lpm wrote: ↑Sun Mar 15, 2020 10:40 am
lpm wrote: ↑Sun Mar 15, 2020 10:11 am
I’ll have a go at writing my own version of that. I know my sort of simplifications, like this YouTube, can be criticised as being too Malcolm Gladwell, but sometimes these kinds of things can give clarity.
Imagine for a moment Covid isn’t one disease. Instead there are two variants circulating simultaneously – Covid-1% and Covid-4%. They are identical in every way except their Case Fatality Rate.
You assume everyone in your population is going to get one or other of the two strains. It can’t be stopped, it’s going to happen over the next 365 days. But imagine there’s a strong seasonal variation in infection rates: people are currently getting Covid-1%, then will catch Covid-4% from 1 April to 30 September, then Covid-1% from 1 October onwards.
In this imaginary scenario, if you care about lives clearly you want as many people as possible to catch the Covid-1% variant and will desperately do everything possible to stop people catching Covid-4%. The difference could be well over a million lives lost.
In Wuhan they caught Covid-4%, in the rest of China Covid-1%. In Lombardy they have Covid-4%, in the rest of Italy Covid-1%.
Obviously the difference between the two strains is healthcare. Where the system can cope, people die of Covid-1%. When the health service is overwhelmed, people die of Covid-4%.
So what happens on 1 October onwards to make it Covid-1%? Hospitals and ventilators and all other necessary health resources. A huge national effort sees the building of not 40 new hospitals, but 400. Not an increase in ventilators from 5,000 to 10,000, but to 100,000. An effort to get every possible resource in place, knowing every day’s delay means another day’s worth of Covid-4% fatalities instead of Covid-1%
And in the meantime? Delay, delay, delay. Apply the maximum pressure now because Covid-4% is two weeks away. Buy time wherever possible, hindering the Covid-4% enemy in our retreat, buying time to switch it into Covid-1%.
This is the difference between the UK and the rest of Europe. The UK is concerned about multiple waves, the exponential curves re-igniting in Italy and Spain when lockdowns end. Which is a massive problem. You need to slam down new waves multiple times. But each lockdown generates the time and space to get resources in place for the waves that’ll hit in a few months – and those resources can make the waves from October onwards Covid-1% waves.
The UK is choosing to allow higher infection rates now. For example requiring people with mild Covid illness to self-isolate for 7 days only, when infectiousness likely lingers on for a further 7 days after that. They accept this will increase infection rates a little, but see that as worth it for the normality to the economy and ways of life – and crucially the hope that we will then see lower subsequent waves later in the year. When Italy and Spain are struggling with re-ignition, we will be on lower exponential pathways due to more people with acquired immunity.
The flaw is that higher now, in return for much lower later, means a higher case load now with an under-resourced health service – hence the “higher now” is all Covid-4%. While the “lower later” benefits will be seen in the autumn or next winter – when it could have been Covid-1%.
No policy is going to be correct unless it starts with (a) we must build massive healthcare capacity and (b) it's going to take time to get that capacity. Everything else must follow from that.
Think I'll be doing this week's order in the early mornings.
