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Relaxation of restrictions
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TheCitizen wrote: »Reasoned and researched he says:pac:
This is what you said in post 1924; "The lockdown policy is driven by fear and panic.".
Do you think politicians across Europe and elsewhere lockdown or impose restrictions on their countries economies due to "fear and panic"? Do you think they arrive at these difficult decisions easily? They have taken advice from the experts and have acted on that.
Your post is anything but reasoned and researched, to repeat; it's utter utter bollocks.
Now I remember why I don't spend much time on message boards. Thanks for the reminder
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housemouse wrote: »Now I remember why I don't spend much time on message boards. Thanks for the reminder
Oh right, you're going to pretend your words meant something different now. Yep, you're right, why bother if you're just going to backtrack and put a different spin on what you originally said0 -
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So for anyone that didn't know this poster is a HSE consultant doing an AMA here on boards.
Essentially thinks we'll have to accept a certain amount of daily deaths even post lockdown
Pseudonym121 wrote: »So, I see lots of talk about when restrictions will be lifted and the probable course and so I think it makes sense to post a reasonable middle case scenario ( not best case and not worst case ). I'll refer to best and worst case alternatives later. The key point about this post is that NO-ONE knows how this will turn out. What we can know is what is probable based on a number of assumptions.
So, what are those assumptions:
1. That this has some seasonality - there is growing evidence that this will be so. This would lead to a scenario where we could expect a Q4 resurgence.
2. That a vaccine is possible - it isn't possible for all viruses or at least isn't possible in the sort of time frame we need. Everything I've seen says that vaccines should be possible for SARS-CoV2.
3. That by the time a vaccine arrives there will be multiple strains. This isn't a huge problem as we have many vaccines for seasonal viruses which protect against multiple strains of said virus.
4. That the decision about lifting restrictions will be at least partly political and economic and not just based purely on medical advice.
5. That the decision about lifting restrictions will be based largely on medical advice, although not solely - this doesn't contradict point 4.
6. That SOME treatment currently being trialled will be found to be effective by September 2020. I don't know which one but I'm certain some reasonable treatment(s) will be found and production increased to meet demand.
7. That the majority of high risk individuals will continue to largely cocoon until such time as they can access a vaccine. If they come out before a vaccine is available, irrespective of government advice, deaths will skyrocket again.
Overall I think this is a good news story in that we aren't facing the destruction of technological society or the death of western liberal democracy but we are about to lose a lot more people than seems to be understood in the megathread. This isn't surprising as one of the defence mechanisms most people use to deal with the fragility of life is simply denial of its fragility... in spite of all evidence to the contrary.
So, first phase: Now till end of September
This will be the phase in which we will likely see 1500 to 2000 dead in Ireland by the end of May and a smaller daily number from June to September - I expect Ireland would tolerate 5 to 10 dead per day during that period in return for things largely returning to normal. So call it a low of 2100 and a high of 3200 dead by end of September. The main clusters will be in nursing homes, roma gypsies and traveller groupings because of their medical risk factors, proximity and intergenerational living setups.
Interpreting the data for Ireland is difficult because due to the lack of results from testing there is such a huge backlog that the one thing we can say is that our current numbers bear no relation to reality. Saying they might is purely a PR exercise. I understand why that is being said but that information isn't good enough for me to base decisions on the health of my loved ones on.
Anyways the normal rule for an epidemic is that you can say it is over when you've gone two 95% confidence intervals of the incubation period without a new case. This equates to about 28 days for SARS-CoV2.
Another way of looking at this is that we need to get the R0 below 1 to have fewer infections every day than the previous day. With an R0 of 3 and 90% of people obeying the lockdown/disinfecting rules 90% of the time and actually being effective with this 90% of the time you can see that we'd end up with roughly a 73% reduction in R0 from those assumptions. So R0 = 3 would become 0.813. Let's round that to 0.8 and if we had 5,000 transmissions a day to start with that'd drop as follows:
Day 0: beginning of lockdown 5000 new cases per day
Infection Cycle 1: 4,000
IC 2: 3,200
IC 3: 2560
IC 4: 2048
IC 5: 1638
IC 6: 1310
IC 7: 1049
IC 14: 220
IC 21: 46
IC 28: 10
Obviously I'm rounding and just approximating here but as you can see by IC7 you'd reduce transmission by about 80%.
A lot of people would look at IC 14 and say that by then with the number of new daily infections falling by 96% that if you lifted the restrictions then things would be fine but if we went back to the way we were behaving previously you'd be back to 5000 infections a day in 14 more ICs.
Why IC and not day? Well, the best data out there is that infections were growing at about 25% a day when we were looking at an R0 and doubling every 3 days but there's no guarantee that things will rise or fall by 20 to 25% per day. So I used IC. For ease of examples going forward lets just assume an IC is a day as that'll make it easier for people to grasp.
So what does the above tell us?
Well, it tells us that even if do a massive lockdown obeyed by 90% of the people 90% of the time with 90% effectiveness for 28 days if we go back to "life as normal" after that we'll be right back where we starting 28 days later.
And bearing in mind the death rate lags behind infection rate by somewhere between 14 to 26 days the death rate would start to fall just as new infections were really starting to rise again and we'd end up with another bad peak of deaths.
So, where to from there?
Well, it seems that the best way to play this would be to keep a really strict lockdown for about 28 days and then reduce it slightly, combined with advice for people to ALL wear masks when out and about, really strong, rapid testing and contact tracing. There would be separate advice for high risk groups who would be asked to continue cocooning as much as possible for as long as possible.
The 28 days gives the state the time to ramp up swabbing ability and test throughput ability as well as to train and man contact tracing centres and establish rapid response teams to respond once a new case is confirmed.
This would be something akin to the South Korean/Singaporean model and the goal would be to allow low risk groups to return to normal economic activity ( albeit with masks for everyone ) while cocooning those likely to die. Usage of masks by the young would be enforced by peer pressure as there would be a constant drumbeat of people in their 20s and 30s still dying and that would act to motivate them to wear masks. The goal wouldn't be to stop deaths but to keep them to a reasonable level - say 5 to 10 per day with the majority of those being the elderly obviously but probably a good 10% being young to middle-aged.
After another 28 days go by the government could look at loosening restrictions a little more if the death rate was on the lower side. Essentially they'd be balancing daily deaths vs economic activity... And before someone argues that every life is priceless. No it isn't. Your lives all have a very specific monetary value. The measure most used in the UK by NICE is called the QALY - Quality Adjusted Life Year. Most recently it was somewhere between about 15k and 20k Euro
Here's a link to explain it: https://en.wikipedia.org/wiki/Quality-adjusted_life_year
For what it is worth this is why we will always have private health insurance. Some people have a lot more than 20K discretionary income per year and if faced with death or spending 30K a year to stay alive with a discretionary income of 50K per year you can bet a rich person will spend the 30K. You can have all the ideology you want but when push comes to shove people who can afford to pay to live longer will find a way to pay for it. Perhaps not a popular thing to say but I'm all about objective reality and that's just objective reality.
I'd imagine that every 14 to 28 days restrictions will be loosened somewhat. This will be possible because even if the R0 remains above 1 we should find some treatments which reduce mortality. Statistically this will allow us to keep the same death rate for higher rates of infection than is currently possible.
So, Phase 2: October to December
I'll assume we don't even have an experimental vaccine... If that is true then we'll have a choice between accepting higher daily death rates - which we'll have become accustomed to by the next two months - for those three months or we'll go into whatever of lockdown the statisticians and PR guys have figured will result in the daily death rate which the public will tolerate versus the severity of the lockdown.
This will be when you'll really see the selfishness in society. Things happened so quickly this time there wasn't much debate. Come October there will be a very active pushback against another lockdown. There will be a very active - but they're old and will die soon anyway lobby, much more active than it is now.
Unfortunately when push comes to shove people tend to be very selfish and when they've had a taste of freedom after two months of lockdown they really won't, en masse, want to go back to lockdown. The line that those whose families are high risk can choose to behave how they want instead of forcing all of society into lockdown will be prevalent.
How many will die in Q4? Well, easily 6k to 8k but a lot of that depends on the political and economic balancing vs deaths. How many die will be a choice the public and our government will make. They'll have the information to project the death rates from various courses of action much more accurately than they had now. This is why they were so cautious this time. Come October they'll have greater confidence in balancing life vs economics.
I suspect they'll strike a balance somewhat below the peak of April/May as people will be habituated to view anything below that peak as being "good". That would argue that they won't exceed 50 daily deaths for those 3 months and would result in 4500 dead in Q4. They may draw the line differently but I don't see the government enacting a full three month lockdown. I'd be impressed if they did, but I just don't see it happening for economic reasons.
The key point is we'll have the number of dead in Q4 we choose to have politically. There's a lower bound on that number below which we probably can't go but that lower bound may be as low as 1,000... but achieving that number would really impact the economy.
Phase 3: 2021 Q1-Q3 aka waiting for the vaccine.
Well that's what it will all be about. We'll throttle economic and social activity to control death rates. As our treatments improve and the virus adapts to us and selects for greater infectivity at the cost of lethality we'll be able to have more economic and social activity for the same number of daily deaths.
Once we get a vaccine which is good for the main strains around we'll largely return to normal. I, personally, expect we'll have a vaccine which is usable for the majority of the population by March of 2021.
We will probably have an experimental one by Q4 but the risks may outweigh the benefits for all but the highest risk groups with that experimental vaccine as they just won't have had time to prove its long-term safety.
Phase 4: Q4 2021
At that point we'll really get a sense for how effective the vaccine was and whether or not we get a strain which the vaccine doesn't provide protection for. If we guess right with the vaccine then Q4 2021 will be alright and this will just become a yearly "bad flu". If we guess wrong with the vaccine then Q4 2021 will be bad and we'll just have to work harder to get the vaccine right for 2022.
This is the same process that we follow with seasonal flu. The good news is that mostly we get the seasonal flu vaccines right.
Summary:
People talking with any certainty about lockdown being done in 2 to 4 weeks or in for the whole year don't know what they're talking about. The probability is lockdown till the end of May followed by a gradual reduction in the severity of lockdown until a death rate, which is deemed the maximum level which the public will tolerate on an ongoing basis, is reached and allowed run to October. In Q4 we'll have to see a tightening of restrictions again to keep the death rate down. What death rate will they view as acceptable? I suspect 50 dead a day or less will be the level but don't know, a lot depends on what the public tells them is acceptable. In 2021 it'll all be about keeping the death rate at an acceptable daily level until we get the vaccine. As treatments improve fewer social and economic restrictions will be required to maintain a stable daily death rate which is acceptable to the public.0 -
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