Suppose you agree with me that containment and elimination strategies pursued regarding Covid-19 do far more harm than good. Suppose you also believe that having an open economy and a vibrant close-contact social life is vital for the long-run health of the country. You want to know how to convince the general public who currently support extended lock downs and social distancing measures. And you have quite a bit of money to spend on the issue.
Where you can help is to put the hurt of the victims of the repression strategies on the table. The population needs to be shown the human costs of the policies so as to get them emotionally involved with the victims they have made. It is easy to ignore the pain one causes if one doesnt see it. It is harder to pretend one is nobly saving lives if confronted with the emotions of the victims made along the way.
I think a professional campaign costing tens of millions of dollars and lasting for months is the way to go. That requires big money to get involved and professionally organise the campaign, primarily via television ads. Obvious sources of that big money are the industries decimated by the lock down policies, such as the tourism and hospitality industries.
There are several victim groups that one would think make strongly emotive cases against the lock downs and social distancing measures.
I imagine a woman who missed her last chance at starting a family because of the cancellation of IVF treatments due to corona being able to make a powerful example of the human costs of the “safety” mantra.
I imagine some institutionalised locked-away elderly demented woman continuously asking when she is going to see her family again making a powerful case against lock downs and social distancing.
I imagine a few children from disadvantaged backgrounds rioting in a home whilst the mother cant cope with them, as compared to children going to school, making a powerful visual image of the costs of school closures.
I imagine tearful Australians abroad or in other states prevented from seeing each other being good ammunition against quarantines.
I imagine small businesses whose livelihoods has been destroyed making a strong case against the notion the economy is not about lives.
I imagine family members whose elderly relatives passed away from cancer or some other non-corona disease, but whom they were not allowed to see in their dying days because of the fear, making a strong visual against the inhumanity of the apartheid system that has now emerged.
Etc.
A professional effort is needed to track down the right examples, make high-quality videos, get a good narrator or quick sound-bites, place the ads in front of the right audience, have a clear message throughout the campaign, etc. A bombardment of emotive examples of the human cost of lock downs and the collapsing economy seem a good way to me to try and wean the population off the idea that they are protecting lives via support for lock downs and social distancing.
The ads should not be judgmental or use difficult terms, indulging in statistics or ideologies, because those would allow the audience to dismiss them. All they should do is show the emotions of the victims in the context of how their hurt relates to the policies pursued. Whilst facts and arguments can always be challenged and ignored, hurt is much harder to dismiss.
The hurt of the victims of the policies has to be put on the table.
I am afraid such a campaign would be useless.
As a commenter has said people are not stupid.
Few people wish to get the virus and even fewer want to die from it.
Your problem is you have no alternative.
Herd immunity means lots of people dying. The person suffering from dementia for example. Lots of old people, lots of people with disabilities not to mention the utter decimation of the aboriginal population.
NO nation has actually tried this although some thought about it.
As Margaret Thatcher would have said there is no alternative.
Curiously India’s biggest slum, a place where lock-down is simply not possible, has gone extremely well. Full story.
“57 per cent of residents in Mumbai’s slums had coronavirus antibodies”
wow. and that in the context of very hungry poor Indians with very low reported death numbers. It doesnt quite add up, does it?
You really do wonder whether the authorities are keeping something hidden…
It is India,
however my money would be on they are on average quite young and they had some degree of prexisting tcell immunity – Tcells work less and less well from about 70 onwards.
BTW another result that’s looking more and more solid ,god only knows what’s going on ,
“The new BMJ-Heart COVID paper with 8.3m subjects has smoking data.
It Shows “markedly decreased risk of both COVID-19 disease and intensive care admission in smokers”
…and a greater protective association observed in heavier smokers.”
https://heart.bmj.com/content/heartjnl/early/2020/07/31/heartjnl-2020-317393.full.pdf
Yes, that means according to you 4* prediction, some 228% have now had the virus.
I also suspect the death rates are probably not reported too well for slum dwellers. That being said, they could be lower because they are young (as John notes), presumably living in places you get exposed to large numbers of viruses and hence might have better cross-resistance, and next to none of them are going to have being overweight or obese as a comorbity.
I dislike your idea intensely, because:
(1) The rich people of the world (who might fund your pogrom) are already thought of as having a disproportionate say in the way the world is run;
(2) It would be quite the opposite of having a reasoned debate based upon scientific evidence which I imagine you think you are about;
(3) You could equally fund as campaign of advertisements along the lines: “Oops, I killed granny because I forgot to wear a face mask !! No matter, she was too far gone to change her will. Quite convenient actually !”
So, not at all convinced. Wish I were in New Zealand !
Hi John,
the reasoned debate is had elsewhere, including here on troppo, and indeed on tv possibly too (Gigi Foster is trying!). But because the mainstream media is relentlessly bombarding the population with fear images, there must be a counter-move to get some semblance of balance.
But countervailing forces of unreasoned debate do not, to a reasoned debate, add up.
there is nothing to stop you or others from engaging in that reasoned debate right now! Except emotional reluctance.
Paul don’t know about big money.
Feel that if Victoria’s new case numbers haven’t dropped to say 20 a day by the end of the month, and level four continues on then morale will crack. And even achieving that degree of containment looks like a large project.
Reports are that the residents of the big tower blocks are already at breaking point.
Reports are that the level four restrictions are quite likely to result in serious delays or even outright failures in critical supply chains for example : pharmaceuticals, essential machinery spare parts, even possibly food.
The number of people in severe financial stress can only soar.
Policing normally, largely means dealing with the small slice ,perhaps five percent ,of society that really care little for the law.
The willingness of those under about 40 to keep up the fight ,indefinitely cannot be taken for granted.
Things could get grim.
I gather that the Victorian authorities spoke yesterday of “zero cases”. The number one rule of our RFS is “only attack when you know you can win”
Hi John,
you may be right, but as I said in a previous post, it has surprised me how tenacious the support for lock downs and social distancing are. I did not think in March it would last more than weeks, let alone months or years. The population seems not to notice all the things they are losing. The future and health of their children, the dignity of their elders, the fruition of their life’s work, their own sanity and health. A crowd mentality has taken over in which people have a shared obsession with something they would normally not care so much about.
The obsession of the crowd is vulnerable in terms of its internal information flows, which basically is for sale. I am suggesting someone buys it and shows the population what they have not wanted to see. The reaction of Murph and Homer nicely illustrate this great reluctance to own up to the victims the policies they support have made. The crowd does not want to see the damage it has done to its own members because it would lose cohesion. Some people might actually wake up.
Paul the parts of Melbourne most sharply hit by both the virus and the economic pain are also the most disadvantaged and most likely to speak English as a second language. And it took ages for Victoria’s authorities to issue advice for those who’s english is poor in fact they still haven’t done it. And they nearly all do work that can’t be done at home.
https://www.theage.com.au/national/victoria/a-city-divided-covid-19-finds-a-weakness-in-melbourne-s-social-fault-lines-20200807-p55ji2.html
Little wonder that the rest of the city is not yet too concerned.
Well this idea of letting the infection take an unimpeded course is heartily supported and boosted by Andrew Bolt, Alan Jones and Adam Creighton.
How it is not being embraced by everyone everywhere is hard to understand.
Yes, a fair point.
It’s not as if there’s not a fair bit of powerful support for opening up.
I think these decisions are very hard, particularly with evidence emerging of widespread health complications where the victim escapes death.
I don’t share Paul’s confidence in his ‘herd mentality’ idea. There’s some of that. But I think Paul’s perspective partakes of the kind of fallacy that Nassim Taleb has been so good at skewering, of using intellectual tools developed for the casino where there is well understood risk but no uncertainty.
I think people’s instinct to put their safety from a highly threatening disease makes a lot of evolutionary sense. This video is quite moving to that effect.
It’s pretty arcane ,short of a vaccine the chances of elimination for any length of time are very low. And elimination also depends on us being able to do suppression very well.
Regarding long term complications, am surprised that by now there is still little in the way of data, just anecdotal stuff .
I am sure we all partake in many fallacies.
Quite so
First of all, thanks a lot Paul for sharing a different view than the usual one on the pandemic. Here in Spain, unfortunately, the media basically show one point of view and I guess that dissenting experts don’t dare to voice any opposition. So, some fresh air is truly appreciated, even from the distance.
Although I basically agree overall with your arguments, I am afraid that the strategy you present in this post would not work because (a) it appeals to people’s altruism towards strangers, which is by necessity limited, and (b) people would distrust Big Money’s intentions. With respect to (a), altruism towards our older relatives is indeed a stronger force than benevolence towards strangers. In other words, people support the lockdowns not because they do not anticipate others’ suffering but because they are convinced that the lockdowns are the only way to significantly reduce risk among their parents or grandaparents and, in addition, they grossly overestimate those risks.
I am very concerned that Spain could face a second wave of lockdowns in September-October. The only way out of this, I think, is that a sufficient number of reputed international experts start to defend convincingly the idea of selective, targeted confinements. Further, we need more precise discussion in the media about how lethal the virus is across age groups. In practical terms, experts should dedicate more time to talk about the Swedish experiment. Even if it was very badly implemented in the nursing homes, I think that we can learn from such experience a lot of things about the potential pros and cons of following a well-designed targeted strategy. Sadly, I am not very optimistic that global experts will make that move, either because they are convinced that selective lockdowns are unfeasible or because they do not dare to lead.
Thanks for your intervention Spaniard. I suspect you are right, that we need some of Paul’s critique but also some very hefty policies targeted at the most vulnerable. (I’m not sure Paul would disagree.)
Hi Spaniard (is that you Raul?),
I indeed dont object to what you wish for, but I do think a concerted campaign would help. It would show the victims amongst us and also the loss individuals themselves have incurred, somewhat unwittingly. Many people have kids whose future is diminished with school closures. Many people have elderly relatives now essentially locked away, socially abandoned. Many have other health problems they worry about. Many have jobs and businesses they would normally speaking also fear for.
So it is not so much about the emotions of strangers, but more reminding people about different aspects of their own families and lives.
At least, that’s my hope. Unlike the avalanche of experts descending on Spain and being given a platform, an idea that needs coordination and a change of mind among many, my proposal only needs a few rich people to just do it. In any country.
Yes, Paul, this is Raúl :)
Thanks Nicholas and Paul for your comments. I get your point, Paul, but I am not very sure that people need such reminding.
There is, I believe, a kind of paradox in understanding people’s support for the lockdowns. On one hand, all people seem very willing to endure the costs. For instance, in mid April, a survey in El País, one of the most circulated daily newspapers here, showed that there was no significant difference in support accross income classes. The low income groups suffered most, that is, but they equally agreed with the ‘idea’ of ‘health first’. Also, there are many parents who are very reluctant to take their kids to the school in September (there was a study in mid-July by Ipsos about this). We might conclude that the support is strong and unconditional.
On the other hand, we see in the surveys something not so unusual: Most people think the economy will globally suffer a lot, but the share of households who expect a decline in their own standard of living in the future is much less reduced. In other words, people seem too optimistic about their own prsopects (in Spain, this is partly motivated by the expectation that the rest of Europe and the ECB will help, I guess). It might be the case therefore that support is not so unconditonal, but based on citizens’ positiveness about how large the costs will be and how they will be shared ‒of course governments have not insisted in openly discussing these issues. I am not talking about school closures, but about future increased taxes and public spending cuts. The public deficit in Spain will be huge this fiscal year, for instance, but it is rather nebulous yet who will have to tighten their belts, and by how much.
Going to the point, a precise, non-emotional debate on the extent of the monetary costs and their distribution **might** change minds and increase support for the less costly targeted lockdowns, even if they happen to be (a bit) more risky. Particularly if the debate is led by an ideologically representative sample of experts. In this respect, I think that there is no way around: we need a fair share of experts, both to improve citizen’s understanding of the risks of the virus (and particularly the age gradient) and the costs of the general lockdowns. Btw, Big Money could help in coordinating those experts; it would not be so costly, I guess.
Well Nick that isn’t herd immunity ( which did not occur in Sweden by the way. please tell Gigi and whose example we do not want to follow as the Grattan
Institute so well showed.)
What you are saying is having a clayton’s lockdown for the vulnerable which would invoke a lot of bureaucratic costs however given the comments on the couple having IVF treatment The Paul is somewhat muddelheaded then.
Can I just say to out latter day Admiral Nelson ( not not that one think seaview and the late great Walter Pidgeon) he is mistaken again in another two areas
He thinks it is bad that people die of the virus in an ICU with no family members around.
Well if they died at home it would be worse. It is a terrible slow and painful death and that is how the family members would remember them.
The other is thinking a couple who need IVF to have a child are so selfish they would put other people at risk to have the child. To use IVF require a lot of patience. They know lockdowns are temporary and they also want their parents and even grandparents around when the child arrives. They would not want them dead.
This policy has echoes of eugenics about it.
Re Sweden
https://www.youtube.com/watch?v=CwQpg62Kflg
Freddie Sayers talks to Swedish doctor Soo Aleman about Covid-19.
We hear a lot about Sweden’s experience of Covid-19, with the New York Times declaring this week that that country is now “the world’s cautionary tale.”
But what’s it really like on the ground?
Dr Soo Aleman has been both on the front lines of the Covid-19 epidemic as a senior physician at Stockholm’s leading Karolinska hospital, and on the research side, as Assistant Professor at the Karolinska Institute and one of a group that last week published new data around T-cell immunity.
We talked to her about the findings of that study, and how it matches what she is seeing in her hospital.
Link to the Karolinska Institute T Cell study:
https://news.ki.se/immunity-to-covid-…
Key quotes:
“Intensive care units are getting empty, the wards are getting empty, we are really seeing a decrease — and that despite that people are really loosening up. The beaches are crowded, social distancing is not kept very well … but still the numbers are really decreasing. That means that something else is happening – we are actually getting closer to herd immunity. I can’t really see another reason.”
“I can’t say if the Swedish approach was right or wrong – I think we can say that in one or two years when we are looking back. You have to look at the mortality over the whole period.”
“I don’t think that we have more new cases, I think we are just detecting more cases”
“We found that if you have a mild case you can be negative for antibodies afterwards … in those almost all of them had strong T-cell activity. This study says that there are cases that you can have a strong T-cell response even though you have not had antibodies, meaning that you have encountered the virus and built up immunity.”
Whether or not the Swedish experiment is a success, their economy has suffered just as much as their neighbours’, so this line of argumentation is a stupid as it is nasty.
Really nasty.
Toshi
Think the Swedes would reply that the only difference between the results of their response and the responses of most other nations is that they, got it over and done with it quicker.
Am happy to pay $100 to whatever charity you favour, if by this time next year the figures for Sweden are significantly higher than for the rest of Europe. Personally I’m certain that given time they will all be much the same.
The comment was not about the corona virus statistics being worse, it was about the economy being no better
ToshiSweden is a trading nation its economic problems when the rest of the world does ‘stupid’ are hardly its fault,no?
please do not use such words as “stupid”. We keep discussions civil here on Troppo. It’s the only way for people to have a real exchange of views. Personally derogatory attacks merely gets egos and aggression involved, which crowd out thoughtful deliberation.
So even though we often vehemently disagree with each other and might secretly think all kinds of unkind things about the position of the other, we venture to keep it civil on Troppo.
You should apologise.
Which coronavirus did people ever get herd immunity for? I imagine a more sensible question is whether they have herd immunity now, and, if so, how long it will last before it wears off.
Based on the big Spanish study where there were large differences in antibodies based on where people lived, I find it unlikely. Even if they have herd immunity in Stockholm, all the other smaller places are unlikely to have it. In this respect, it will be interesting to see how winter goes for them (remember how easy it was to get rid of in Australia in Summer?).
Conrad
Two reports by a Swedish Doctor:
How bad is covid really? (A Swedish doctor’s perspective)
“Covid hit Stockholm like a storm in mid-March. One day I was seeing people with appendicitis and kidney stones, the usual things you see in the emergency room. The next day all those patients were gone and the only thing coming in to the hospital was covid. Practically everyone who was tested had covid, regardless of what the presenting symtom was. People came in with a nose bleed and they had covid. They came in with stomach pain and they had covid.
Then, after a few months, all the covid patients disappeared. It is now four months since the start of the pandemic, and I haven’t seen a single covid patient in over a month. When I do test someone because they have a cough or a fever, the test invariably comes back negative. At the peak three months back, a hundred people were dying a day of covid in Sweden, a country with a population of ten million. We are now down to around five people dying per day in the whole country, and that number continues to drop. Since people generally die around three weeks after infection, that means virtually no-one is getting infected any more. If we assume around 0.5 percent of those infected die (which I think is very generous, more on that later), then that means that three weeks back 1,000 people were getting infected per day in the whole country, which works out to a daily risk per person of getting infected of 1 in 10,000, which is miniscule. And remember, the risk of dying is at the very most 1 in 200 if you actually do get infected. And that was three weeks ago. Basically, covid is in all practical senses over and done with in Sweden. After four months.”
and
What is the best way to measure rates of covid immunity?
“A study carried out at Karolinska Institutet (where I went to medical school), which is still awaiting publication, looked at the presence of both antibody-based and T-cell specific immunity to covid among people in Stockholm. The data was collected during May. The first covid fatality in Sweden was in mid-March, so at that point covid had been raging for about two months.”
I’ve read those descriptions. Try substituting “influenza” or any other virus into where “Covid” is. You will notice the fact you can go to close to zero in countries without great population density is what happens with most viruses every year. But this doesn’t stop you getting hit the next year, and the next, and so on ad infinitum. When Sweden doesn’t get Covid again in winter, then I’ll believe it.
It’s also worth noting that the smaller places in Sweden which didn’t get hit as badly (and hence are not at the level of immunity Stockholm is) are also close to zero. So it must the case you can get to zero, with or without immunity in Sweden (and Australia, in summer at least).
Here’s a good paper for you John: https://www.medrxiv.org/content/10.1101/2020.05.11.20086439v2.full.pdf
I’ll wait until it gets reviewed properly, but it looks like the chance of long-term coronavirus immunity even after catching it is not going to be very high. Given this, it is likely herd immunity won’t actually be achievable.
Conrad
https://www.sciencemediacentre.org/expert-reaction-to-a-commentary-on-herd-immunity-in-sweden/
“ you are here: science media centre > roundups for journalists > expert reaction to a commentary on herd immunity in sweden
AUGUST 12, 2020
expert reaction to a commentary on herd immunity in Sweden
A commentary piece, published in the Journal of the Royal Society of Medicine, discusses COVID-19 herd immunity in Sweden.
Dr Julian Tang, Honorary Associate Professor in Respiratory Sciences, University of Leicester, said:
“This is an interesting report though I note that no Swedish public health co-authors were involved.
“The data is a bit patchy, for example, no serology data is given from Finland and Norway in Table 2 – and the line for Denmark seems to have been included with the UK data – likely a formatting error.
“If we assume that what they show is what was available at the time of writing, and that it has been accurately mined from the references given, it appears that the seropositivity rate in Stockholm (17%, Sweden) with no drastic lockdown measures, is about the same as Gangelt (14%, Germany), London (17%, UK) and New York City/State (12.3-21.6%, USA) – during April-May.
“Unfortunately, it is difficult to completely contextualise this data in terms of interventions, as Table 3 does not show the interventions implemented for Gangelt, London or New York during this period, but from what we know from the contemporaneous media and other coverage, all these other locations had imposed some form of lockdown by end of March 2020.
“So, we might have expected that any increase in the number of infections and therefore herd immunity in Gangelt, London and New York would have been frozen during the lockdown, yet that for Stockholm would have continued to rise further. However, there are no additional serology results beyond April shown in this paper to compare and demonstrate this difference between the seropositivity rates between each of these locations into June/July 2020.
“So the data seems a bit disjointed, but maybe that was all that was available for data-mining at the time of writing this article.
“Yet, if we assume that the Norway and Finland seropositivity rates were similar at the time to that of Denmark (2%, April, Table 2), where similar levels of interventions had been implemented (Table 3), you may well end up with the COVID-19 mortality plots shown in Figure 1b. As these are shown up to the end of June 2020, these also imply that the seropositivity rates for Sweden would be much higher than Norway and Finland at that time, given the number of daily new COVID-19 deaths per million population shown (since the more severe infections are likely to produce seroconversion).
“Ideally, we would really need to see the SARS-CoV-2 IgG seropositivity rates for June/July 2020 to compare the current levels of herd immunity across all these locations.
“So the authors’ conclusion from their title: “Four months into the COVID-19 pandemic, Sweden’s prized herd immunity is nowhere in sight” may not be entirely accurate and a bit premature – because we have not seen and compared the updated seropositivity rates for June/July 2020 across these same locations – at least from what I can see presented in the paper….”
Feel that it’s too early to tell, particularly because Tcell resistance is harder to test for etc.
Also as best as I know current cases in Sweden ,unlike much of Europe, are not rising .
BTW if natural immunity arising from infection by a related but not quite the same virus was not possible then inoculating with cow pox would not have worked.
john,
Sweden did NOT indulge in herd immunity.
They had an informal lockdown.
Google stats show little difference in how people reacted in Germany ( formal lockdown) and Sweden ( informal lockdown). After all you do not wear masks not engage in social distancing if the nation has adopted herd immuinity.
I call this The gigi foster disease.
I think the Swedes in my terms believed that , in the absence of rain, what will burn will burn.
And that ineffectual attempts to change that, claim authority over things that are beyond human control, would if anything make outcomes worse ,not better.
Yes, and I think other countries will learn this over time. Daily deaths in Sweden have dropped to near zero. The numbers show a virus which has burnt itself out.
Conrad
There are tens of millions of viruses, most of them we live with with only the occasional problem for some who are infected. Herd immunity is the norm.
That might well be, but it isn’t true of all viruses, presumably including coronaviruses (and obviously there are lots of viruses no-one wants to catch). As these guys note:
“Our study also shows that herd immunity may be challenging due to rapid loss of protective immunity. It was recently suggested that recovered individuals should receive a so-called
“immunity passport”which would allow them to relax social distancing measures and provide governments with data on herd immunity levels in the population. However, as protective immunity may be lost by 6 months post infection, the prospect of reaching functional herd immunity by natural infection seems very unlikely.”
Now just imagine if the neurological damage people are getting from the virus compounds like it does with concussion (if you look at the table one person managed to catch one variety of the virus 12 times in 25 years)
Conrad
True story in 1981 a man was truly worried about the chances of nuclear Armageddon. So he did a lot of research and identified the safest place on the globe re fallout. A week after he moved in, in early 1982, the Argentines invaded.
Nicholas
Extreme Lockdowns are a tiger of a policy , easy to get on to ,but hard to dismount .
Paul eventually the truth about the Victorian hotel quarantine must come out. And pragmatically that cannot be delayed until we get to “zero cases “ – that would need delaying it for many more months (or even years). And when the truth does become public, public morale : willingness to obey orders will crack.
https://www.smh.com.au/politics/federal/accountability-in-a-pandemic-why-aren-t-more-people-mad-at-dan-andrews-20200807-p55jnn.html
All states had to rush their quarantine set-up, and the process was messy, involving much human distress and some very bad hotel food.
It has become increasingly clear, despite Premier Andrews’ attempts to deflect questions, that his government bungled this in Victoria with the appointment of private security contractors to manage the hotel quarantine inmates.
Media reports this week said many of the guards couldn’t cope with the stress and hostility of the pent-up people. They lacked the professionalism and discipline the armed forces or the police brought to quarantine enforcement in other states.
No democratic government wants to restrict the liberty of its citizens and then police them, but that is where Victorians have ended up anyway.
Security guards hired for hotel quarantine in an attempt at social inclusion
In the early days of the pandemic, it was the queues in front of Centrelink that shocked us. Now it seems impossible to believe we are seeing police boots march the darkened streets of Australia’s second most populous city, enforcing a state-mandated curfew.
Nicholas
Elimination is a phantasy ,akin to victory in the war on drugs.
The collateral damage however is not a phantasy .The damage is demonstrably real yet the benefits are theoretical. Am happy to bet $100 to your favourite charity that in a year from now that the figures for Sweden are about the same as for the rest of Europe …
Totally agree Paul. The average person has no interest in facts and stats – I’ve learned that for 4 months now. Minds will only be changed by emotional personal stories. The big problem with this strategy would be government censorship. And many of the fearful millions will support such censorship.
I think the federal government secretly opposes lockdowns because they are bad for business. So they might not want to censor.
Agree, the goverment can’t ignore how reality keeps affirming itself. At some point someone will have to pay the bills …
Nicholas
It’s obvious that the reason for ‘elimination’ as a policy is because the system-institutions can’t do suppression- containment .
In short the reason for elimination as a strategy is to protect the institutions. That’s a very ‘Melbourne response’ .
I think this too — Isn’t that why elimination might seem like a good idea in Australia but suppression-containment is a better idea in Asia (where people are more decent about infecting others) ? Because despite out massive geographical advantage, we still can’t do suppression. Perhaps we will as the bodies pile up in Melbourne and give people something to think about more.
Conrad if you cannot do suppression-containment extremely well then , once its spread out into the community as it now , how can you get to elimination?
And much of the community transmissions have involved people doing essential jobs: aged care , quarantine guards , food processing and distribution centers.
Many of them speak english as a second language.
And they are often working in places where either no work = no pay or when there is paid sick leave , finding enough qualified substitutes- for example forklift drivers, trained cleaners and nurses is not easy ,or are employed in places where the management systems were-are not up to it ( which seems to be the case re the Quarantine hotels).
The government is going to have to try harder. In Victoria they already upped the ante in terms of fines, door knocking, arresting agitators (i.e., people protesting against masks) etc. and it has to some extent worked. I suspect they will simply get more authoritarian if it doesn’t work at the current level and there is not much people can do. Indeed, there was a survey out yesterday, and the majority of people support it over economic consequences (although perhaps they’d change their mind in hindsight).
Carrots may work as well, so they can catch the cases you are talking about better. In terms of sick leave, that one is easy. People will simply have to get used to not having anything or service they want 100% of the time. If this is already a problem with nurses, you can see why having too many Covid cases at one time is not going to be great.
Conrad
“ People will simply have to get used to not having anything or service they want 100% of the time.”
Does that include pharmaceuticals and food?
Pharmaceuticals are not likely to run out as most can be mass manufactured and those that are critical can be treated differently. As for food — I couldn’t get frozen raspberries today, is that going to kill me? Things like like meat might run out for a few days too, but it is not going to kill anyone (indeed, less meat might make people healthier). As I’m sure you remember, once upon a time we couldn’t buy anything at any time of the year, and it wasn’t the end of the world.
Conrad it’s the distribution system that matters not the manufacturing.
And as NZ is showing getting down to zero and staying at zero is not easy even when you’re as isolated as NZ.
Its not just distribution. Abattoirs are causing problems world wide (and getting closed), so it would be unsurprising if the supply of meat was reduced because of this.
The head of australia post in Victoria the other day spoke of serious problems re the distribution of pharmaceuticals caused by the lockdown
Conrad should we fine people for doing essential work ????
No, but we should fine people who were not staying home after positive tests, or who were potentially positive as they were in contact with people who were positive (both of which caused some of the problems in Melbourne). If not, tracing is not going work, and if you don’t want to use tracing there is only one solution if you want to get numbers down (i.e., lock everyone down as Andrews has done, presumably in part due people not respecting the other rules).
In general the people most hit by by the anti Covid19 measures are younger and at the lower socioeconomic end.
Little wonder that protecting the likes of us, English as a first language, are older and fairly well off members of the ruling class is more important.
Conrad the threads are getting too thin
Even Japan ,which for a bit over 200 years under “Sakoku” , isolated itself from the world still allowed some imports and some trading. (For example the lacquer needed for making lacquer ware was extracted from Vietnamese trees.)
For elimination of Covid19 to work for more than a few hundred days at most, containment- suppression needs to work ,incredibly well , all the time.
Pragmatically that is not a strategy ,rather it’s foolhardy, wishful thinking , doomed to fail.
There was no point in seeking to convert the intellectuals. For intellectuals would never be converted and would anyway always yield to the stronger, and this will always be “the man in the street.”
Arguments must therefore be crude, clear, and forcible, and appeal to emotions and instincts, not the intellect. Truth was unimportant and entirely subordinate to tactics and psychology.
British Historian Hugh Trevor-Roper in his book “Final Entries 1945” based on Goebbels’ diaries.
Yet human beings love to believe they are rational and logical.
Hard to feel much hope for the world, and for democracy in particular, when truth is so unimportant.
Mind , eternal truths did ‘win’ as in : fighting wars on multiple fronts and invading Russia, in the hope that your opponents moral would fail ,long before you ran out of resources, proved as always to be eternally bad ideas.
The real world odds are very stacked towards elimination( without a working vaccine ) ,in practice simply being a more expensive version of suppression plus ,by raising false hope , being destructive of morale.
Doing cost benefits of perfect vs reality seems to me , at best to be totally academic .
Dear Paul, have you used ‘incremental cost-effectiveness ratio (ICER)’ in any of your calculations or processes or opinion formation please?
John Sternman as modeller.
“Estimating COVID-19 Under-Reporting Across 86 Nations: Implications for Projections and Control
93 Pages
Posted: 1 Jul 2020
Last revised: 4 Aug 2020
Massachusetts Institute of Technology (MIT) – Sloan School of Management
“Abstract
COVID-19 prevalence and mortality remain uncertain. For all 86 countries with reliable testing data we estimate how asymptomatic transmission, disease acuity, hospitalization, and behavioral responses to risk shape pandemic dynamics. Estimated cumulative cases and deaths through 10 July 2020 are 10.5 and 1.47 times official reports, yielding an infection fatality rate (IFR) of 0.65%, with wide variation across nations. Despite underestimation, herd immunity remains distant. Sufficient early testing could have averted 39.7 (35.3-45.3) million cases and 218 (191-257) thousand deaths. Responses to perceived risk cause the reproduction number to settle near 1, but with very different steady-state incidence, while some nations experience endogenous rebounds. Scenarios through March 2021 show modest enhancements in responsiveness could reduce cumulative cases ≈80%, to 271 (254-412) million across these nations.
Rahmandad, Hazhir and Lim, Tse Yang and Sterman, John,
Estimating COVID-19 Under-Reporting Across 86 Nations: Implications for Projections and Control
(August 3, 2020).
Available at SSRN:https://ssrn.com/abstract=3635047
Any comment anyone? NG? Dugald?
sure, I know about ICERs. I teach this kind of stuff. An ICER is pretty much a cost-benefit ratio with a nominated best alternative to the supposed treatment. So it needs a counter-factual as all cost-benefit analyses, cost-effectiveness analyses, and indeed any choice at all. So I can re-write all my previous analyses as ICER (and indeed often have given ratios).
I dont think the piece you cite is worth discussing. There are more thoughtful pieces than that in the “pro-lockdown” camp.
I haven’t read that paper. I guess I’m not that interested in anything attempting to support lockdowns and distancing because of the mountain of evidence against it.
Their conclusion that “herd immunity remains distant” is clearly wrong. Look at any of the countries and regions where the virus has run its course (New York, Italy, Sweden etc), daily deaths have collapsed to near zero and herd immunity has been achieved.
JB Handley’s blog is really good on the herd immunity issue. He collects evidence that the herd immunity threshold originally believed to require 60-80% of a population to be infected is probably closer to 15-20%. This may be because there is a high level of natural immunity to covid-19. Maybe it’s not so “novel” after all.
Conrad
Elimination promises that if we push hard enough then we can, at least within a quarantine wall, live normally.
The Swedes believe that if we allow Covid19 to burn what it will burn , we can again live normally.
However anywall no matter how skilfully designed and manned will have leaks.
But we can also be sure that any area that has burnt will in time burn again.
The theatre of politics demands the appearance of control and actively acts against the kinds of feedback needed to improve real world performance .
So we will be stuck in a kind of zigzagging limbo until either exhaustion or blessed rain happens.
John — I agree with you that elimination is essentially impossible. The best I think we can hope for is something like Japan who have 50K cases despite 126 million people living on top of each (and hence having a vastly high risk of transmission than here), and they never had exponential growth. I can certainly put up with those odds. But Australians will have learn to wear masks, wash their hands, be clean, not go to work sick etc. to get there. But people don’t seem to care for that sort of a solution yet.
As for the herd the immunity stuff — trying to get it in a big bang seems ludicrous to me, especially given how quickly immunity wears off (which I wasn’t aware until recently — I was aware it did wear off, but not that it essentially did for all coronaviruses and did very quickly). I don’t even think its worth considering any more. In this case, if the best we can hope for is 3 years immunity, then that is hardly enough time for everyone to get it even without trying to avoid it. So you really would have to go for a big bang to be protected for a short time. Alternatively, if people lose immunity in a year (or less), you can just imagine how that is going to look for all the places that thought not worrying about keeping the cases low was a good idea — especially because the non-death consequences (neurological damage) now seem far worse than people thought to start with, and the consequences of getting neurological damage more than once in other other areas (e.g., concussion) is cumulative and has non-additive consequences in the direction you don’t want.
Conrad
Data from China indicates that the really high risk of transmitting is within households, not out on the street and the like . (Obviously the Chinese do wear masks etc. )
While Japan is crowded their individual houses are on the whole not crowded.
Again in the west the worst outcomes are among people where there are many people living in the same house. ( and most aged care places essentially fit that description).
In short it’s less about wearing masks and the like ,and more about the number of people sharing the same home.
The questions re immunity seem to get more complex by the day, time will tell. (It might endup resembling flu but who knows.)
Re long term after effects ,you know of any studies from Sweden or Australia ?
Saw a very apt statement for the situation in Melbourne as a comment somewhere else:
”
if I had fronted up to my PhD or Masters thesis university ethics committing asking to lock up 50 human subjects for 23 hours a day with an hour in the exercise yard to gain insight into the social, mental, emotional and physical effects of isolation on their overall wellbeing, I would have been tossed out on my ear for suggesting something so unethical and immoral. Then I would have been recommended for further psychological testing to find out why I thought such an egregious experiment was such as good idea.
Yet, here we are.
”
My solace and hope is that civil liberties did not arise because of moral reasons or individual fortitude, but because totalitarianism is inefficient and loses out to other systems. If nothing else, people eventually vote with their feet.
Yup, here we are. Elimination at any cost.
Michael Wyres
@mwyres
Level 1:
My dad is dying in #agedcare in Ballarat. He’s in his final days. We can’t get in to see him. The centre is locked down completely, and there are no COVID cases in his centre.
There is a way to manage this in these centres… #insiders
9:16 AM · Aug 16, 2020·Twitter Web App
It has not burnt out in Sweden.
This statement might be correct if a large majority indeed most had gotten the virus.
This has not been the case, most have not.
What is more likely is the large death rate in Sweden from the virus has made most of the population very wary. The complete opposite of what has occurred in Victoria for example.
By the way a public hospital cannot tell people suffering from the virus to sod off and employers cannot keep employees on knowing they have the virus
From News
How coronavirus devastated a family from Sunshine
On Friday July 17, Tina Dinh begged her mother Dung Huynh, 60, not to go to work.
Coronavirus cases had been confirmed among her colleagues at Bertocchi Smallgoods but, as a casual worker, Dung felt she had no choice.
By noon, Dung and her workmates were told to go home, undergo COVID-19 tests and isolate.
“Over the weekend, it was scary because she had call after call after call from people crying and saying they had tested positive,” Tina said.
“Over the weekend, there were 17 who had tested positive.
“From that Sunday onwards my parents got sick — really, really sick.”
After initially testing negative, Dung and husband Hoang, 72, underwent another test that came back on July 25, confirming both had COVID-19.
Although symptom-free, 26-year-old Tina underwent a test that afternoon, but soon realised she didn’t need to wait for the result.
“From Sunday, I just woke up and I knew I had COVID. You just feel it in your bones.
“This isn’t normal sickness. You suddenly lose your sense of smell, you lose your sense of taste and you get this constant 24/7 headache.
“I remember getting these chills I couldn’t shake off.”
Although her parents were already bedridden, Tina quickly became the sickest person in the household.
Despite her young age and lack of underlying health issues, aside from mild asthma, she suffered a constant temperature, headache, nausea and chills — finally needing an ambulance at 8pm on July 29.
At Footscray hospital, Tina rallied over the next 24 hours and was discharged with a machine to monitor her oxygen levels at home, and was getting regular phone checks from Western Health’s “hospital in the home” medics.
But once at home, she was alarmed to find her father had been sent to Sunshine Hospital. After shivering through the night, he had become partially unresponsive.
By Saturday morning, Tina’s own oxygen levels had plummeted to a dangerous 84 per cent and doctors urged her to return to hospital.
Paramedics arrived just in time.
“They took me straight away because I couldn’t breathe. It happens very, very quickly and you stop breathing. You just can’t take in any air,” she said.
“I can’t even describe it. It is the most terrifying feeling because you don’t understand why.
“You are trying to do everything you can with your mouth and your nose, you are trying to gasp in the air, but nothing is going in. It is like suffocating.”
A team of about 10 specialists in Footscray Hospital’s respiratory unit quickly realised they had no choice other than to place her on a ventilator in an induced coma.
Four days later, Tina woke up alone, trapped in a plastic bubble with tubes coming out of her throat and everywhere else.
“When I opened my eyes I didn’t know how long had passed and I didn’t know where I was.
“I just remember lying there being scared, really scared. I was completely alone and I didn’t understand what was happening to me. All I knew was that I could not breathe.
“I owe the doctors and nurses my life. I can’t describe how much love I have for them.
“The only thing I looked forward to every day … every time they came in the first thing they would do is hold my hand and give my hand a squeeze.
“That was the only contact that you can get, and the only reminder that you are still here.
“It is a really surreal experience being trapped under that plastic 24/7. You reach out and you don’t touch anything, you just touch plastic.”
Over the course of several days, Tina became more lucid, but hit rock bottom when she learned her father had been intubated on the same day as her. Worse, Hoang was still too sick to be taken off life support.
“There were these moments where I just wanted to die. It was unbearable. I couldn’t deal with it any more.
“I was worried about dad, but I just didn’t want to do it any more.”
When well enough, Tina was able to check her phone for news of the world outside her bubble. What she saw was horrifying.
A 33-year-old Melbourne man had just died from COVID-19, and Tina feared the possibility of soon being reported anonymously as “a woman in her 20s”.
Her fears then turned to fury.
“I was really scared and to see the news of people protesting the lockdown, to hear about people not following the rules and calling it a hoax. I was angry.
She says she thought at the time: “I am stuck here. Nobody knows that people like me … we are in ICU right now and I can’t breathe on my own. I want to rip everything off because I have so many things attached to me right now, I have needle lines everywhere and this is real.
“I don’t understand what there is not to believe.”
Determined to return home and support her mother, Tina was finally able to leave ICU and eventually returned home on Monday.
Having had pneumonia and still positive for COVID-19, it will take months for Tina to recover from the worst the coronavirus threw at her.
“You have no strength. There is no dignity because you can’t do anything on your own.
“I still can’t even sit up for longer than half an hour.
Video: Vic records another 264 ‘mystery cases’
“I have no muscle strength. You can’t walk, you can’t even stand up so physiotherapists have to help you build your muscle again.
“I don’t have a spot on my body where they didn’t actually inject or do something to me.
“I have COVID taste in my mouth — it has a metallic taste and it just doesn’t go away. I even woke up at 4am this morning just to brush my teeth because I couldn’t deal with it.”
But Tina’s focus is now all on her father.
The ventilators that have preserved Hoang’s life for a fortnight must now be removed before his body suffers further damage.
Still battling pneumonia and three infections, Hoang’s heart and kidneys are strong which is a good sign, though nobody knows what will happen when he wakes.
“I’m hoping he gets better soon because we all miss him so much. We FaceTime him every day and it is so hard to see him like that, we just want to hold him,” she said.
“He hears us. Last night, he was really trying hard to move and he was crying, so the nurses were dabbing his eyes.
“It breaks your heart because the doctors and nurses are saying: ‘He’s trying to respond to you.’”
Seems to me that a critical ,but still missing figure in all this, is not the mortality rate, rather it’s how many of those under say fifty that suffer some degree of illness are still seriously ill after say one hundred days.
We know that the vast majority of the dead were already in the last years of their lives, but we also know that the majority of total infections are in much younger people, so the prognosis-odds for them is important for any balanced thinking.
So far all I’ve seen are ‘anecdotal’ reports of long term problems -terrible for the sufferers -however answers to this question : are they outliers in the millions of younger people who are listed as recovered or are they a significant percent of those millions ? Seems to be completely absent.
Most of the data shows most people who go to hospital get pretty reasonable symptoms for quite some time. I haven’t seen any Australian stuff. More importantly, if it’s anything like concussion, there are common and nasty long term effects. Like I noted, these compound, so betting your money on an untested theory that currently goes against most of what people have previously noted about coronaviruses (you can get them multiple times), is quite a bet, and if you are wrong, likely to be extremely expensive one.
https://qbi.uq.edu.au/concussion/how-long-does-concussion-last-long-term-effects
Conrad can we usefully compare the after effects of Covid19 with the after effects of, concussion?
Millions of younger people have had Covid19, and that’s only the ones we know about, and god knows how many tens of millions have had infections of related viruses .
So why the lack of data?
Given that elimination is extremely unlikely
( even if we get a vaccine I.e. it’s likely to be as imperfect as the flu vaccine)
Then; if a very large majority of adverse outcomes are the death of a person aged 65 or more ,then a focus on the whole of society ( rather than on the over 65 and othe vulnerable groups ) is both a waste of resources assets spread too thin, and also taking the risk of significant collateral damage and losses – a poor wasteful strategy .
So data on the number of younger people with lasting serious after effects is essential I feel to judging whether whole of society treatments are justified or are unjustified, or possibly worse than that.
It’s basically a known unknown as Rumsfeld would put it — We don’t know what long term effects it will have, because we don’t know enough to predict them. This is why there are things like the “Cognitive Reserve Hypothesis” which basically says:”We see great variations in brains from things like disease that don’t correlate well with outcomes, and some social ones do a better job”. Now just imagine if you don’t see big differences in people’s brains (like, for example, people who have been concussed once).
If you want a good example on what you can find that wouldn’t have been predicted in terms of brain damage, just look at the effect of drugs. If you smoke heaps of cannibis for years, it won’t do anything. If you drink heavily, you will certainly decline, but it won’t be until you get old (but daily light drinking will do nothing). If you take amphetamines, your brain will be fried quickly enough.
So you can see why you arn’t going to get a good _long term_ answer from something that has only been around 6 months. Just look at the history of concussion. People didn’t worry until more recent times, when they first started looking at people doing sports like rugby, boxing etc. . Then they started looking more carefully, and only more recently was it found out that concussion is bad news (especially heavy concussion), but it is later life when you see the big effects.
Conrad
Was thinking about the percent that after say three months are still seriously effected.
The concerns you raise about what might happen in say thirty years from now ,are too abstract , to be the basis for how we allocate assets and resources, now.
There is a huge list of things where the government acted or should have acted early that required forward planning in decades, often to things which were abstract at the time. This includes both health and non health things. For example: Smoking, asbestos, HIV, trans-fats, prion diseases, tight drug standards (thalidamide), global warming, fisheries, aging (yet to come), economic deregulation….
Conrad serious infectious diseases pandemics need , tight focus , squandering resources on what might happen in twenty years ( which could be almost anything or nothing )and the resulting very evident confusion of chain of command is not how you deal with an emergency
It’s not an emergency anymore — it’s something we have to deal with and something which we have a good idea about dealing with. So we either choose to do nothing, keep cases down, or get rid of it. Keeping cases down has the added benefit of keeping other damage down. I don’t think we’ll ever get rid of it until a vaccine turns up (now looking far more likely).
Incidentally, early recognition of potential long term problems and actions that were performed for many of those examples I gave saved huge amounts of lives and billions of dollars. That’s why Australia had almost no HIV and why we couldn’t smoke in our office a decade before Euroland stopped it . It’s also why if I want to buy an asbestos concrete sheet, I now need to go overseas to do it.
Conrad thread is too squeezed
Of the examples you gave only HIV is an , infectious condition (and it needs fairly special situations for it to transmit). People with mesothelioma do not transmit it to others.
It still is an emergency; the example of how just a tiny few leaks out of quarantine could result in the lockdown of the whole of Melbourne and most of Victoria (and total panic in NZ) gives the lie to your assertion.
Our public health systems are not focused on infectious pandemics and it shows, they are not fit for purpose and must, will be, rebuilt.
Perhaps we just have different definitions about what an emergency is, but if not, then generally the first priority in an emergency is to minimize immediate risk and remove those in potential danger. If this is the case, we don’t need to worry about trade-offs in 10 year times like unemployment and economic damage yet.
absolutely totally wrong ( I’ve been an eye witness to real leadership when the shit hitting the fan was very hot)….
from a command and control perspective, it’s all about where you focus your , of necessity, limited resources to achieve the best outcome.
And also it’s about protecting, as best as you can ,what resources you currently have, which for example ten years of economic collapse will certainly reduce enormously .
Doing things as ‘we have always done them’ is not possible.
The system as it stands I.e. it’s rigid focus on whole of society treatments for everything, is not fit for purpose in a pandemic, it must and will change .
alas and alack Mary Louis McClaws informs us the practice of herd immunity does not stack up to the theory. Admittedly early days but it is looking bad.
Add this to basic legal research which tells anyone herd immunity could not be implemented any way and also people’s behaviour which would also make it impossible then it makes the let her rip strategy much ado about nothing.
no wonder the proponents are vague about what it is and how it would be implemented!
The Swedish view was and is that this is a marathon, the restrictions that they implemented at the beginning are still in force. What they are not facing is a wild unpredictable occultation between extreme lockdowns and brief periods of easing. What they admit to having got wrong is they didn’t target their testing on health workers particularly those involved in aged care.
As for the “emergency being over” far from it , fear is still ruling most with its resultant inability to focus clearly on what is of primary, secondary and tertiary importance.