Why you need to restrict your freedom and stay at home
As the lockdown wears on, people are bristling and trying to wonder why they should stay home. After all, aren't virus deaths on the decline? Isn't the risk very low for younger people, and from things like outdoor activities? Aren't people suffering great economic harm? Don't we have a free society where people have the right to decide for themselves what risks they want to take?
I have made a Covid song parody (a popular pastime) about the need to stay at home.
All these are true, but...
You're not staying at home to protect yourself. It's to protect others by not letting yourself be a virus-breeding vector
Yes, the odds of death for young people are low enough that we wouldn't lock down the economy to prevent it. The problem is, while you do have the right to take on risks for yourself (or more questionably, for your family and house-mates) you don't have the right to put others at risk. Every risky activity increases the viruses chances to breed, and to move through you to other people. This is an epidemic. It's about society being at risk, not just you.
Perhaps you have a 0.1% chance of dying if you get infected. Your chance of killing someone, though, is much higher. While it's hard to give a certain number because we don't know how long the virus will be around, but a pretty rough guess is that on average, if you get infected, then you have around a 1% chance of killing somebody else who gets it from you, or gets it from a chain that goes through you. You can take that 0.1% chance with your own life -- people do that all the time -- but how can you justify doing something that has a serious chance of leaving others who didn't sign up dead, with more sick or chronically ill?
Your chance of dying depends on your own health and age. Your chance of killing somebody largely does not. The virus isn't out to get you, it's out to use you to help itself breed. And it's sneaky -- half the people who have it don't even know they have it.
Don't we put others at risk all the time?
We do. If you drive for 10,000 miles (about a year) I calculate probably around a 1 in 1500 (.06%) chance of killing somebody. As we know, while car crashes kill about 40,000/year in the USA -- a horrible toll -- the virus will probably kill 200,000. But to drive you need a licence and to pass a test, and follow tons of laws and restrictions on your freedoms to get it down to that number. If you keep breaking those laws, you'll lose that licence. If, after you learned about what the virus will do to people who get it from you, you decided to keep breaking the rules and recklessly breed and spread it, well, don't be surprised if people are not so fond of what you are doing with your freedom.
Aren't lots of prohibited activities actually pretty low risk of transmission?
They are. But one of the things we have trouble understanding about exponential threats like a virus is that risks don't add, they multiply. You understand that if one person litters, it's annoying, and if 1,000 people litter it's 1,000 times as annoying. Viruses don't work that way. They're more like nuclear reactors. A certain low amount of activity produces a relatively small result, but as the level of activity increases, suddenly it reaches a point where it goes exponential -- doubling every round instead of just growing in the linear way we understand. If it does, it melts -- or if contained, explodes.
You saw that happen at the start of the virus, when there were just a few cases found. Every few days the newspapers reported twice as many cases. What seemed like barely anything in early March had left 20,000 extra people dead 2 months later. That's the deceptive nature of the exponential.
Risk multiplies which means that what one person does is little, but if too many people do it, it explodes. If 10 people go to a rally, it won't be very much, and 1,000 people isn't just 100 times as bad. Based on the parameters of the virus it can be many thousands of times as bad. That's why only the essential workers and travelers should stay at home, to keep us below that threshold.
Yes, the lockdowns are too much. They have to start that way.
The lockdowns are definitely more than we need. They have to be, because at the start, we didn't know for sure what we needed. Right now, people are trying to learn as much as they can about how the virus moves -- unfortunately they are not learning nearly as fast as they should or could -- but each thing they learn will allow reasoned decisions to be made about what activities are low enough risk to go on, and which need to be curtailed. In spite of what I sing, certain beach activity (with family) is probably OK. Loosely packed protests with masks may not be that bad. Church and hair salons, not so much.
A super-strong lockdown, as was done in China, can make the virus die off very quickly, just as wide open activity can make it explode. If you can really shrink it down, that lets you actually let off the lockdown a fair bit, just to the point before it goes exponential. Each defiance, each new risk, is delaying the day we can do that. By congregating, by defying the stay-at-home, you are the one delaying the day we can open up again. Around the world, other countries which didn't defy have declining cases, while many of the states in the USA have increasing ones. You are the cause of the very thing you are marching against.
What about forcing us to wear masks?
Perhaps you've guessed this by now, but the mask is there more to protect other people than it is to protect you. Sure, it's an infringement on your freedoms to force you to wear stuff, but people have asked you to wear them, and now they're telling you to, because once you realize it's to stop you from killing somebody's grandpa, you would never be the sort of asshole who refuses -- or so I hope.
Isn't religious practice constitutionally protected?
It is, though it is not immune from rules which apply regardless of religion. The church still has to follow the building and safety codes. But you don't need to look at the constitution. If you're Christian, Jesus himself gave very clear instructions on how to worship and pray. They are found in Matthew 6:6. This is not some random part of the bible, it is the Sermon on the Mount, the very core of the teachings of Jesus. If your pastor tells you to disobey Jesus on this, it should not be hard to decide who to listen to.
Stay at home. If something would cause an exponential explosion of death if everybody did it, don't imagine you will be the only one to do it. Don't do it.
Fri, 2020-06-19 14:00
It's a big country
The US is huge, and each town, city, county, state is subject to its own unique situation. It doesn't make too much sense to make one set of rules for an entire state or country.
The median age of Covid death in Minnesota is 83.6 !!! Well over 80% of deaths are from people living in nursing homes or assisted living. Governor Tim Walz of MN and Governor Cuomo of NY are responsible for the murder of thousands of senior citizens in nursing homes when those nursing homes were forced to accept Covid-positive patients into facilities that weren't prepared to deal with them and stop it from spreading to other residents and healthcare workers. Those senior citizens are dying because of government policies, not because young people congregate in groups and then go hang out in the nursing homes.
The state supreme court of Wisconsin ruled that their lockdown was not constitutional. Wisconsin opened up over 1 month ago. There's been no spike in hospitalizations or deaths. Governor Walz, next door in Minnesota, isn't paying attention to that data. He's keeping his foot on the brakes. Because he's a blue state Democrat that wants to keep the economy in a recession/depression until the November election. He violated his own laws/rules when it suited him. If my mother or father died, I couldn't have a funeral with more than 10 people. But he attended a funeral with more than 500 people and NO social distancing. Hypocrite! He also didn't have a problem with thousands of protesters-rioters- arsonists congregating on the streets of Minneapolis & St. Paul with no social distancing. Hypocrite.
Where's the science that shows that young people shouldn't play baseball? The world has gone crazy. Minneapolis burned down, but it's important that kids don't play any sports?
If a person is high-risk or is afraid of getting the virus, then they're free to take all their own precautions. Why should they force the rest of the world to behave a certain way. Let's say this lockdown is costing the US economy $12 trillion in lost economic activity. Divide that by 120,000 deaths and you get $100 million per death. Does this seem like a good tradeoff?
What about the 40+ million Americans that lost their jobs? If we're sacrificing their jobs for the sake of retirees, how do we make this fair? Do we impose huge taxes on retirees to pay for young people that are now unemployed? We probably borrow trillions more, adding to the national debt, that the young unemployed people will have to repay. But how will they repay it? Or how will the US government ever repay all the debt it's taken on? This economy is not sustainable. There's no choice but to get people employed again and open up the economy.
The "experts" that I hear have been saying since February that 60%-70% of the US population is going to end up getting Covid-19, regardless of what we do. They say we can slow the spread, but it'll get over 60% of us eventually. The only rationale for the lock-down initially was to give the hospitals time to prepare. They said the lock-down would only last a couple weeks, 15 days, 30 days. Now there's no end in sight. They keep moving the goalpost further away. Especially the Democrat governors. Look at Washington state, Minnesota. What these governors are doing has nothing to do with "the science." They do whatever suits their political goals, and they say it is for our own good. They're here to help us because we're too stupid to take care of ourselves. I've had enough of their unwise "leadership" that has resulted in chaos, unemployment, rioting, looting, arson, and mass murder in the nursing homes (thanks to their rules).
Fri, 2020-06-19 15:05
Why shouldn't young people play baseball?
Baseball would be only a moderate risk for the young people. (Though because people touch that ball with their bare hands and spit all the time, it certainly needs a little modification of habits.)
But how do you think those people in those nursing homes came to die? You think they got the virus only by transmission from old person to old person? They got it via a younger nurse or visitor. Who got it because there was too much prevalence of it among the young people. Possibly because of baseball games, but really a million things.
Sat, 2020-06-20 11:37
Stop the Lockdowns
BRAVO! I agree with all the points you made in your essay and was ranting about the same things when Michigan was being tyranized by our Democratic governor. Lots of aftermath and heartbreak for so many who were forced to not work and still haven't received their rightful unemployment benefits for the past 3 months because governor had no clue how to fix "the system" and no clue who to hire that can fix it. After what we have endured because of sheer stupidity and lack of logic, I am determined to vote straight Republican tickets for the rest of my life. Thank you for writing such a well written essay filled with logic, common sense, and humanity.
Fri, 2020-06-19 19:32
Staying home to protect others
I just don't see it. If you have older family at home, or if you work somewhere with older folks, yeah, I can see why you should avoid getting it to protect others. But if you're young and live alone or live with other young people, and say you're a student or are unemployed or work from home, the chances of killing someone are very low. And in fact the chances are probably higher that you'll save a life by getting it, recovering, getting the antibodies, and contributing to herd immunity. Maybe you can even save a life by donating your antibody-filled blood.
Not if you mainly interact with other young people.
Moreover, what are the chances that someone is going to get it from you who didn't knowingly assume the risk that they might get it? Very low unless you're a nurse or something.
And that's the fault of the younger nurse or visitor. Not of the person who gave it to the younger nurse or visitor (unless they broke into the person's house or secretly licked their hamburger or something).
Hair salons, with masks, seem to be fairly low risk.
If you think this virus is going to keep spreading until we reach herd immunity, and it's starting to look that way, then the opposite is true. The more people who get it, the closer we are to herd immunity. Flattening the curve means the virus stays around much longer.
Maybe we'll get a vaccine before then, but IHME is projecting 20 million cases by October 1, and we'll likely be several months away from a vaccine still. We might very well wind up with 100 million cases before we get a vaccine.
Fri, 2020-06-19 19:52
We went over this before
If you live only with young people, odds are you might not give it to an at-risk person directly. But the more people you interact with (of any age) the greater the odds of being part of a transmission chain. Because they interact with their own set of people. Who interact with their own set of people. And in the end, the chains always lead out to the at-risk population.
Only in a locked down world does this not happen. Only if the members of your young household are staying at home, not interacting with others outside the household. That's the whole point!
Stop social distancing and the probability of transmission increases for all the people who meet. You give it to your young housemate, who gives it to his young hairstylist, who gives it to 20 customers, young and old, who ... and so on. Unless the chains are stopped by distancing and stay at home.
It doesn't matter at all what your age are, or the age of the people you live with. They only matter as to who you might give it to directly.
Fri, 2020-06-19 21:26
Just answer this one question, first.
In the short-term, yes. In the long-term, no.
Or by herd immunity.
Let's say 25% of the population having antibodies, combined with moderate social distancing, gets the R0 below 1. (It seems to have done so in NYC, and NYC has about the highest R0 in the world.) Isn't it better if that 25% of the population is mostly under 35?
Fri, 2020-06-19 22:54
The example of Bergamo suggests that the quest for herd immunity would kill about 0.6% of the population of the USA, or around 2 million people, with a decent chance that one of them is me. That's the best information we have. And no, old people are not of lesser value as human beings.
So no. Hell, no. As such, the governments of the world, mostly democratically elected but even if not, have overwhelmingly decided to say, "hell, no."
SARS-1 and MERS both were defeated with no need for herd immunity, and good, because they might have killed more. Spanish flu was defeated using herd immunity, and 100M people died around the world.
There are many paths to defeating this without herd immunity, and while victory is not assured, they are well worth trying, even if millions lose jobs for a while, and other terrible things happen. So no.
Sat, 2020-06-20 11:28
Bergamo isn't the only way
Because the only thing stopping you from going out partying is the law against it?
What is a decent chance? One in a thousand? One in ten thousand? If you're practicing social distancing, working from home, and under 65, your chances of dying from this are low. Preexisting conditions matter, but the common preexisting conditions matter a lot less than age. And if everyone in your household is staying home, your chances of even getting this are near zero.
I'm staying home too. I'm at higher than average risk too (though that risk is still much lower than the 85 and older crowd, and it probably is for you too). And I'd feel a lot safer right now if 25% of the population was immune. Once we reach herd immunity (naturally or with a vaccine), I'll feel safe enough to return to my normal routine. Until then, no lockdown is going to make me feel safe.
And if 80% of that immune population was under the age of 35, we'd have had much much much fewer than 0.6% of the population dead.
I'm disappointed that you didn't answer my question: Let's say 25% of the population having antibodies, combined with moderate social distancing, gets the R0 below 1. Isn't it better if that 25% of the population is mostly under 35?
They were very different viruses, that never grew anywhere near the size we're seeing with SARS-2 now.
And I'm pretty sure they haven't even been defeated yet. MERS hasn't been defeated. It just doesn't spread as easily.
Name the best one. One that is realistic, please. Pick your position. President of the USA? Mayor of Los Angeles? Pick some jurisdiction within the USA (or the jurisdiction of the US federal government). Not New York City, because the antibody rate there is already so high that they are benefitting from partial herd immunity. I'll even give you the support of your legislative body. You can pass any law you want, within the juisdiction of your chosen governmental unit. (You can't control all the governments of the world, and you can't control the free will of the people to break any laws that you don't have enough police to enforce. You have to respect the Constitution, at least to the extent that you're unlikely to get away with violating it. I'll be lenient there. You can get pretty draconian, but you can't do things like restrict interstate travel unless you choose to be the POTUS. And if you choose to be the POTUS you're going to have to explain a lot about how you're going to enforce the rules without unconstitutionally commandeering state police.) What's your strategy to defeat this virus, within your jurisdiction, without relying on herd immunity?
Maybe we'll come up with a treatment before we get herd immunity. Even that wouldn't be defeating the virus, though.
New Zealand hasn't even defeated it, and they're an island with a tiny fraction of the international travel of the United States.
We did try it. It didn't work. Now we're faced with having lost millions of jobs, other terrible things, and failing to stop the virus.
We need to do something that is sustainable well into 2021. Hopefully we'll have a vaccine by then. Hopefully we'll have an effective treatment even before that, but I wouldn't count on that.
There are going to be a lot of infections between now and then, and I'd much prefer that those infections are younger and more healthy people. While it wouldn't be ethical to intentionally infect young and healthy people, it's perfectly ethical to rescind the laws that are stopping them from voluntarily infecting themselves. (You seem to even recognize this yourself, so I'm not sure what the problem is.)
Sat, 2020-06-20 11:25
Very different viruses
Odd you should say that. This virus (known as SARS-Cov2) is the closest relative known, I believe, of SARS.
We are genetically the same as the residents of Italy. In Bergamo, on their way to getting closer to herd immunity (they are not quite there yet, but closest of anywhere) they had 0.58% population fatality rate. They had big spreading events, like a giant football match which much of the town attended. They show us what would happen to us if we socialized and allowed the virus to grow until it reached herd immunity levels.
(We don't know precisely what herd immunity level is, but Bergamo puts a floor on it of being at least 60%, and probably a bit more.)
Those who locked down in time, avoided events like the Bergamo football match, were able to reverse the growth. Why is that so hard for people to see?
If you think we would somehow have done better than them without restrictions, that's for you to prove.
Now, it is true that you can do much better than Bergamo with no forced lockdown, but with the natural fear based restrictions that come when people become aware of the lockdown. But, without other measures, as you say, that just slows things down on the path to herd immunity -- which is 2 million dead in the USA.
You need a path to victory. I have outlined the steps of that path to victory several times.
Sat, 2020-06-20 12:18
Very different viruses
There's nothing odd about it. The viruses are very different in all the ways that are relevant to my statement. The fact that they are closely related doesn't negate that.
Herd immunity levels depend on more than just genetics. You agree with that, right?
The herd immunity levels are not the same in every location. You agree with that, right?
Even within the same location, the herd immunity levels depend on behavior. You agree with that, right?
If 50% of people wear masks regularly, herd immunity is drastically easier to achieve. You agree with that, right?
Bergamo let their hospital systems get overwhelmed. We're nowhere near that, anywhere in the USA. You agree with that, right?
In NYC, during their lockdown, the herd immunity rate was about 25%. We'll see in a few months what the herd immunity rate will be in a partial reopening phase. But NYC is one of the most densely populated cities in the world. The herd immunity rate will be much lower in almost all other locations.
I think I specifically said that I'm not interested in speculating on hypotheticals about the past. My focus is on what we should do going forward, and there's just no way we'd see anything remotely close to Bergamo in our future. We know a lot more now (which you admit yourself in the very next sentence).
So when you say, "the quest for herd immunity would kill about 0.6% of the population of the USA" you are wrong. It wouldn't. Not necessarily, anyway.
I think it'd be much less than 2 million if we protected the oldest and most vulnerable, and got the vast majority of our herd immunity from people who are least at risk. And as you recognize, this virus will spread much less viciously than it did in Bergamo just from the fact that we know more about it now. So the levels of infection that we'll need to reach herd immunity will be lower than Bergamo. And as testing gets better, and contact tracing gets better, and our knowledge of the virus gets better, the levels of infection needed to reach herd immunity will continue to drop.
But most importantly, we don't have any other choice. We can't stop this virus. It's too late for that. We can only slow it down.
What you outline is what we're doing. The end of that path is herd immunity.
I think we'd achieve that with far fewer deaths if we encouraged people under 35 to get infected as soon as possible.
That part is a pipe dream.
Sat, 2020-06-20 16:55
Herd immunity levels
I am not sure herd immunity levels will vary greatly from location to location. It will tie closely to R0, which can differ from location to location, but I don't know how much data we have on how much it differs. I don't understand how the level can differ within a location, which is to say, within a "herd." That seems contradictory.
The virus grows exponentially within populations. Prior to lockdown, we had populations of tremendous intermixing. Millions flying every day. Many millions driving. Even rural people regularly socializing and going to group activities and dining.
You are using the term herd immunity in a different sense from most usage. Yes, if everybody wears a mask, the virus has a harder time spreading. Many factors do that. Herd immunity applies to normal behaviour. You can change it only if you change normal. Which we may be considering doing, of course. So if we all wear masks forever, you could attain it more quickly. Until you take the masks off.
In the end, it's about the R0 value. If it's more than one, the virus grows. As more people become immune, that gradually reduces the R0 and it becomes less than one. This happens naturally (herd immunity as the name suggests is a natural process for groups of animals.) You can generate synthetic immunity via vaccines to get the same phenomenon because they are permanent/renewable. You don't generate herd immunity with temporary behaviour modification. Otherwise one could say that under lockdown we now have herd immunity, which I don't think anybody would say.
I agree that Bergamo had it worse, but that doesn't affect the question of herd immunity. That happens or doesn't happen no matter how well you treat the ill.
The herd immunity rate is inherent to the disease and the hosts, it does not change, absent permanent behavior changes -- ie. effectively inherent changes in the hosts.
It is still correct that a "quest" for herd immunity would kill 0.6% of the population unless the changes are permanent, or if a vaccine or treatment arrives before herd immunity. As such, you do not quest for it!
Yes, one could follow a strategy of:
If you divided things up so that only 0.1% of the less-risk crowd (say 200M people) that's still 200,000 dead. Congratulations -- that's less than the 300K who died in WWII! Yay! Or maybe just 140,000 if that sub-population gets herd immunity at 70%.
Except herd immunity does not work that way. Because if you have 60% young that are 70% immune, you have now only 42% of total population not immune. You open up again and BOOM, no herd immunity any more.
My path is not to herd immunity. Other than in the sense that my path is the path to give time for vaccine/treatments. I am optimistic they will arrive. As permanent changes to the transmission vectors of the virus, they can change what herd immunity means. Well, vaccines can. Treatments that reduce shedding also can.
Treatments which reduce severity give us a path to herd immunity with low fatality, but only if we only start the path to herd immunity after we have the treatment.
Sat, 2020-06-20 20:17
Do some research.
"Limited evidence supports the applicability of R0 outside the region where the value was calculated" https://wwwnc.cdc.gov/eid/article/25/1/17-1901_article
How else would you explain why NYC was still growing exponentially while other locations didn't grow at all? It wasn't because NYC didn't lock down as tightly. It was because dense populations have a higher R0.
R0 varies over time.
"Yet, even if the infectiousness of a pathogen (that is, the likelihood of infection occurring after an effective contact event has occurred) and the duration of contagiousness are biological constants, R0 will fluctuate if the rate of human–human or human–vector interactions varies over time or space." https://wwwnc.cdc.gov/eid/article/25/1/17-1901_article
You are talking about Re, which is R0 times (1 minus the percentage of the population that is immune).
The 0 in R0 refers to the fact that it represents the spread of the virus if no one is immune.
Herd immunity can be natural, or it can be artificial (via a vaccine).
If a long-term lockdown brings R0 to a level above 1, and herd immunity brings Re to a level below zero, I think it's fair to say that you have herd immunity.
I don't know where you're getting 0.6% from, but behavior doesn't need to change permanently. Behavior needs to change until the immunity level goes up because of vaccinations.
The death rate of people under 45 is about 0.1%. But most of that 0.1% is people with severe preexisting conditions. So the death rate would likely be much less than that.
And even 200,000 is probably lower than what the death rate is going to be.
Or maybe 50,000 if the sub-population gets herd immunity at 50% and the mortality rate is 0.05%.
You don't completely open up again until there's a vaccine. You are able to have the different populations interact, though. People with antibodies can interact with both groups. They can work in the nursing homes. They can deliver groceries. Etc.
But my suggestion wouldn't be to use force. If low-risk people want to isolate, they can isolate. If high-risk people want to party at the bars, they can party at the bars. It wouldn't be perfect. But the vast majority of higher risk people are going to choose to isolate themselves. Maybe the lower risk people will, and maybe they won't. If they do isolate themselves, then we're in the lockdown scenario that you suggest, except without the use of force.
(And even more realistically, there will be way more than two subgroups. The 21-25-year-old, healthiest, stupidest, subpopulation will do the really high risk activities, and will have the highest rates of infection. The old and sick will tend to avoid any risky activities. The middle-aged folks will tend to behave somewhere in-between. The notion of there only being one R0 in a large geographic location is an oversimplification.)
Widely deployed vaccines provide herd immunity (immunity for the entire herd, including members of the herd who aren't vaccinated). But I'm getting the impression that you didn't understand that, and that's probably part of the reason for our disagreement.
Sat, 2020-06-20 20:16
Of course R0 varies, not just by locations, but over time. That's not the same as saying that herd immunity levels vary greatly from place to place. What is the same in every place is the general infectiousness of the virus. It transmits through a variety of means and behaviors. In some areas there are lots of those behaviours. In others there are less. Some behaviours change, mostly temporarily, in rare cases permanently.
In our default state, we are a global, super-social species. One herd. We have temporarily stopped that and broken ourselves up into sub-herds but that's all, we hope, temporary.
But knowing all that, what I am saying is that the patterns of most of the western world are similar enough, in their default form, that there will not be great variation. You won't see Bergamo needing 70% infection to gain some immunity and another place in the west needing only 20% under normal rules of life. Of course you reduce the R0 locally, that's been the whole point of the lockdowns and other rules.
I get 0.6% because in about the only place where we had data that started to approach herd immunity (we don't know if they really have it yet) that's how many died.
Of course immunity is granted via vaccines. You have been talking about natural herd immunity, not vaccine generated. I am all for vaccine generated herd immunity being the goal.
Still, so you want 50,000 young people dead, and because nothing is imperfect, a fair number of the at-risks who were isolating also dead, and when that's over the at risks still have to isolate? Over 45s are a large part of the economy. Their jobs would vanish, not just during the isolation, but forever. I wrote about this plan last month. I don't think it would fly, even if it would work. It would be a massive age discrimination.
Sat, 2020-06-20 21:23
"Limited evidence supports the applicability of R0 outside the region where the value was calculated" https://wwwnc.cdc.gov/eid/article/25/1/17-1901_article
I assume you recognize that the level of immunity needed for herd immunity is a function of R0. (I think you even said something like that.) R0 varies greatly from place to place. I'm not sure how you can understand the definition of R0 and not intuitively understand that. But I provided a link where you can read all about it.
If you need me to quote some more: "Any factor having the potential to influence the contact rate, including population density (e.g., rural vs. urban), social organization (e.g., integrated vs. segregated), and seasonality (e.g., wet vs. rainy season for vectorborne infections), will ultimately affect R0. Because R0 is a function of the effective contact rate, the value of R0 is a function of human social behavior and organization, as well as the innate biological characteristics of particular pathogens. More than 20 different R0 values (range 5.4–18) were reported for measles in a variety of study areas and periods (22), and a review in 2017 identified feasible measles R0 values of 3.7–203.3 (23). This wide range highlights the potential variability in the value of R0 for an infectious disease event on the basis of local sociobehavioral and environmental circumstances."
And you are wrong. There obviously is great variation. NYC experienced nothing remotely close to Tulsa, Oklahoma.
Or to put it another way, "Limited evidence supports the applicability of R0 outside the region where the value was calculated" https://wwwnc.cdc.gov/eid/article/25/1/17-1901_article
You are wrong. Very very wrong. There are significant variations from zip-code to zip-code. There are huge variations between cities and rural areas. In fact, you use Bergamo as an example not because they did something drastically different with regard to lockdowns, but because they got hit so much harder than just about anyone else.
But moreover, we are not in a time when normal rules of life apply.
Wearing masks alone could potentially cut R0 in half. If R0 was 4 in Bergamo (which would require 75% immunity to get Re of 1), wearing masks could cut it to 2 (cutting required immunity to 50% to get Re of 1). Combine this with social distancing and frequent hand washing, and you might even get R0 down to 1, though in practice not everyone will follow best practices, so maybe you only lower R0 to 1.3, and need about 25% immunity.
And that is not appropriate. For the multiple reasons I already pointed out two messages ago.
You may have assumed that, but you assumed incorrectly. When I talked specifically about natural herd immunity, I included the word "natural." If I said "herd immunity" and didn't include the term "natural" then I meant any type of herd immunity.
It's fine if you misunderstood me. But don't try to tell me what I meant.
I don't want anyone dead, but we're already at 121,000 dead after trying lockdowns, and we're nowhere near herd immunity. (Note that I didn't use the word "natural.")
Have their jobs vanished forever? We've just had 3 months of isolation.
I don't know the exact numbers, but most are probably working from home.
What you wrote about, and what would be age discrimination, is forcing people to do this.
What I am suggesting is that we let people decide for themselves what they want to do.
Sun, 2020-06-21 14:33
How much variation in R0
Sorry, but I have not seen a demonstration that the level required for herd immunity is greatly different in different places. Yes, lots of places have different levels of virus spread. There is effectively no place in the world where you can measure herd immunity, which I am saying is the level of immunity needed without the use of temporary mitigation measures. Every place in the world (even Bergamo) is under temporary mitigation measures, in many cases extreme ones. Bergamo is different because they had events like their football match and others before they started their eventually extreme mitigation measures.
The virus has been (temporarily) beaten back by these measures in many places, but still is on the increase in the USA even though it also has fairly extreme measures in place, but enforced irregularly.
So you can start telling me the herd immunity levels for a place only after we have enough data to calculate them absent the social distancing etc.. Absent masks. Absent lockdowns. Absent the closing of large public events. Absent the shutdown of travel and factories.
Before we have that, we can only look at the largest examples. They will tell you a floor for the value in similar places, unless you can present a strong case for how it will be different.
Yes, rural and urban show different growth rates. But under normal circumstances, rural and urban are not different herds. They normally intermix greatly in mobile and wealthy societies.
Mon, 2020-06-22 06:31
You're smarter than this
I haven't seen a demonstration that you're qualified to speculate on that.
You don't even seem to have read the links I provided. That or you don't understand them. But you're smart enough to understand them. So you probably haven't read them.
You can calculate the level of herd immunity required from R0, and you can measure R0 (not perfectly accurately, but well enough to see that it is greatly different in different places).
To achieve herd immunity, 1-1/R0 as a percentage of the population must be immune. If R0 is 4, then 75% of the population must be immune to have herd immunity (1-1/4=.75). If R0 is 2, then 50% (1-1/2=.5). If R0 is 1.33333, then 25% (1-1/1.33333=.25).
You admitted earlier that R0 differs by location. And I gave you a link that discusses it in detail, and even provides an example of how widely the R0 for the measles differs.
And if you understand the definition of R0 (and the reason for the the 1-1/R0 formula), you would intuitively understand why this is true.
The level of immunity needed without the use of any temporary mitigation measures is irrelevant.
And that's exactly why the level of immunity needed without the use of temporary mitigation measures is irrelevant.
No one is arguing that we should eliminate all temporary mitigation measures. (Okay some conspiracy theorists probably are, but I'm certainly not.)
I'm arguing for eliminating mandatory stay-at-home orders for non-sick, mentally competent individuals. We'd still have masks. We'd still have increased hand washing, and increased use of hand sanitizer. We'd still have one-way markers on the grocery store isles. Most people (especially older people) would still stay at home. We'd still have testing, and contact tracing, and social distancing. We just wouldn't have government-mandated shutdowns of businesses and non-profit gatherings.
If we had that, this virus would kill fewer people. And it would mostly kill people who chose to ignore science.
"Limited evidence supports the applicability of R0 outside the region where the value was calculated" https://wwwnc.cdc.gov/eid/article/25/1/17-1901_article
You're smart enough to understand what that means. If you're still unwilling to accept it then you are being willfully ignorant.
Read the link. Educate yourself.
Mon, 2020-06-22 14:50
Understand all that
I understand the math of the immunity and the ways that R0 can vary. And the components of R0 include some that are inherent to the virus and human biology, and some that are the result of the variations in human activity in an area. So yes, a virus can have a much larger number in a dense city where everybody kisses on greeting than in a rural hermit enclave. And so yes, herd immunity can be attained at different levels in those places -- I'm already aware of that.
But make no mistake, there's also the part inherent to the biology which makes some pathogens more scary than others, and this virus is one of them. And there are things that the big cities have in common which limit the variation.
But more to the point, until you understand the methods of transmission, you don't know what that variation is. As I have always said, the right approach is to start with a conservative lockdown until you can learn more about the transmission rates under all the different circumstances. Then relax the rules.
The reason I say that we can't know the number while we have all these temporary mitigations in place is that if you reach the low R0 (as we did under lockdown) it goes back up if you relax the restrictions too much, and of course if you relax them all the way. There are few places where we know enough to say what R0 becomes if we return to old normal, and thus you can't easily predict a herd immunity. What we do know from Bergamo is in the patterns of life found in northern Italy, which are not too different from many other places in the world, you probably need 70% immune, and this matches estimates of R0 made before the lockdowns in some places.
If the patterns of life in Tulsa are super different from Lombardy or New York, we need data to figure that out. Then perhaps it can run with fewer restrictions, but probably still can't run with no restrictions, until there is a vaccine.
I fail to see why the level required without temporary mitigations is irrelevant. Our goal is to get rid of those mitigations. If you turn off the mitigations then the virus will grow again, until it reaches the new equilibrium and you very much want to know what that is.
Tue, 2020-06-23 04:07
Your previous comments suggested otherwise
I don't agree. Many temporary mitigations need to remain in place until we can achieve artificial herd immunity through a vaccine. Otherwise we are simply going to see a surge as soon as the mitigations are lifted.
Proper hand hygiene (which frankly should last forever), use of masks, a level of social distancing. These probably need to be in place for another year or more.
Temporary measures that are removed after a few months are not likely to decrease the total number of deaths, as it only postpones the inevitable - exponential spread until herd immunity is reached. And given the nature of this virus, having such a disproportionate effect on such a small portion of the population, such unsustainable measures are likely to actually make things worse. As people get infected and recover, we get closer to herd immunity.
I do agree that it was helpful to have some more temporary measures in place at the beginning. First of all, we didn't know if we had a chance not just to mitigate, but to suppress (not just to slow the spread, but to completely wipe out the virus without a vaccine). We moved too late for that. In hindsight, given what we know now about asymptomatic carriers and carriers with very minor symptoms, probably much too late. But something else we accomplished by the initial lockdowns was, as you point out, getting time to learn more about the virus. We know a bit more about how to treat it, and we know a lot more about how it spreads.
We know that the R0 under strict lockdowns is greater than 1 in New York City, and lower than 1 nearly everywhere else. In fact, with 20% of NYC residents showing antibodies, we can estimate that R0 during the lockdown was about 1.25. Some better antibody studies could get us a more exact figure, but we don't need an exact figure. It's safe to speculate that R0 is also probably much much higher in NYC than just about everywhere else even with no mitigations in place. But as I've said before, it's not clear what we gain from that, because unless this virus dies out on its own or we come up with a miracle treatment (two possible scenarios but very unlikely ones) we are going to keep some mitigations in place for another year or more. Some (like increased telework and telemedicine) will probably even become permanent.
What is most important for us to figure out right now is what mitigations can society withstand keeping in place through the containment of this virus (likely due to a vaccine) that minimize R0. The approach, outlined by the white house team before they were taken out of the public view, is a very sound one. Slowly reopen. Test. Contact trace. Figure out what types of activities are causing the spread.
Masks are going to play a huge role in this, I think. Evidence suggests that the widespread use of masks can have a dramatic effect on lowering R0. That means that wearing masks helps us open wider, sooner.
The biggest obstacle we face is disinformation. Unfortunately, disinformation is the mantra of our president, and is in overdrive right now as he strives for reelection. Lockdowns and other draconian measures that unnecessarily take away personal liberty only serve to help in the disinformation campaign.
Tue, 2020-06-23 17:49
Until the vaccine
OK, if you are saying "until the vaccine" then that is something I've said as well. Pretty much all other discussion of herd immunity I have seen has referred to pre-vaccine herd immunity, generally because the writer feels that the temporary mitigations are too much of a burden to do them until a vaccine.
So yes, the strategy is indeed to find mitigations that keep the virus from going exponential until we can either gain sufficient immunity through a vaccine, or reduce the harm of the disease through treatments. I have seen (and been debating with) others who are saying we should give up mitigations and go for herd immunity in the traditional sense.
And yes, the easy ones -- hygiene of all sorts, distancing, masks, are obvious ones. There is debate, and research into whether they are enough. If they are enough then of course the others should be relaxed.
(Well, the way you relax them is you first do a short hard lockdown to get the virus down to low numbers, and then let it coast at those numbers with the minimal mitigations needed to do that. This is what we sort of are doing, but should be doing much more deliberately with lots and lots and lots of research and testing to figure out what's needed.)
Did we move too late? Other countries moved just as late, but moved better, and got their virus beaten down quite a bit. The USA, not so much.
Actually, the fact that NYC has seen major drops in cases and hospitalizations and fatalities shows that it is less than 1 -- a fair bit less -- under their lockdown. They only have about 20% antibody-positive, not enough for herd immunity without their lockdown.
Wow -- we're pretty close to agreement...
Wed, 2020-06-24 05:02
The world moved too late to contain the virus. I mean that as a neutral, judgment-free fact.
R0 was never less than 1 in NYC. The major drop in cases there was due to herd immunity. That's clear from the fact that cases were still growing exponentially even after the lockdowns were fully implemented.
Not enough for herd immunity without the lockdown, but the lockdown combined with 20%+ herd immunity (and even higher in the hardest hit areas, and with the hardest hit demographic populations) brought effective R below zero.
Maybe, but that last comment suggests that you still don't understand how herd immunity works. Effective R = R0 times (1-immunity percentage).
In NYC, if 20% were immune (it's higher now but maybe was 20% at the peak), and new daily cases are shrinking, then what we know is that R0*(1-0.2)<1.
Depends on the location, but it's becoming pretty clear that you can't have people partying at bars while not wearing masks in Florida and have an R0 below 1. What percentage herd immunity you would need to bring effective R below 1 in that scenario is unknown.
I think we should let the fearless 20-somethings party until enough of them get it and recover, so we can find out. The more people who are immune, the more we can open up.
Re=R0*(1-immune population percentage). Re<1 means new daily cases goes down.
If R0 is greater than 1, the virus spreads until there is enough herd immunity (as calculated above), then starts going away. I don't think we have the resolve in the USA to get R0 under 1 in reasonably well-populated areas for an entire year or more (until we have a vaccine and can induce artificial herd immunity). So we're going to have to rely on natural herd immunity in addition to social distancing, etc.
If we're going to rely on herd immunity in addition to mitigation, then we want the infected people to be the ones least harmed by this virus (and we also want them to be people who have voluntarily agreed to be infected).
So open the bars. Let the volunteers get it. If there was a chance the hospitals might get overwhelmed, then that might be a bad idea, but in almost all of the USA there's very little chance of that.
Opening bars is especially convenient, because every single person who goes there knows exactly what they're risking.
Wed, 2020-06-24 19:18
"Herd immunity with lockdown"
I have to say this sounds very strange when you say it. Can you cite any epidemiologist writing about the concept of reaching herd immunity under a lockdown? I mean I understand what you mean by it but I am not sure anybody else describes it that way.
So in the way I think the phrase works, no, New York does not have herd immunity because lockdowns are intended to be very short term measures. Some would argue they can't be long term measures because people revolt against them.
To my mind, herd immunity is a state that occurs because the herd, following its normal behavior, has enough immunity (which can come from virus or antibodies) to halt growth of the virus.
I just went and read a variety of definitions and more to the point explanations of herd immunity, and they all matched my sense of it and none of them matched yours. They did not all explicitly write that you can't use it your way, but some do so explicitly, and none of them do use it your way so I will ask you to stop, at least if you want to be able to discuss this with others.
There is no such thing as "herd immunity with a lockdown." Unless you wanted to describe a permanent lockdown that lasts for the rest of civilization. Perhaps you can find me an example of somebody else using it that way, but you will need to find a majority of cases using it that way to make that point.
Instead, you can refer to a level of immunity which reduces the spread rate below 1 under a set of mitigations. And yes, New York and every place that has had a decline in cases reached that. None of them except maybe Bergamo reached herd immunity. And we can't be sure yet about Bergamo.
The problem is the partying 20somethings cause a virus explosion which infects many more 60-somethings, even if those 60somethings are staying home.
Most disease require on the order of 80% immune to get herd immunity, many require more. We don't know the number for this virus.
There could only be herd immunity for the 20somethings if this virus has a particularly low herd immunity requirement, and it would still come at a high cost. Particularly because we don't know what the percentage is (other than that it's probably at least 70%.) But what if it's more, and you cause all that carnage among the 50% who try to get their own herd fully infected and find it did very little.
Thu, 2020-06-25 10:29
Is not a quote of something I’ve said
Maybe not using the term “lockdown” (which isn’t so well defined anyway, and if you did define it scientifically I’m not sure that what NYC did would qualify). But mitigation and herd immunity go hand in hand. Would you like some sources about that?
So would you say that mitigation and herd immunity are incompatible? Would you say that you can only have herd immunity in the complete absence of mitigation?
“Control aims can be broadly categorised as either suppression or mitigation. Suppression aims to keep cases to an absolute minimum for as long as possible. Mitigation aims to allow a controlled outbreak to occur, with the aim of preventing significant overloads on healthcare systems and gradually allowing the population to develop herd immunity.”
Do you agree with that?
Well, that’s the question. Whether or not it’s true depends on how well you can isolate the two populations.
I think it’d be much easier to impose a strict lockdown on everyone working or living in a nursing home or long-term care facility than it would be to impose one on everyone. That alone accounts for 1/3 of all deaths.
I also think it’d be much easier for the 60-somethings and older not in a congregate living facility to avoid high risk contact with younger people for a month or two while immunity levels are growing, than to have everyone avoid high risk contact with everyone for a year or two, until there’s a vaccine.
Thu, 2020-06-25 11:33
No herd immunity with mitigations
Correct. There is no herd immunity while under temporary mitigations. Herd immunity with mitigations would only apply to permanent mitigations, what might be called "new normal." For example, it is likely that handshakes and European kiss greetings are gone until there is a vaccine. So there could be a concept of a herd immunity with those, but even that would be an unusual use of the term, because it's a very rare thing for an epidemic to cause a permanent change. I mean, it's happened in history -- that's where realizing sanitation must improve comes from. But it's not the usual use of this term. I haven't read every use of the term but all the ones I have seen so far treat herd immunity as the non-mitigation way to end an epidemic.
How do you isolate the young from the old? There are 20 year old students living with 50 year old parents. Tons of them.
Thu, 2020-06-25 15:10
I'm not sure what you mean by that
I don't. It's not my job.
What do you call it when, under temporary mitigations, the new cases per day curve reaches its peak and starts going down?
I'm not sure where you're reading that. Maybe some news articles, but surely not in actual research papers.
What is the difference between a mitigation strategy and a suppression strategy?
Thu, 2020-06-25 15:42
When temporary mitigations cause the curve to go down, I would call that success of the mitigations. I don't know if it has another name.
If you propose that we should solve the problem by dividing the young from the old, it is your job, if you want the proposal to be taken seriously, to outline how that's practical.
While I don't know if the terms are well defined, some people say mitigation can be done just to "flatten the curve" to avoid overloading the health system. But every mitigating strategy delays how long it takes for the virus to spread, which increases the chance that we learn new things, of develop a vaccine or treatment, to allow proper suppression (which is to say near-elimination, as we did for SARS and MERS)
If you have confidence in new knowledge, you don't have to try to fully suppress if that's too expensive. If you don't think something new is coming, your two choices are herd immunity and suppression. The latter worked very well for SARS/MERS and other diseases. Some feel it's too late for this one, but that's not fully clear.
If you lock down enough, you can wipe out a virus. Severe lockdown plus lots and lots of testing can wipe out a virus from humanity much more cheaply than a long lockdown, I think. Though it's almost impossible to do it globally so you can only wipe it out in a country, and then you have to put up a barrier on travel from places that still have it. But not an impermeable one. If you have lots of testing, then any small outbreak can be stamped out. This is what New Zealand has done.
Fri, 2020-06-26 05:16
Mitigation: What does it mean?
I’m not talking about when temporary mitigations cause the curve to go down. I’m talking about when temporary mitigations combine with the number of people infected to cause the curve to go down. I’m talking about when temporary mitigation flattens the curve.
Curves don’t go up forever. Eventually they start coming down. Eventually, a form of indirect protection from infectious disease occurs when a large percentage of a population has become immune to an infection. What’s that called?
I didn’t propose that. I said it would be relatively easy "for the 60-somethings and older not in a congregate living facility to avoid high risk contact with younger people for a month or two while immunity levels are growing." I never said that I would personally be involved in forcibly separating the two groups in order to solve a perceived problem.
I did suggest that it would be okay to impose strict lockdowns on people working in congregate living facilities. I think that's within the realm of proper government authority. And that alone could reduce deaths by over 30%. I'd add anyone taking care of a disabled vulnerable person in their home to that list.
I don't think it's within the realm of proper government authority to protect able-bodied, mentally competent adults from themselves. If they want to maintain close contact with 20-year-olds, that is their right, and they bear the responsibility for that decision. They tend not to, though, and there was a recent paper that showed mathematically how such natural heterogeneity reduces the necessary herd immunity threshold. (Google heterogeneity and herd immunity.) It’ll also greatly lower the IFR, whereas across the board lockdowns promote a homogeneous herd immunity threshold, which increases the IFR. (For this virus, which disproportionately kills people who are most likely to be staying at home or in a hospital already.)
Then you haven’t been reading much about mitigation, despite using the word quite a bit. If you don’t know the definition, how can you be so sure of your statements that use the term?
And which of those two does mitigation fall under?
We’ll see. But as I’ve said before, New Zealand is a much easier case than the USA.
Sat, 2020-06-20 10:10
BRAD....Lose millions of jobs is ok? Are you one of them? That's ridiculous and anyone with a modicum of intelligence knows it. Get real or none of us will have a life to come back to. Is that what us "old" people want to leave to the next generation. More debt than the GDP, abandoned malls and restaurants.
Poverty and homelessness. Us old people don't have the right to destroy the entire nation for a really bad bug. I assume you also believe that the democrats will save us all while dismantling the history of our once great nation. Sad legacy our young people have in store.
Sat, 2020-06-20 11:12
Loss of jobs
Yes, I am one of them. I have made almost nothing this year thanks to the virus.
You think anybody wants this lockdown? Maybe a few fringe crazies. People are doing this lockdown because, at least at the start, it was the only tool we knew could stop the death of millions.
Sat, 2020-06-20 12:03
Obviously you want this lockdown, as you're constantly arguing in favor of it.
We'll see if we're going to stop the deaths of millions. I think we probably will, but not because of lockdowns.
Sat, 2020-06-20 16:56
Want the lockdown?
It's cost me almost all my income. I don't want it. Nobody wants it. They just don't see another path that doesn't have too high a probability of ending in catastrophic death.
Sat, 2020-06-20 06:58
X95 Masks - Where are they?
Any idea about the state of N95/P95 mask production? When/if those are available, the incentive to wear a mask becomes aligned with one's self-interest rather than concern for others. Instead of the hand-wringing about social distancing and helping others by wearing marginally effective masks we could rely on good old self-interest. Another in the litany of institutional failures is why we haven't spent whatever it would take (billions to save trillions?) over the past few months to start production of these.
Where are the impressive graphics showing the increase in mask production and availability?
Sat, 2020-06-20 09:05
What a joke. Do you realize
What a joke. Do you realize that we have a Constitution? My rights don't end where your beliefs begin. If you are so worried about a fake virus then you
stay the hell at home and quit trying to tell the rest of us how to live our lives.
Sat, 2020-06-20 11:14
You may find it worthwhile to read it. You have no right to breed and spread fatal pathogens, not in any constitution or system in the world, not under the most libertarian or even anarchist rule systems. In fact, you have less right under those systems because in those cases, if you do that, your neighbours will shoot you and be done with you in self defence.
Sat, 2020-06-20 10:42
Amen to all of this article!
Amen to all of this article! You may have no rights to worry about if COVID-19 kills you and how would you feel then if a loved one of yours became extremely ill? Put the political agenda aside and think of someone else other than yourself .. selfish SOB's
Fri, 2020-09-04 15:40
If you're at low risk and a utilitarian, wouldn't the most utilitarian thing to do be to intentionally get infected and then quarantine yourself for a few weeks?
For bonus utilitarian points, then get a job as an Uber driver or something.
Sat, 2020-09-05 01:49
Rarely seem to suggest that sort of self sacrifice, they just want societies where others do it. Well, rather they will usually talk about general risk (which they do assume themselves as everybody assumes it.) Rarely does it get to the point of "we should sacrifice these non-volunteers for the greater good." But sometimes that happens.
Sat, 2020-09-05 07:09
Seems like a muddled philosophy that people are hypocritical about following. Your very article talks about sacrifices that everyone is supposed to make for the supposed greater good. But it's a flawed strategy, so you wind up with sacrifices that everyone is supposed to make and you don't even have the greater good.
I disagree that it would have been a self-sacrifice for a young and healthy person to get the virus early on, though. It wasn't so clear several months ago, but this virus is not nearly as harmful to young and healthy people as we thought it would be, and preventing its spread requires a tremendous amount of isolation for a very long time.
I'm not saying that we should have forced young people to take risks that they didn't want to take. But we shouldn't have banned them from doing so. Keeping college campuses opened would have been an excellent way to let young people voluntarily acquire immunity while staying away from the rest of their families.
Sat, 2020-09-05 11:47
Real people are very muddled in their philosophy, rarely being in just one of the schools that philosophers name. It's so common I am not sure hypocrisy is even the right word for it.
In many cases though, the "sacrifice for the greater good" is a "sacrifice now for good later." This is true with Covid. People who don't want to do the "sacrifice" of a virus lockdown, for example, make the lockdowns last longer, which hurts them in the end, though it hurts others even more. If you lock down successfully enough to nearly eradicate, as they did in New Zealand, and follow up with massiv testing, you get most of your life back quickly. If you draw it out, you suffer a little less in the more open society, but you do it for a lot longer.
Mon, 2020-09-07 14:32
With all due respect, that's completely wrong. A flatter curve lasts longer. As more people become immune, the spread slows. That is pretty basic stuff.
If you can get cases down to zero, and keep new cases from coming in from outside, then you can lift a lockdown without seeing a rise in new daily cases. But that wasn't a reasonable possibility for the vast majority of the world. This virus will probably be present in the world for generations to come. Apart from islands and sparsely populated areas that can feasibly test and/or quarantine everyone coming in and out, the only way out of this is herd immunity. (As we've seen, even New Zealand is stuck repeating the hammer and the dance until a vaccine comes along, albeit at a relatively low level of peak cases.)
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