I don't know, I never had an issue with that point. "Flatten the curve" is alright, but then what? It would be stupid to "flatten the curve" for a while, then call "mission accomplished" and pretend covid is over if that causes the situation to immediately go critical again.
So far the playbook seems to have been:
1) Flatten the curve: Use lockdowns, masks and social distancing measures to maintain a situation where hospitals can still cope. This is not a one-time goal, it's an ongoing effort: As long as there was no vaccine, "no significant transmission right now" does not mean everything is back to normal - because if measures are lifted, transmission can quickly increase and become critical again.
2) Because the situation in 1) seriously sucks for everyone, try to come up with solutions to end the pandemic permanently (or at least make it permanently nonthreatening for the health system so we can leave "pandemic mode" and treat it as an ordinary disease). So far the most obvious strategy for this is vaccination - hence the increasing push to get everyone vaccinated.
3) Evolutionary pressures on the virus might cause the vaccines to become less effective. This unfortunately calls into question whether 2) is really able to bring an end to the pandemic. If this is really the case, then new plans are needed, such as boosters, new vaccines, I don't know. This stuff is currently being figured out.
1) and 2) does not seem like "moving the goalposts" to me. The goals were the same since the beginning of the pandemic, though of course the situation and circumstances were changing (you can only keep up a lockdown for so long, vaccines changed from "vague hope" to "viable strategy", etc)
3) is a new development that was apparently somewhat unexpected (I remember the virus was being talked about as relatively mutation resistant, which evidently wasn't the case.) - but this was simply new knowledge and new developments that might require a change in strategy - the overall goal to get out of this mess (by either eradicating covid or make it nonthreatening) did not change IMO.
Of course if this goal turns out to be permanently unarchievable, the goalpost shifting might start...
There is no scientific proof, e.g. RCT, that lockdowns work. When did 'stay at home if sick, live life otherwise' become obsoleted?
Edit: "3) is a new development that was apparently somewhat unexpected". That evolutionary pressures on the virus might^H^H^H will cause the vaccines to become less effective was and is the #1 concern of the critics of mass mRNA vaccination campaigns.
> "There is no scientific proof, e.g. RCT, that lockdowns work.
You want to make a randomized, controlled study on entire countries? That's your idea of ethics in science?
> That evolutionary pressures on the virus might^H^H^H will cause the vaccines to become less effective was and is the #1 concern of the critics of mass mRNA vaccination campaigns.
No, it was one argument of whatever seemed convenient at that point to argue against vaccines. Consequently, their only advice how to cope with that problem seems to basically give up and don't do anything.
Honestly, I don't understand what strategy you guys would propose to end the pandemic. Apart from pretending it doesn't exist of course.
Sometimes I picture a lot of the covid measures as raising sandbag walls in front of a tsunami. Feels good to do something, anything, but the tsunami is going to do its thing, at best delayed a bit. The second the earthquake hit, Sendai was gone. There was nothing anybody could do about it. If that's "pretending it doesn't exist", then so be it.
* Vaccines are useful in preventing severe disease. Get one, especially if your are not a child. But they are also fragile and it's anybody's guess how they'll interact with a 'likely vaccine evading variant' (quoting Pfizer CEO here).
* It is unclear what effect the vaccines have on the virus evolution. We assume its going to be positive, but have no actual data on it.
* It is unclear what effect the vaccines have on disease spread. The big question is the effect of vaccines on the rate of 'asymptomatic spreaders', which may increase under a regimen of reducing symptom severity.
* Lockdowns have massive costs. Keeping the world running also saves lives, and it's not at all clear that the balance favors hard covid measures.
* Suspended school, masks and social distancing have severe costs in children. I am not sure we thought through the consequences on the next generation.
* The scapegoating shaping online is grotesque. Being a fortunate to be born post WW2 world with its bounty of health, I never understood the story of touching the leper. Until the reaction to the covid pandemic finally illuminated my mind.
The costs of attempts to cure the disease may be worse than the disease. And the disease is horrible.
I think it's an interesting discussion. Thanks for explaining your viewpoint, even if I don't agree with it.
But I'd like to ask again: You've listed a lot of points on what not to do. But so what should we do to tackle this virus? A virus that will quickly cause enough severe cases to require triage at hospitals.if left unchecked and that will not go away anymore on its own.
Or do you really view this as some sort of slow-motion Armageddon, destinied to bring in the end times - so any resistance is futile on principle?
The reality: The tsunami didn't end Japan. <50 age group covid is survived by 99.9% of the population. There is no Armageddon, at least not if the virus doesn't get significantly worse. Life expectancy might get a hit, fewer people are going to make it all the way to 80 and beyond.
The hope: Eventually everyone is getting exposed to covid, via vaccines, infection or both. At that point, hopefully, epidemic spikes will become minor, though sadly I don't think there is a path back to pre-pandemic innocence.
* Encourage vaccinations for everyone over 18, and especially over 65 where the bulk of the burden is. I say this with a heavy heart, because there appears to be at least one instance of leaky vaccines selecting for hypervirulent variants in veterinary applications. This is what gives me nightmares. I won't link to it, it's somewhere in my comment history if you are super-curious. Praying for the best. Maybe it's just me being prone to overweigh worst case scenarios. Maybe it's my grandma saying "God's punishment" for instances of lack of humility turning for the worse.
* Lift restrictions for children, especially under 12. I've seen credible data indicating that unvaxxed child covid risk is less than vaxxed parent covid risk. Keep schools open, remove blanket mask mandates, stop pushing vaccines, when it's beyond clear the risk and benefits for them are minuscule, and there are long-term questions around virus evolution trajectory. If I'm not mistaken, something like that happens already in a number of European countries: Swe and Den, possibly UK and NL.
* Exercise regularly, vitamin C & D, zinc, especially in winter season. This is a good time to open the conversation about obesity and diabetes. One side effect of the lockdowns is increased child obesity rates; this metric is trending the wrong way.
* Stay at home if having symptoms. Employer pays no questions asked.
* Probably a system of aid for symptomatic long covid cases. It is unclear how prevalent it is, but, for example, losing lung capacity is an absolute nightmare. Source: I could barely climb a flight of 5 stairs after a bout of pneumonia a few years back. Can't imagine holding a blue collar job in those circumstances.
* Probably skip eating out, partying or sports during an active infection spike, usually about 2 months. See covidestim.org for a very useful resource in estimating whether there is an ongoing spike or not.
* Hospitals are going to get overwhelmed during a spike because they are simply not built for spikes. If that is a concern, we should think on how to quickly scale capacity up and down. Might be very expensive. Perhaps something crazy like a National Health Guard.
* There are going to be victims, mostly old but some young. Please try to keep a bit of decency instead of rushing with every single case on social media for clicks and fear and panic. We are incurring great loss, we are supposed to mourn. It's disturbing.
* Stop scapegoating. The situation is miserable as is, no need to make it even worse through a hellish social landscape.
* Finally, please stop playing God. Recently a grant proposing to essentially design covid at WIH was leaked to the press. The grant was thankfully denied, but the thought that we are 2 inches away from triggering the next pandemic is troubling.
Edit: Come to think of it, this is how the system is supposed to work. People have different stations in life and different concerns. We stand together through hell and high water. We compromise. What we are getting instead is extremes: either hyper drastic measures or, I presume, complete lack of caution.
> When did 'stay at home if sick, live life otherwise' become obsoleted?
When we figured out there was asymptomatic and pre-symptomatic spread. Your advice probably leads to significantly more than 219 million cases worldwide, and 4.5 million dead.
That is not a RCT, that is comparing 2 data points selected after the results were known. The reason we have RCTs is that it is very easy to fool oneself, for example by filtering the experiment populations after the results are known. Remember when peer reviewed journals published experiments 'proving' ESP. https://www.cbc.ca/radio/ideas/psychologists-confront-imposs...
Re asymptomatic. Vaccinated people also spread the disease asymptomatically. I have seen zero rigorous studies showing how vaccinated asymptomatic spread compares with unvaccinated asymptomatic spread. No, picking 3 studies and linking data between them is not a replacement for a rigorous RCT. This is a particularly salient question as the biggest selling point of vaccines is that they reduce symptom severity.
> I have seen zero rigorous studies showing how vaccinated asymptomatic spread compares with unvaccinated asymptomatic spread. [...] This is a particularly salient question as the biggest selling point of vaccines is that they reduce symptom severity.
And why are you linking spread & symptom severity?
Asymptomatic spreader: Person with an active infection that exhibits symptoms under their own personal threshold for self quarantine.
Core vaccines observable effect: Reduce manifestation of symptoms in infected persons.
It is possible that the vaccinated population has a larger rate and/or absolute numbers of people with no/low symptoms, aka 'asymptomatic spreaders'. It is also possible the other way around. I don't have hard data, nobody else seems to do.
Given that I don't actually know, I'm happy to refrain from speculation. I wish I could say the same from the 'any measure that may have some conceivable effect of reducing R0 must be mandated yesterday, or else you are personally responsible for the death of 4M people worldwide, and counting' crowd.
> I wish I could say the same from the 'any measure that may have some conceivable effect of reducing R0 must be mandated yesterday, or else you are personally responsible for the death of 4M people worldwide, and counting' crowd.
>> This is a particularly salient question as the biggest selling point of vaccines is that they reduce symptom severity.
You mean the 'any measure that may have some conceivable effect of reducing symptom severity must be mandated yesterday, or else you are personally responsible for the death of 4M people worldwide, and counting' crowd.
So far the playbook seems to have been:
1) Flatten the curve: Use lockdowns, masks and social distancing measures to maintain a situation where hospitals can still cope. This is not a one-time goal, it's an ongoing effort: As long as there was no vaccine, "no significant transmission right now" does not mean everything is back to normal - because if measures are lifted, transmission can quickly increase and become critical again.
2) Because the situation in 1) seriously sucks for everyone, try to come up with solutions to end the pandemic permanently (or at least make it permanently nonthreatening for the health system so we can leave "pandemic mode" and treat it as an ordinary disease). So far the most obvious strategy for this is vaccination - hence the increasing push to get everyone vaccinated.
3) Evolutionary pressures on the virus might cause the vaccines to become less effective. This unfortunately calls into question whether 2) is really able to bring an end to the pandemic. If this is really the case, then new plans are needed, such as boosters, new vaccines, I don't know. This stuff is currently being figured out.
1) and 2) does not seem like "moving the goalposts" to me. The goals were the same since the beginning of the pandemic, though of course the situation and circumstances were changing (you can only keep up a lockdown for so long, vaccines changed from "vague hope" to "viable strategy", etc)
3) is a new development that was apparently somewhat unexpected (I remember the virus was being talked about as relatively mutation resistant, which evidently wasn't the case.) - but this was simply new knowledge and new developments that might require a change in strategy - the overall goal to get out of this mess (by either eradicating covid or make it nonthreatening) did not change IMO.
Of course if this goal turns out to be permanently unarchievable, the goalpost shifting might start...