/ Tell me about exit strategies.

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DaveHK 26 Mar 2020

I know another COVID-19 thread. C'est la vie.

I'm a teacher and I've produced a couple of online resources for pupils on some of the science behind the current situation.

Thus far I've done one on why schools closed and another explaining the IC model that has proved so critical in changing policy.

I've found the threads on here very useful as there are clearly people on here who have a much better grasp of this than I do.

I've promised that the next one will be about what happens next. I have a layperson's understanding of the basic options but I'd be really interested to hear what some of you think on this or any suggestions for further reading.

Thanks,

Dave

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In reply to DaveHK:

The exit strategies are fraught with difficulties. A vaccine  seems to be 18 months away. There will most likely be a second wave of infections.

If you have had the virus and have had the test for antibodies do you get a certificate to prove it? What about those people haven't caught it yet?

How much can people take of a lockdown?

How much economic distress are we willing to handle?

I was able to buy and read Laura Spinney's book 'Pale Rider' about the 1918-20 pandemic before it started selling at ridiculous prices.

Having read that and veiwing the consequences of the Spanish flu on the 1920's I think the future is going to be difficult. I imagine a lot of austerity and nations will not be the same. 

But then, more optimistically, the mountains and climbing will still be there and young people of the next generation are marvelous and will always get on and make it work. And all this may make us think more about our economics, society and environment. 

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Dr.S at work 26 Mar 2020
In reply to Heartinthe highlands:

I think you are correct thats its likely to catalyse many social changes - I've been in some shocking web meetings in the last few weeks, but in fact it all works, and the 40 min guillotine on the free version of Zoom is an absolute godsend!

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DaveHK 27 Mar 2020
In reply to DaveHK:

As I understand it barring something changing in the disease or our understanding of it the options for getting out of this without a healthcare disaster are:

A vaccine. 

An effective treatment.

Gradually develop herd immunity through cycles of tighter and looser restrictions.

Obviously there are massive issues/questions with all of them and ultimately it might be a combination of the above.

Am I missing something obvious?

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Toerag 27 Mar 2020
In reply to DaveHK:

For isolatable communities (small islands) you could have total 14 day lockdown and mass testing. Any person entering the island is quarantined until proven disease free by testing (10 days?). Tested people are allowed back out into the economy. This should result in the virus dying out like it has in Wuhan. Theoretically, if you reduce R to <1 the virus will die out, the issue is how to do that.  Keeping borders closed is massively beneficial as it prevents importation of cases which would prolong any restrictions.  A combination of closed borders and social distancing could well be enough if testing is thorough.

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climbercool 27 Mar 2020
In reply to Toerag:

Thank you Toerag, this should have been the only policy on the table from the start, this can work, it is what China is successfully doing and we can do the same.  

The antibody test is thought to be not that far away and once that arrives people wont be required to quarantine for 14 days on arrival, they can be tested and immediately be shown to be safe or not.  Also as soon as another country is proven safe i.e china now, people from that country should be free to travel without quarantine.

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mullermn 27 Mar 2020
In reply to Toerag:

Isn’t this basically what New Zealand is doing?

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HansStuttgart 27 Mar 2020
In reply to DaveHK:

in Germany the plan is to increase the testing capability (to something like 200000 tests per day). The goal is to contain the spread by finding, isolating and curing infected persons as soon as possible. And then the rest of the country can go back to normal life. It is a similar strategy to the ones of South Korea and Japan.

Post edited at 16:38
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Eric9Points 27 Mar 2020
In reply to climbercool:

Trouble is that until the majority of the population becomes immune, either through contracting the virus or getting vaccinated, it'll keep coming back. 

That means lockdowns will have to re occur periodically until we reach "herd immunity" one way or the other.

I'm really not sure restrictions on international travel are going to be lifted any time soon. For one thing, packing hundreds of people together in a sealed box for several hours must be a great way of transmitting the virus.

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BnB 27 Mar 2020
In reply to DaveHK:

Once infections have peaked in the current lockdown, why not keep the most vulnerable in lockdown (tough on them I know) and allow immunity to build in the more robust, more economically productive, and much larger, segment of the population who can be encouraged back to normal life, thus rebooting the economy? I understand this may have to be phased in, to manage the strain on the NHS, but the instances of hospitalisation among less vulnerable groups are, by definition, far lower.

Post edited at 17:00
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jkarran 27 Mar 2020
In reply to HansStuttgart:

> in Germany the plan is to increase the testing capability (to something like 200000 tests per day). The goal is to contain the spread by finding, isolating and curing infected persons as soon as possible. And then the rest of the country can go back to normal life. It is a similar strategy to the ones of South Korea and Japan.

This looks like the viable short term technical solution especially if it's coupled with the discovery of an effective drug therapy, behavioural change and managed social restrictions, we can learn to live with this in a limited way but international travel will remain problematic until we and other linked nations/regions have our herd immunity (one way or another) and with it the accelerated growth of toxic ultra-nationalism.

jk

Post edited at 17:01
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tom_in_edinburgh 27 Mar 2020
In reply to Eric9Points:

> Trouble is that until the majority of the population becomes immune, either through contracting the virus or getting vaccinated, it'll keep coming back. 

I'm not sure it will take the majority of the population to be immune.  The key thing is that the people with jobs where they come into contact with a lot of different people are immune or protected.  These are also the people who will catch it first.   Maybe you can get it suppressed to the point where contact tracing and isolation can stamp it out long before you get to > 50% of the population immune.  That seems to have happened in Wuhan.

The argument is going to be about economic costs of the slower approach against the much higher death rate.   It doesn't need to be stated explicitly, all that's needed is inaction or insufficient action and you get the fast and lots of death option by default.

I think what is being missed in the 'get it over with' scenario is the potential long term health problems and vulnerability of people who don't fully recover to other infections or next year's strain of corona virus.

We'd be better off taking it slow and developing the technology and social norms to manage this kind of epidemic effectively without a vaccine or cure.  This is the third one SARS, MERS, Corona, we shouldn't expect it to be the last.

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HansStuttgart 27 Mar 2020
In reply to BnB:

> Once infections have peaked in the current lockdown, why not keep the most vulnerable in lockdown (tough on them I know) and allow immunity to build in the more robust, more economically productive, and much larger, segment of the population who can be encouraged back to normal life, thus rebooting the economy? I understand this may have to be phased in, to manage the strain on the NHS, but the instances of hospitalisation among less vulnerable groups are, by definition, far lower.


I think the problem is that this process will be very slow. And then you might as well wait for a vaccine.

Some numbers for the fun of it (don't take this too seriously, I am improvising here ):

current UK number of reported cases: order of 15.000. This seriously underestimates the amount of actual cases as only serious cases are reported. Let's assume there are actually 200.000 cases in the UK.

If the UK would be able to manage this level of cases, with 200.000 cases per month, the time needed for herd immunity is 40M/200k = 200 months.

Even if the UK would be amazing and manages 2M cases a month, it would still take about the same time as the expected time for a vaccine to become available.

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HansStuttgart 27 Mar 2020
In reply to jkarran:

I am not too worried about international travel. I think in a few months travel will resume, at least between the countries that have the virus well under control. 

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Eric9Points 27 Mar 2020
In reply to BnB:

> Once infections have peaked in the current lockdown, why not keep the most vulnerable in lockdown (tough on them I know) and allow immunity to build in the more robust, more economically productive, and much larger, segment of the population who can be encouraged back to normal life, thus rebooting the economy? I understand this may have to be phased in, to manage the strain on the NHS, but the instances of hospitalisation among less vulnerable groups are, by definition, far lower.


If you have a look at fig 4 in the Imperial College paper which I believe is the basis for government policy they seem to recommend a series of lockdowns.

https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf

Presumably as each lockdown ends more people will be able to safely return to work so I'd imagine the economy will kick back into life in a series of steps over the next year or so.

Assuming of course everything works like the model thinks it'll work.

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Gordon Stainforth 27 Mar 2020
In reply to HansStuttgart:

> in Germany the plan is to increase the testing capability (to something like 200000 tests per day). The goal is to contain the spread by finding, isolating and curing infected persons as soon as possible. And then the rest of the country can go back to normal life. It is a similar strategy to the ones of South Korea and Japan.

And that's why their/your? death toll has been so relatively low.

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HansStuttgart 27 Mar 2020
In reply to Gordon Stainforth:

> And that's why their/your? death toll has been so relatively low.

partially, yes. Germany identified a larger portion of the infected persons with mild symptoms. But also mainly younger people were infected. And in contrast to Italy, not a lot of families live with the grandparents in the same building.

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Rob Parsons 27 Mar 2020
In reply to DaveHK:

> I know another COVID-19 thread. C'est la vie.

> I'm a teacher and I've produced a couple of online resources for pupils on some of the science behind the current situation ...

> I've promised that the next one will be about what happens next. I have a layperson's understanding of the basic options but I'd be really interested to hear what some of you think on this or any suggestions for further reading.

You might or might not get good suggestions here. If you get useful info, great - but the question remains how you can verify anything you do get.

I think you should be very cautious about producing any kind of advice for your pupils, and I would suggest you wait until any such is officially issued from upstream. (Are you the headteacher, by the way?) What the world definitely doesn't need right now is armchair medics/epidemiologists/ventilator-manufacturers etc.

No offence taken, I hope. But the answer 'we don't know yet' is currently an honest one.

Post edited at 19:31
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DaveHK 27 Mar 2020
In reply to Rob Parsons:

Totally understand that Rob and I'm right on it already. Just using UKC as a sounding board. It's great for that.

All the materials I've produced so far have emphasized the uncertainties. In fact if there's one thing I hope they learn from it it's living with uncertainty as that's something pupils seem to struggle with.

I'm not issuing advice, just trying to help them understand what's going on. 

I'm not a head, just a foot soldier but HT and people further up the tree have seen and approve of this work.

Thanks.

Post edited at 19:47
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