What's your proposal for an alternative? I've heard this kind of criticism of the lockdown a lot in recent weeks, but I'm unsure of what the alternative is at present. If we go completely back to normal without herd immunity, there will be a massive exponential outbreak that will overwhelm the healthcare system of just about any country in the world.

As far as I can see, the main benefit of a lockdown should be buying the time to put a proper testing system in place and driving the numbers down to the level where we can effectively contact trace. But certainly in the UK I have little confidence that our test-and-trace system is going to be fit for purpose or that community infection levels are low enough to keep track of. So that logic would lend credence to the idea we're exiting lockdown too early rather than too late.

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Last edited by SYSTEM-J on May-29-2020 at 11:51

Meh. Governments can say or do whatever they want about 'lockdowns,' but they can't force people to start going out again. People will only 'vote with their feet' when they feel it is safe to do so. Governments should focus resources to areas that will reduce the likelihood of future large outbreaks, i.e. building up testing and tracing systems.

Now, if the US and UK had locked down earlier, perhaps we could have prevented this from getting out of control in the first place, allowing us to reopen now like Austria and Denmark have. But, we didn't. Late to close, late to open. Can't wait for the inquiries to begin.

quote:

Originally posted by SYSTEM-J What's your proposal for an alternative? I've heard this kind of criticism of the lockdown a lot in recent weeks, but I'm unsure of what the alternative is at present. If we go completely back to normal without herd immunity, there will be a massive exponential outbreak that will overwhelm the healthcare system of just about any country in the world.

I am interested to see if herd immunity even applies. We assume if you have had it you would be less likely to get it again...or maybe it will reduce the severity. but the thing hasn't been around long enough to show that is the case.

And I am thinking the next year or 2 will be an exercise in finding out how we can socially interact the safest way, while being able to find and stop little outbreaks. It is crazy how long you can show no symptoms and be contagious to others. And the seemingly random severity among people also makes you not want to get this at all.

I also think its wild to talk about public health in terms of available space in hospitals instead of avoiding infection. I guess because we never have before and it sounds weird. Would we increase the legal alcohol limit for driving because we have enough hospital/morgue space...

quote:

Originally posted by Boomer187 I am interested to see if herd immunity even applies.

I really don't believe it does. As I understand it, relying on a supposed herd immunity with RNA viruses, when it's not herd immunity via vaccine, truly is gambling with lives, and potentially not just those of the old and/or weak. The more people get it, and thus the more there is of the virus, the higher are the chances of it mutating into something more dangerous too.

In the long run, yes, mostly only those viruses that didn't completely eradicate their hosts are left, which I guess should be almost obvious. That doesn't mean that there can't be particularly bad variations of any given RNA virus in the short term, which can still do a lot of damage before their deadliness turns against them.

I suspect we've had a bit of luck in that this particular virus has been reportedly very slow at mutating.

Last edited by JEO on May-29-2020 at 15:37

quote:

Originally posted by SYSTEM-J What's your proposal for an alternative? I've heard this kind of criticism of the lockdown a lot in recent weeks, but I'm unsure of what the alternative is at present. If we go completely back to normal without herd immunity, there will be a massive exponential outbreak that will overwhelm the healthcare system of just about any country in the world. As far as I can see, the main benefit of a lockdown should be buying the time to put a proper testing system in place and driving the numbers down to the level where we can effectively contact trace. But certainly in the UK I have little confidence that our test-and-trace system is going to be fit for purpose or that community infection levels are low enough to keep track of. So that logic would lend credence to the idea we're exiting lockdown too early rather than too late.

What's the alternative is certainly a fair question, but also a somewhat odd one. After all, such sweeping lockdowns were not part of the playbook in dealing with most previous pandemics, and they have not been universally implemented even in this one, as can be seen in countries as diverse as Japan, Laos, Sweden, and Belarus. None of those countries experienced exponential growth in infections that overwhelmed hospitals, so a lockdown was certainly not necessary to avoid that outcome. Instead, to varying degrees they followed what was the WHO's position on how to deal with similar pandemic respiratory illnesses as recently as last year (here). Namely, they focused on hand hygiene, respiratory etiquette, and voluntary isolation of sick individuals. In some cases they also employed face mask usage and limitations on mass gatherings, particularly in areas with poor ventilation.

Under the WHO's guidelines, home isolation of even exposed individuals was "not recommended in any circumstances" even during "extraordinary" pandemics. This recommendation was based both on the lack of quality evidence supporting the practice, and because "there is no obvious rationale for this measure, and there would be considerable difficulties in implementing it." Stay-at-home orders for non-exposed individuals were apparently not even considered, likely because the evidence was even weaker and the practice considered too extreme. Such quaint times!

Simply put, lockdowns similar to those imposed in the United States and most of Europe were not previously recommended or even seriously considered, had little to no scientific support, and had only meager precedent in previous pandemic responses. So it seems to me that the question we should really be asking is not what the alternatives are, but instead why lockdowns were even considered to be among the alternatives to begin with.

Incidentally, contact tracing was also "not recommended in any circumstances" by the WHO due to poor evidence of efficacy. Unlike the lockdowns the costs of contact tracing are quite modest. So as long as we're not talking building some kind of panopticon-like surveillance state, I think it's probably worth trying despite the weak evidence of efficacy. But we shouldn't have high expectations for it, and I definitely don't think the hopes of constructing an effective contact tracing regime can justify a protracted lockdown. Even proponents of contact tracing admit that for it to be effective in controlling the spread of the disease, (1) the rate of positive tests must be very low; (2) the percentage of contacts identified must be very high; and (3) the contacts must be identified, tested, and isolated very quickly, generally in less than two days (see here for a very longform version). That is, to be effective, you need to isolate 70-90% of an infected person's contacts--including even brief contacts like random people they crossed paths with in a grocery store--within a day or so. That seems quite unrealistic to me, especially in places like the United States, where half the population is likely to be belligerently uncooperative.

bum_sword_queer

Arbiter, completely random question here, but have you read Machiavelli's Discourses on Livy?

quote:

Originally posted by Arbiter After all, such sweeping lockdowns were not part of the playbook in dealing with most previous pandemics, and they have not been universally implemented even in this one, as can be seen in countries as diverse as Japan, Laos, Sweden, and Belarus. None of those countries experienced exponential growth in infections that overwhelmed hospitals, so a lockdown was certainly not necessary to avoid that outcome. Instead, to varying degrees they followed what was the WHO's position on how to deal with similar pandemic respiratory illnesses as recently as last year (here). Namely, they focused on hand hygiene, respiratory etiquette, and voluntary isolation of sick individuals. In some cases they also employed face mask usage and limitations on mass gatherings, particularly in areas with poor ventilation.

Two obvious points occur here:

1. I can only speak with experience of what's happened in my own country, but we certainly tried implementing all of those measures initially, and the number of infections still exploded. So obviously there are additional factors to explain why those measures seem sufficient in certain countries but not in others. Saying "It worked in Sweden" doesn't strike me as sufficient.

2. Regardless of the above, we're living in countries where an exponential outbreak did occur, so the horse has very much bolted on that front. Your contention seems to be that the US, or at least your state, has taken too long to exit lockdown ("That's overdue, to say the least"). Therefore I don't think it's unreasonable to expect you to have an alternative set of measures to replace lockdown in preventing a second peak of cases. Unless, of course, your stance is basically "Let the disease kill who it's going to kill", in which case I don't know why you're bothering quoting the WHO.

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Also duh, the main factor is that people are stupid assholes.

quote:

Originally posted by SYSTEM-J Two obvious points occur here: 1. I can only speak with experience of what's happened in my own country, but we certainly tried implementing all of those measures initially, and the number of infections still exploded. So obviously there are additional factors to explain why those measures seem sufficient in certain countries but not in others. Saying "It worked in Sweden" doesn't strike me as sufficient. 2. Regardless of the above, we're living in countries where an exponential outbreak did occur, so the horse has very much bolted on that front. Your contention seems to be that the US, or at least your state, has taken too long to exit lockdown ("That's overdue, to say the least"). Therefore I don't think it's unreasonable to expect you to have an alternative set of measures to replace lockdown in preventing a second peak of cases. Unless, of course, your stance is basically "Let the disease kill who it's going to kill", in which case I don't know why you're bothering quoting the WHO.

I don't think we gave the traditional tools of disease mitigation enough time before locking down to conclude they weren't working. In many places the transmission rate was dropping significantly even before the lockdowns, probably because people had already began behaving much more carefully. Norway's public health institute, for example, recently concluded that it probably could have controlled the disease without a lockdown based on that evidence (source).

It could be that certain densely-populated regions like New York City or London required even stronger interventions. But I tend to think the explosive growth in infections that they saw was mostly a result of implementing even basic precautions too late. That would explain why Tokyo, which never locked down but implemented more modest measures much earlier thanks to the Diamond Princess, never saw growth on the same scale.

Of course you are correct that the virus has now established itself in the US and UK to a degree where we cannot go back and try to replicate Japan's apparent success with lighter measures implemented earlier. I don't know if we can fully prevent a second wave of cases upon reopening. It's a good sign that places which reopened early, such as the state of Georgia, have generally not yet seen the predicted acceleration of infections over a month later. But life there is still hardly "normal," and regional differences may make other places more vulnerable to another spike in infections. Even if a second wave will occur, however, a longer lockdown will only delay it, not prevent it. The lack of a straightforward exit strategy from lockdowns is part of the problem with them, not a reason to prolong them.

I very much hope you are right, because that would mean the very gradual relaxation of lockdown we're currently going through will not result in another explosive growth of cases. There's an awful lot of hand-wringing in the media right now from various public health officials who are claiming we're going too quickly with this.

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