This was more or less the original UK strategy: isolate the elderly and go full-bore for herd immunity. They scrapped that plan after they updated the model to account for ventilator shortages.
There is lots of commentary on that strategy if you want to go back and read it. Even if you were gonna do this, you’d have to figure out how to isolate high-risk populations as thoroughly as possible, to the point of locking caretakers in with them and whatnot. If you lock everyone down, you have a lot more latitude to half-ass things as long as you keep R below 1. Isolating high-risk populations and deliberately pursuing herd immunity means operating consistently under the assumption that virtually everyone else will, as opposed to may, be contagious.
Deaths in the elderly is precisely what the UK strategy is aiming to avoid. Isolate elderly and other at risk groups until there is herd immunity in the rest of the population.
The problem is that most of the people in the nursing home are the residents. If none of them get the disease, The R0 in the nursing home is still going to be well above one. The minute one person who is infected shows up at the nursing home, it races through the whole place.
Meanwhile, in the schools, the intention is to get the rate of kids that are immune as close to 100% as possible. That will be difficult without deliberately inoculating them, because they will develop herd immunity at about 66% in their population and it won't spread in that population anymore.
In the nuclear reactor analogy, it's as if you put in half the control rods, but only the ones on the left side of the reactor. That might make the left side strongly subcritical, but the right side might still be critical, even if with an even distribution of the same number of rods, the whole reactor would be subcritical.
This plan is not going to work and it will kill millions of people in Britain unless Chloroquine or something else ends up being a silver bullet for treatment.
Indeed, you realy want the bulk of those who will not have complications to catch it early and leaving schools open, enables that. Over making every parent stay at home to look after their child!
Coz you need to balance out infections and with that manage them, so you will see periodic lockdowns in some parts to throttle back infection and also those most at risk will see themselves issolating for months and however you do things, you want to be doing that anyhow.
So infect, isolating those who high risk and letting others carry on and manage infection rate with hospital numbers as you will get risk people getting infected anyhow, so focusing on managing infection in those you can and getting it out the way, has logic behind it. yes people will die, they are not flowing that up, but equally, they are planning for those longterm to be lower than falling victim to the seasonal waves ala spanish flu and how that went.
Yes it does seem harsh, but as an older person it is the best plan for the whole and I'm high risk.
I'm not really qualified to comment on this strategy, but isn't this going to lead to stronger exposure to virus specimens per individual, i.e. more severe infections and thus higher CFR?
The actual goal of the UK might be to sacrifice a few people to boost the economy while the rest of the world wrecks its economy.
There are millions of people in high risk groups outside of nursing homes. How do you propose protecting them?
There are also millions of people in low risk groups who care for people in nursing homes and other high risk populations. How do you propose keeping them from infecting those they are caring for?
The thread is also predicated on a very high base reproduction number. A high R0 means a very large percentage of the population needs to be immunity before "herd immunity" is a thing (on the order of 80-90%). Even with a very low IFR, that is hundreds of thousands dead.
Honest question (I initially reacted strongly against their herd immunity idea but I've started to rethink my position):
Isn't there evidence that a high enough proportion of those low risk people would require hospitalization too and that would overwhelm the capacity? That's my only remaining concern about the idea.
I just want to point out that the government has not clearly outlined its strategy, and the reason is that the end-goal is to reach herd immunity in 12-18 month. Infections are OK, what's not OK is too-high rates of hospitalization which leads to death that can be prevented.
It's done by all authoritarian regimes on purpose.
They want people to get sick to shorten the time to herd immunity.
Of you don't care about pensioners dying, only getting to fully working economy the fastest, this may be a strategy to try.
The only problem with this is that people get really scared after thousands of people die in their country from COVID, so I don't think that herd immunity strategy works.
There are ways to limit the number of deaths and still reach herd immunity. For instance by keeping elderly and sick people isolated but the healthier part not, until herd immunity is reached.
This disease has to be handled with intelligence and common sense, not with rethorics and dogma's.
The UK (and I'm not saying I agree with this) says that people are going to get covid-19 no matter what we do, so we want to get as many young healthy people to get now as possible. That means they stop being vectors for transmission, and it means we can manage hospital admissions and "cocoon" vulnerable people.
personally, I think this is a risky strategy that's going to cause hundreds of thousands of deaths and totally over-whelm our hospitals who are already struggling under winter pressures.
The problem is the hospitalization rate is too high even for a younger population. If you could target even 2% hospitalized at 60% of population, you would still need >4+ years at current capacity to get through this. You'd also still lose 1/1000 lives (of younger people) which still is unacceptable.
Why is it guaranteed you need to get herd immunity? Can you not take the Singapore/SK route indefinitely - heavy contact tracing + mask wearing + limit mass groups to keep basic reproduction number under 1 indefinitely?
I appreciate the correction from 99.9% to 97% survival rate for those under 70.
Thank you for sharing the link to the imperial college article. Here are some of my key take aways:
- 100,000's of people will still die even under ideal isolation conditions (didn't see an exact #).
- Isolation must happen until a vaccine is available (likely 12-18+ months).
- If isolation ends before a vaccine is found infections will quickly spike thus only delaying the dreaded hospital overflow.
- Best reasonable NPIs appear to be isolating 70+ and having sick people stay at home.
- The authors state there are many uncertainties in NPI policy effectiveness.
As with any complex topic, nuance and detail is important. The American populace is accepting of mass isolation for a few weeks, but what about months or years?
Do we really want to be isolated for the next 18+ months? Are we comfortable with families losing their jobs, home, and more?
Are we comfortable with the elderly losing a big chunk of their retirement investments which may not rebound before they need it?
Again, if we don't mass isolate until a vaccine is discovered, then all we're doing is wasting time and money with mass isolations.
There are lots of diseases in this world that kill people and we can't control them all. This is a normal and sad part of the circle of life. We must evaluate reasonable measures, with clear and honest public discussions (a stretch, I know).
I understand my perspective against mass isolations isn't popular, but I'm not seeing much evidence to refute it.
There is no reason why an all or none approach is necessary here, is there?
By my count, 10,120/15,740 of deaths have been folks over 70. If you kept people over 70 locked down (including their caretakers), you could significantly reduce the number of deaths while increasing the percentage that have had it.
In fact, only 9% of New York's population is over 70. So theoretically (though clearly not practically), you could get over the percentage required for herd immunity while reducing the deaths by 66%
This is not a selfless thing to do (if it were, we could isolate only high-risk groups rather than everyone). If we all get it simultaneously, and run out of nurses and ventilators, the fatality rate might not be low.
Studies show it wouldn't work if _everyone_ thought like that at the same time. But studies also show that you need to "pulse" the infection rate among low-risk populations in order to get past this in a controllable fashion by temporarily and partially lifting the restrictions on those people and letting them acquire immunity, while carefully isolating and supporting the high risk populations. The fundamental truth of the situation is: 60-70% will have to go through the wringer before this is over. "When", "which subset", and "how" will determine the fatality rate. One thing is absolutely clear: we _must_ completely isolate (and support) the elderly and those with severe pre-existing conditions. Large numbers of immune people could help with that. Complete shutdown of the economy (if such a thing were even possible) would condemn a lot of the vulnerable people to die, since they still need food and a lot of them also need medical care, which could become unavailable, like in Italy.
The UK plan is insane and could result in massive deaths. But hopefully will just be rolled once the deaths begin.
You can read the discussion of the reasons to be pretty certain of the 1%+ fatality rate and how that's catastrophic on the rest of my thread and in more detail elsewhere. As to the UK plan, look here:
"I'm an epidemiologist, when I heard the UK plan, I thought it was satire":
There is lots of commentary on that strategy if you want to go back and read it. Even if you were gonna do this, you’d have to figure out how to isolate high-risk populations as thoroughly as possible, to the point of locking caretakers in with them and whatnot. If you lock everyone down, you have a lot more latitude to half-ass things as long as you keep R below 1. Isolating high-risk populations and deliberately pursuing herd immunity means operating consistently under the assumption that virtually everyone else will, as opposed to may, be contagious.
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