USA is huge, and the virus is hitting different areas with different intensities. Its spread is heavily impacted by population density and rates of random social encounters. A Nationwide lockdown might make sense if the goal was to snuff the infection out, but as of now the goal is to lower the peak of the curve. If you lock down too early, you extend the infection to a length of time that makes the lockdown impossible.
I agree... it doesn't make sense to just throw a blanket lock down over the whole county indiscriminately. Same goes for state governors to throw these blanket shutdowns of bars a restaurants over the whole state at once.
I don't understand why we can't take a more localize approach to this. Maybe only implement the lock downs in the worst areas, or areas entering acceleration phase. Can't we be smarter about this?
We don't even know if it will snuff the infection out. It might just be kicking the can down the road. In my area, it is still very low risk. Meanwhile, businesses are already beginning to shut down, and people's are loosing their livelihoods.
This is true, but you don't need blanket testing to have adequate testing for estimation of community spread. There is a fantastic video here[1] that covers the specifics, but basically we know enough about how the virus spreads that if we just track who is in the hospital or dead from the virus, we can estimate its state of community spread, and thus know when to lock down.
Agreed, I don't understand why there isn't a concerted effort to ramp up testing. NYC is doing this now, part of the reason their total cases are going so high so quickly. Lockdown makes sense for them right now. The medical facilities are starting to feel the pressure.
Poster seems to be thinking about the "UK approach" which is declared to be managing the situation until population immunity catches up and helps snuff it out.
But, since we're starting from zero natural immunity and a virulent disease with long hospitalizations, if you actually do the math here it never works - there's no situation where you can keep the number of infected low enough to not use up too many hospital beds and also high enough to get population immunity in any reasonable period of time. Those values simply don't overlap (which apparently someone has told the UK now, I guess).
The only viable approach is massive lockdowns to reduce the number of infected to a reasonable number followed by super-aggressive public health interventions for each and every infected person to control future spread.
You can't have a lockdown for more than a few months, otherwise the economy grinds to a halt and you get something akin to or worse than the great depression.
This virus will be with everyone for 18+ months, the point of the lockdown is allow the Health system to catch up
If you lock down early you irreparably harm the local economy and simply delay a spike instead of "flattening the curve" unless you are willing to except a year long lock down, massive economic depression and the colapse of the US Dollar
This is happening in my area right now. The number of cases is little to none, but the governor threw a blanket lock down on bars and restaurants, etc, over the whole state. It was too early for my area for sure. So in the meantime, businesses and people's livelihoods are already being destroyed.
The number of infected though is unknown because we haven't tested many people. When it is known then lock down on bars restaurants etc. will be too late.
I live in South Carolina https://www.scdhec.gov/monitoring-testing-covid-19. You are correct testing is still low, but I don't think that data is useless. I don't agree with the notion that it 'will be too late'.
As others have said, the point of a lock down should to prevent the hospitals from getting overwhelmed, prevent ventilator shortages, etc. Nobody even knows if a preemptive lock down can 'squash' the virus. While testing is being ramped up, aren't there other ways to determine outbreaks? Can't our leaders communicate with hospitals and find out number of open beds, ventilators, an influx of patients with suspected symptoms?
It is still going to be around once we come of of hiding, whenever that is, so it's possible we are just delaying the acceleration phase and we end up with the same result later instead of facing it now. I'm not saying there is never a time for a lock down, I just wonder if my local leaders panicked and did it to early, because they didn't know what else to do?
So in my area, the hospitals are fine. People are not flooding in the doors. Meanwhile thousands of jobs & businesses are being torched. My mom is a massage therapist, and is out of work for the foreseeable future. I just think there are smarter ways to go about it.
> A Nationwide lockdown might make sense if the goal was to snuff the infection out
The goal needs to be to snuff the infection out. Otherwise, we will be like this for the next year and a half while we wait for the vaccine, which IMO is not acceptable when a little extra short-term sacrifice can get us near eradication inside two months.
Also, even if the curve is mediated by density, it seems clear enough that a lack of density is not going to be sufficient to prevent it from becoming a crisis. The infection is spreading even in less dense cities like Atlanta, New Orleans, and Saint Louis.
> a little extra short-term sacrifice can get us near eradication inside two months.
"Near eradication" is not enough if you want to "snuff it out". COVID-19 started with only a couple of cases. There was a patient zero.
So no, "a little extra short-term sacrifice" would not be enough, because you are very unlikely to catch everything, especially worldwide. Health workers would inevitably catch it by treating patients, and you can't just tell the entire world to stay home for 3 weeks. Even if you could snap your fingers and do that and have everyone obey, we don't have the infrastructure to provide worldwide basic needs, for free, for everyone, in an automated way; billions would die.
Mitigation until vaccine is the only sensible way we know of at this time. Gradual lockdowns to help contain the virus for cities and countries that don't have the testing infrastructure available to seriously prevent spread.
We're lucky that this is treated in days/weeks (rather than months/years), and that we have already found a promising treatment (hydroxychloroquine). It'll help the mitigation phase a lot.
Edit: To address "If we adopt a stance that makes R0 < 1, there is no other stochastically possible outcome.": This is untrue if you're time-bounding this to "before we make a generally-available vaccine".
Oh, I don't think near eradication is an acceptable goal either. We need to actually eradicate it. I specified near eradication because we have proof by example that it is possible. As yet, nobody has actually eradicated the virus in their borders, so I don't want to presume it is possible. However, it needs to be the goal.
> To address "If we adopt a stance that makes R0 < 1, there is no other stochastically possible outcome.": This is untrue if you're time-bounding this to "before we make a generally-available vaccine".
Depends on what we get the value to. If we get it to 0.5 or below, as it appears China has done, then probably before we get the vaccine ready. But sure if it's at 0.95 then we will have to wait for the vaccine.
I think everyone would agree with you. The question is how long that realistically takes, in a minimally-damaging way.
I don't think there's a world in which there's a better option than "waiting for the vaccine with various forms of mitigation". Boy would I love to be proven wrong.
At this point it's hard to imagine doing much more damage to the economy than what is already being done, at least not in any way that would be useful for stopping the spread of the virus. We should take any further actions that seem likely to curtail the spread (massive testing, massively expanded surveillance and data publishing about the virus, centralized quarantines if needed to engender compliance). And then I guess we can see. If China has not managed to stamp it out in the next month or so, that will be a pretty bad sign for our ability to do.
> Boy would I love to be proven wrong.
I would love you to be proven wrong. And I'd accept being proven wrong, with deep regret. But it's definitely possible to get within striking distance. I hope we can see China jump the gap from few to no new cases soon. That would give me hope for the rest of us.
Snuffing the virus out is not an option at this point. Perhaps they could have done that in Wuhan in December, but it is not an choice we can make for the United States in March. And no, we aren't waiting for a vaccine. We will build herd immunity as people contract the virus, develop antibodies and recover from it. The goal now is to moderate the rate at which people acquire the disease so that the critical cases do not overflow health care capacity.
Snuffing out the virus absolutely is an option. If we adopt a stance that makes R0 < 1, there is no other stochastically possible outcome. Whether we will is another question.
> We will build herd immunity as people contract the virus, develop antibodies and recover from it.
This is a pipe dream, at least outside the context where we are going to accept megadeaths or years of social distancing. The hospital capacity of the US is such that, if we were to run them all at 100% and somehow hold the virus exactly to the level that maximally utilizes ICUs, it would still take the better part of a decade before we got to the point of having herd immunity.
How is it possible to make R0 < 1 for rural Africa? Or for the remote areas of the world? For something more infectious than the flu?
It's impossible, unfortunately. There are billions on the planet without even access to the internet. Many don't have running water or consistent food. How can we get R0 less than 1 there?
> How is it possible to make R0 < 1 for rural Africa? Or for the remote areas of the world? For something more infectious than the flu?
That's not relevant to the United States if we eradicate domestically and close borders. That said, Africa managed to contain the Ebola epidemic. Let's not underestimate their resolve.
That would do more harm than the virus. The virus is not everywhere[1] and no lockdown is perfect, so the virus will spread hit different places at different times. It is better to lock down regions or states as needed
Also, unnecessary lockdowns can ruin the credibility of the heath authorities. IF we lock down counties with no cases, not only are we needlessly disrupting lives, people wont listen to the order when it IS necessary.
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