The big lesson from the 1918 flu pandemic was that lockdowns didn’t really work.
The scientific consensus after that was to isolate the highest risk populations, and let it run through the rest of the population. That way, it hits herd immunity / becomes endemic without infecting people that are likely to die from it. For COVID, the conventional approach would be to lock down nursing homes and provide shelter in place orders / resources for the top 1-5% risk groups for 3 months while otherwise ignoring the pandemic.
If it were not for RNA vaccines, that approach certainly would have been better than what we did with COVID. Economic disruption would be minimal, per case fatality would be cut significantly, and the tripledemic / avian flu / 2021 famine / rebound of malaria, etc. probably would not have happened.
With the vaccines, it is unclear if the lockdowns helped or hurt average life expectancies. We will know in a few more years.
In retrospect, herd immunity for COVID doesn't seem like it ever was possible. It's a ridiculously infectious disease, basically everyone has to get infected and even then herd immunity is not guaranteed.
The most likely outcome without lockdowns, even if you isolate the 1-5% most vulnerable, would be catastrophic failure of the healthcare system. Plenty of countries really did try not to use lockdowns, but invariably all countries that didn't have extremely young demographics and tried not using lockdowns were at the brink at least once.
The approach you suggest would have been disastrous without RNA vaccines and from what happened in most countries which lifted restrictions too early, would also have been disastrous with them. The government where I live is one of them and they had to flip-flop on the issue about 7 times as the system got close to the breaking point. Increasing capacity wasn't feasible either because trained personnel was the bottleneck, and even if you could train three times faster, no one would want to do the job anyways.
The problem with health system breakdown is that at some point it's not even COVID that kills people. If that happens, even just a broken bone can be genuinely life threatening. People will start dying of a plethora of things they'd normally be able to easily deal with.
I think you missed the part of the guidance where you lock down the 1-5% of the population that is most vulnerable, but only for 1-3 months.
For Covid, that would have greatly reduced peak health care loads, and had a much more modest economic impact, and fewer secondary effects (RSV wouldn’t have been a issue, for example.)
Locking down 1-5% is not nearly enough, though. Hospitalisation rate just for nauve people above 60, which are a quarter of the population, was above 5%. No healthcare system can handle the hospitalization of over 1% of the population in a few weeks.
> If it were not for RNA vaccines, that approach certainly would have been better than what we did with COVID.
I know that 'flatten the curve' largely left the public consciousness, but wouldn't letting the virus run largely unrestricted have overwhelmed the health care system?
The curve flattening was initially proposed for a short period of time. Maybe weeks or a few months, I forget.
I think some initial panic is forgivable, even if it led to actions that were counter to previous guidance. We were ventilating patients early on, for instance, and we later learned that this causes more harm than good for many patients and should be deferred if at all possible. I think it's arguable that a short term lockdown was the right call. It's arguable it wasn't, but in my opinion it wasn't crazy.
During that initial period we were supposed to be increasing capacity and learning treatment. Encouraging people to lose weight and improve their health during this time would probably help with outcomes as well.
Capacity was increased to some extent. Remember the tents and the medical ship in NYC? I think neither were used at all. We don't seem to be having conversations now about more long-term increases in health care capacity. It's just like nothing was learned. It all just became political and like all things political in the US, incredibly stupid and tribal.
For what it's worth, when DeSantis started relaxing Florida lockdowns I thought the death toll in Florida was going to be sobering and it was reckless. I now think it was the right thing to do. DeSantis seemed to be following the pre-COVID playbook. I was scared and clung on too much to the status quo procedure on COVID.
>Capacity was increased to some extent. Remember the tents and the medical ship in NYC? I think neither were used at all.
They were not. Even in NYC, which really did see overloaded hospitals briefly in March-April 2020, USNS Comfort treated a *total* (not at one time; from start to finish) of 182 patients <https://www.latimes.com/world-nation/story/2020-05-01/navy-h...>. USNS Mercy, with 1000 beds, treated a total of 77 patients in LA.
Same elsewhere. In Wales, Millennium Stadium was converted into a temporary field hospital with 300 beds and capacity to expand to 2000 beds. It was such a big deal that a public contest was held to name it. However, the newly dubbed Dragon's Heart Hospital <https://en.wikipedia.org/wiki/Dragon%27s_Heart_Hospital> never had more than 46 patients at one time, and was closed in six weeks for lack of use.
The scientific consensus after that was to isolate the highest risk populations, and let it run through the rest of the population. That way, it hits herd immunity / becomes endemic without infecting people that are likely to die from it. For COVID, the conventional approach would be to lock down nursing homes and provide shelter in place orders / resources for the top 1-5% risk groups for 3 months while otherwise ignoring the pandemic.
If it were not for RNA vaccines, that approach certainly would have been better than what we did with COVID. Economic disruption would be minimal, per case fatality would be cut significantly, and the tripledemic / avian flu / 2021 famine / rebound of malaria, etc. probably would not have happened.
With the vaccines, it is unclear if the lockdowns helped or hurt average life expectancies. We will know in a few more years.