under the Surgeon General. These State and Federal public officials are responsible for planning, messaging, securing the borders and catching the scofflaws.

    One in place, the virus will be eradicated within months and the economy can return to normal.

    Reply

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