Covid-19 the unlockdown

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Re: Covid-19 the unlockdown

Post by headshot » Sun Apr 12, 2020 9:50 am

purplehaze wrote:
Sun Apr 12, 2020 9:13 am
This seems to be the right place to post this.

Interesting thread from twitter. Comparison of deaths in Ireland and the UK and why isn't the media all over this.

https://twitter.com/laineydoyle/status/ ... 8876128259
I suspect population density and socio-economic factors (several generations in households in many English cities) might also be an issue.

https://www.theguardian.com/world/2020/ ... rian-slums

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Re: Covid-19 the unlockdown

Post by raven » Sun Apr 12, 2020 1:39 pm

Perhaps we have higher numbers of homeless in one-room B&Bs too.
Herainestold wrote:
Fri Apr 10, 2020 8:51 pm
China has the best results and they insisted on locking people right inside their dwellings. Outside air is dangerous.
Just to pick up on that, I don't think China thought inside air was any safer.

One of the things they did that we haven't was to take people out of their homes and put them in big quarantine centres to stop spread within households. And at least one SE Asian country - might even have been China, can't remember - was also giving out boxes of masks/gloves/antiseptic to households with a case so they could attempt to quarantine the sufferer from everyone else in the family.

Close contact, indoors - definitely a risk. That's why the UK is saying shut yourself in a separate room, open the window and ventilate as much as possible, clean down any shared areas after every use, etc etc.

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Re: Covid-19 the unlockdown

Post by purplehaze » Sun Apr 12, 2020 2:09 pm

headshot wrote:
Sun Apr 12, 2020 9:50 am
purplehaze wrote:
Sun Apr 12, 2020 9:13 am
This seems to be the right place to post this.

Interesting thread from twitter. Comparison of deaths in Ireland and the UK and why isn't the media all over this.

https://twitter.com/laineydoyle/status/ ... 8876128259
I suspect population density and socio-economic factors (several generations in households in many English cities) might also be an issue.

https://www.theguardian.com/world/2020/ ... rian-slums
Ireland has it's slums too and population density per capita so it clearly isn't an issue. The famine hit Cork and Lurgan and Portadown the highest. Not Belfast and not Dublin. In the UK the highest hit is the West Midlands and Hampshire.

Why aren't the media reporting the difference between it and its nearest neighbour of which it shares a United Kingdom.

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Re: Covid-19 the unlockdown

Post by sTeamTraen » Sun Apr 12, 2020 2:19 pm

Assuming that the science in it is correct, this piece by a Democrat state senator from North Carolina seems like a good explanation of the issues involved and the choices that need to be made to back out of this situation.
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Re: Covid-19 the unlockdown

Post by Herainestold » Mon Apr 13, 2020 12:09 am

Millennie Al wrote:
Sun Apr 12, 2020 3:06 am
Herainestold wrote:
Fri Apr 10, 2020 8:51 pm
I really wonder if there is a lot of transmission outside. One virus particle can infect. It can last in air for over 3 hours.
Outside, breezes and wind can create a plume of viruses , for many metres.
It seems likely that a lot more than one is needed: Influenza Virus Aerosols in the Air and Their Infectiousness - though obviously it's too soon to have data for Covid-19.

One thing quite noticeable about outside is that it is quite considerably bigger than inside - especially in the upward direction. This means that exhaled virions will mostly disperse and never encounter anyone to infect, while indoors there is much more scope for them to be trapped in areas where they have repeated opportunities to encounter new victims.
I don't know. That data is for an influenza virus. Many people will have some immunity to it, its not completely novel to the immune system. This corona virus is completely new the immune system has never encountered anything like it. I am told I ( I have no medical experitse myself) that one virus particle, if you breath it in, is all it takes to set off an infection.

If you have a number of people outside, say walking or running or cycling along a path in a park, at proper physical distancing of six feet or so, you would have 200 people in a quarter mile, and if 2% are infective that is 4 people spreading virus not in a limited area like inside, but being carried in slipstreams and plumes along the pathway and only one particle is needed to initiate an infection, and you could see how a pandemic could spread to the other 196 people on the pathway.

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Re: Covid-19 the unlockdown

Post by sTeamTraen » Mon Apr 13, 2020 12:29 am

Herainestold wrote:
Mon Apr 13, 2020 12:09 am
This corona virus is completely new the immune system has never encountered anything like it. I am told I ( I have no medical experitse myself) that one virus particle, if you breath it in, is all it takes to set off an infection.
One copy of any virus is enough if it gets into your system far enough to replicate. There are probably billions of viruses in a droplet of expelled phlegm from an infected person. The vast majority won't make it through your body's first lines of defence, but with a few billion deployed there's a good chance that some will.
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Re: Covid-19 the unlockdown

Post by bob sterman » Mon Apr 13, 2020 7:59 am

On the possibility of outdoor transmission - it's worth looking at some of the papers on the transmission of SARS at the Amoy Gardens apartment complex in 2003.

There, in addition to transmission via pipework, it is now thought transmission between apartments occurred through rising and drifting plumes of warm contaminated air entering open windows.

In that case the vector was aerosolised faecal matter - so probably not an issue when passing joggers in the park. But with the warm weather the possibility of infection via open bathroom windows cannot be discounted.

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Re: Covid-19 the unlockdown

Post by bob sterman » Mon Apr 13, 2020 9:21 am

To add - the following paper suggested that the virus-laden aerosol could have infected residents quite some distance from the original source (via entry through open windows). But to reiterate - this is from a faecal not respiratory source...

Evidence of Airborne Transmission of the Severe Acute Respiratory Syndrome Virus
https://www.nejm.org/doi/full/10.1056/NEJMoa032867

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Re: Covid-19 the unlockdown

Post by Herainestold » Mon Apr 13, 2020 2:34 pm

bob sterman wrote:
Mon Apr 13, 2020 9:21 am
To add - the following paper suggested that the virus-laden aerosol could have infected residents quite some distance from the original source (via entry through open windows). But to reiterate - this is from a faecal not respiratory source...

Evidence of Airborne Transmission of the Severe Acute Respiratory Syndrome Virus
https://www.nejm.org/doi/full/10.1056/NEJMoa032867

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Re: Covid-19 the unlockdown

Post by lpm » Mon Apr 13, 2020 2:52 pm

No. That's absurdly misleading.

Nobody knows what the R0 is. 2.5? 3.5? 5.0? Whatever, huge chunks need to be knocked off in order to get close to R0=1.

To do that you have to prevent meeting indoors and stop inter-household mingling. That's what blows out single digits of R0.

There will still be some indoor leakage from encountering other people in supermarkets and public transport. Deal with that better and you are cutting away at the 0.1s of R0.

There will then be outdoor leakage from going past people on pavements and drifting through open windows. But that's the 0.01s region of R0. Any improvements a country makes by dealing with infections via the outside routes gets lost compared to the far bigger indoor wins - and the huge uncertainty range around R0 to begin with. It would be embarrassing for the UK to worry about outdoor routes seeing as it's still keeping workplaces open for business.

It's a mistake to look at policies for SARS - very few cases, but where you want to avoid every single one due to the mortality, hence rare cases of RNA drifting through the open air could make a difference. This is less deadly virus with tens of thousands of cases spreading mostly via indoor hospitals, indoor care homes and indoor workplaces.

The moral of the story is go outside 10x more often, but reduce your supermarket shopping by 1 a week.
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Re: Covid-19 the unlockdown

Post by Herainestold » Mon Apr 13, 2020 3:04 pm

Don't go to the supermarket, get your food delivered.
Don't go outside unless you are an essential worker.
Don't mix with other households, other people.
Stay inside, stay safe.

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Re: Covid-19 the unlockdown

Post by RoMo » Mon Apr 13, 2020 3:28 pm

Herainestold wrote:
Mon Apr 13, 2020 3:04 pm
Don't go to the supermarket, get your food delivered.
Yeah, good luck with that.

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Re: Covid-19 the unlockdown

Post by bob sterman » Mon Apr 13, 2020 4:49 pm

Of course, SARS-CoV-2 is not going to behave exactly like SARS-CoV-1.

But it is nevertheless worth considering the research that has been done on SARS-CoV-2 transmission routes - when thinking about the "unlockdown". E.g. particularly when we think about reopening buildings and facilities with public toilets - where people will be defecating and flushing.

In the Amoy Gardens outbreak - it appears that the majority of inter-household transmission came via the aerosol route (not necessarily through direct inhalation - but through fomites getting deposited on surfaces).

During the current pandemic - people in Hong Kong are using their experience with SARS to guide their behaviour now. E.g. it's common to have a disinfectant tray/pad at the front door to clean footwear on returning home (due to the risk of picking up fomites). And Hong Kong seems to have managed to control case numbers a lot more effectively than the UK.

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Re: Covid-19 the unlockdown

Post by basementer » Mon Apr 13, 2020 6:43 pm

Strictly speaking the fomite is not the infective agent itself but the object on which it is carried. The shoe, mobile phone, pencil etc rather than the droplet that's landed or been smeared upon it.
I'll think of something.

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Re: Covid-19 the unlockdown

Post by Woodchopper » Mon Apr 13, 2020 8:06 pm

The French president says crèches and schools will begin to reopen on 11 May, saying the date will mark the start of a new phase. But the lockdown will continue until then.

Macron says he will work on a plan to help struggling sectors, such as tourism and leisure and will extend aid measures for companies and workers. Moreover, Macron calls on insurance companies to help in the fight.

[...]

He said that by 11 May, France will be able to test every citizen presenting symptoms.
From the Guardian.

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Re: Covid-19 the unlockdown

Post by lpm » Thu Apr 16, 2020 12:06 pm

Woodchopper wrote:
Thu Apr 09, 2020 10:08 am
The 7 April Imperial College weekly forecast has R0 as being over 2 in the UK.
Where's this week's forecast from IC? Have they given up because they were so wildly out last week?
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Re: Covid-19 the unlockdown

Post by PeteB » Thu Apr 16, 2020 12:17 pm

Even worse than that, the 7 April Forecast has 'disappeared' or they have restricted access

meanwhile James Annan's forecast seems pretty accurate - he updates it daily but even from last week seems not too bad

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Re: Covid-19 the unlockdown

Post by Bird on a Fire » Thu Apr 16, 2020 2:15 pm

PeteB wrote:
Thu Apr 16, 2020 12:17 pm
Even worse than that, the 7 April Forecast has 'disappeared' or they have restricted access

meanwhile James Annan's forecast seems pretty accurate - he updates it daily but even from last week seems not too bad
He seems to be relying on official death figures, though(?), in which case he's missing about half of them.

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Re: Covid-19 the unlockdown

Post by lpm » Thu Apr 16, 2020 2:33 pm

...only matters if the proportion is changing.

We are probably going along the flat bit at the top of the curve, given official figures are flattish on a 7 day average, and it would be odd if unofficial figures were rising or falling out of sync.
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Re: Covid-19 the unlockdown

Post by Woodchopper » Thu Apr 16, 2020 5:16 pm

Angela Merkel goes into detail on the need to manage R0
https://twitter.com/benjalvarez1/status ... 40800?s=21

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Re: Covid-19 the unlockdown

Post by Woodchopper » Thu Apr 16, 2020 6:11 pm

PeteB wrote:
Thu Apr 16, 2020 12:17 pm
Even worse than that, the 7 April Forecast has 'disappeared' or they have restricted access

meanwhile James Annan's forecast seems pretty accurate - he updates it daily but even from last week seems not too bad
Yes, looks like they are a bit embarrassed about that one. Annan’s prediction looks more accurate. Though depressingly we’d be looking at a long period with similar mortality.

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Re: Covid-19 the unlockdown

Post by sTeamTraen » Thu Apr 16, 2020 6:22 pm

Some people seem to be talking about what I think of as a "hokey cokey" lockdown --- once you get below a certain rate of new cases you relax the rules, and then when^h^h^h^hif the rate goes back up above a certain number, you tighten up again. (Some people use the phrase "hammer and dance" for this, but I don't think the author of the original article with that title really argued for a yo-yo approach.)

This seems to me like a terrible idea. First, people would be very confused about what is in effect at any given time (and if you announce the changes a week in advance, people will game them to f.ck in many different ways). Second, it will be terrible for business. You can't spend the week or so that would be needed to reopen a restaurant from scratch only to have to throw all that away ten days later. There would be a huge burden on suppliers, staff, and even the administrative systems needed to ensure that people get paid when they're furloughed but not when they're working.

(I don't have a better idea --- I don't think the universe owes us a solution --- but I just can't see the hokey-cokey working. After the first or second U-turn, people would seriously start to lose confidence in the government's authority --- in whichever country tried it.)
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Re: Covid-19 the unlockdown

Post by AMS » Thu Apr 16, 2020 6:58 pm

I think it has to be some version of:

1) Wait until active community transmission has dropped to some low threshold.
1b) During this time, build capacity for testing and contact tracing. Also, work on vaccines and therapies, plus capacity to manufacture them at scale.
2) Start to relax restrictions on economic activity - possibly tiered somehow by risk. (There may be some devil in the detail here, especially where public transport is involved.)
3) Test, test, test. Contract trace, test, test, test, quarantine. Test. Test. This is how S Korea got ahead of the virus.
4) Vaccinate

Testing needs to be anyone with symptoms, obviously, but also random sampling to spot emerging hotspots. E.g. stand in the doorways of train stations and supermarkets and swab every 20th person.

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Re: Covid-19 the unlockdown

Post by sTeamTraen » Thu Apr 16, 2020 7:13 pm

AMS wrote:
Thu Apr 16, 2020 6:58 pm
Testing needs to be anyone with symptoms, obviously, but also random sampling to spot emerging hotspots. E.g. stand in the doorways of train stations and supermarkets and swab every 20th person.
That's difficult, though, unless you use some degree of coercion. The people who consent will probably be quite different from the people who don't. AFAIK the current testing procedure is quite unpleasant (blood draw or nasal swab that goes some way in) and can't really be done easily in a crowded public place. When we've got a litmus paper that you can just lick, then sure.
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Re: Covid-19 the unlockdown

Post by Millennie Al » Fri Apr 17, 2020 1:13 am

sTeamTraen wrote:
Thu Apr 16, 2020 6:22 pm
Some people seem to be talking about what I think of as a "hokey cokey" lockdown --- once you get below a certain rate of new cases you relax the rules, and then when^h^h^h^hif the rate goes back up above a certain number, you tighten up again. (Some people use the phrase "hammer and dance" for this, but I don't think the author of the original article with that title really argued for a yo-yo approach.)

This seems to me like a terrible idea.
Yes, it's a really stupid idea. It's like calling out the fire brigade when a row of terraced houses catches fire, and then when the fire has been fought down to only one house still on fire, telling the fire brigade to take a break for lunch as it's no longer so bad.

It's essential that we throw everythig we have at this problem until the number of cases is low enough to switch to testing, contact tracing, and quarantining every single case. For every approximately 100 extra cases we allow, that's one extra death. And the more cases the bigger the death rate - either from covid-19 cases themselves overloading the facilities or indirectly by reducing treatments for other illnesses. And, of course, the longer it goes on for the more the whole thing costs. If we relax controls too early and let it get out of hand again then we are back to where we started and have effectively wasted all the hundreds of billions of pounds that the measures have cost us so far.
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