Is "flattening the curve" really the best strategy in the long-term?

Accepting the idea that this things is all as bad as we're being told (and my jury is still out on that) ...

All the buzz is about "flattening the curve," which essentially means that we limit the spread of the contagion and keep the total number of infections and deaths to a minimum in the immediate future. Sounds good and sensible and humane and all that. But, I see a problem with that approach.

You see, what we need is a solid herd immunity, and that can only be achieved through herd exposure. Seems to me that flattening the curve now means that we just hold off the inevitable, which would be an overall heard exposure leading to a stronger herd immunity response. If we flatten the curve now but do not eliminate the infection from society (which thing I do not see that we could do), do we not risk a later resurgence of the infection because so many have not been exposed?

Certainly, not flattening the curve now would mean more infections and deaths, but in the long run I'm not sure that it wouldn't be better to let nature run its course. Sounds terrible, I know. Sounds inhumane and calloused and terribly pragmatic.

You know the old saying, That which does not kill you only makes you stronger? I always add a corollary (at least, I think of it as a corollary): That which does not kill you only postpones the inevitable.

So, am I a calloused, hard-hearted jerk or am I talking sense here?

Maybe both? Sometimes nature can be cruel.
:

a reply to: incoserv

The reason for the emphasis is on "flattening the curve" is to prevent our health care system from being overwhelmed by too many hospitalizations too rapidly.

Here's a good read:
COVID PDF

Herd immunity will kick in, but that takes time.

originally posted by: Phage
a reply to: incoserv

The reason for the emphasis is on "flattening the curve" is to prevent our health care system from being overwhelmed by too many hospitalizations too rapidly.

Here's a good read:
COVID PDF

So, ultimately the idea is not so much to reduce the number of infections, but to stretch them out over time and so as to lessen the impact on the health care system?

I can see that.

a reply to: incoserv

Precisely.
Herd immunity will kick in (and likely a vaccine will become available) but that takes time.

a reply to: incoserv

(SNIP) no, it is not.

I am willing to sign a piece of paper, that says if i do get this crow disease i will not be treated in a hospital, if we can arrange the peak to hit tomorrow and get this over with already.

Retards.

originally posted by: incoserv

originally posted by: Phage
a reply to: incoserv

The reason for the emphasis is on "flattening the curve" is to prevent our health care system from being overwhelmed by too many hospitalizations too rapidly.

Here's a good read:
COVID PDF

So, ultimately the idea is not so much to reduce the number of infections, but to stretch them out over time and so as to lessen the impact on the health care system?

I can see that.

Flattening the curve also reduces the number of people who will die during the process of achieving herd immunity.

Right now, about 5% of those infected are hospitalized; about 20% of those die, leading to an effective Infection Mortality Rate (IMR) of about 1%. If the hospital system gets saturated and can’t accept any new patients (as is happening in Italy) then every new case that needs hospitalization but can’t get it will have a higher probability of dying. In some of the cases that are currently being modeled by the public health organizations, the need for hospital beds could be only 1/10 of what’s needed, at the peak of the epidemic. That could push the IMR to 2% or more for those periods of time. Recent research appears to indicate that nearly 100% people who survive COVID-19 infection do have immunity to reinfection for probably at least a year or two. That means that if more of the infected are dying because there are no hospital beds available, there aren’t as many immune people going back into the population, so natural herd immunity takes longer to build up.

Also, the more you delay the occurrence of the peak, the more time there is to get medical interventions in play. There are already several trials of antiviral medications underway (Remdesivir, Hydroxychloroquine, Losartan) that could have results as early as next month and could possibly be administered a month after that. There are also vaccines already in clinical trials. The time to go from first infection to trial vaccine is now much faster than it was let’s say, 10 years ago. Public pronouncements by CDC and others that it might take 12 to 18 months to have a vaccine are probably worst case; I wouldn’t be surprised to see some available in half that time.

a reply to: 1947boomer

They have been saying for a long time that there are too many mother(SNIPPERS) out there so why it suddenly is a bad thing if we die?

If the curve is flattened to the end of the year all has gone to (SNIP) by then.

Welcome to the dark ages man.

originally posted by: 1947boomer

originally posted by: incoserv

originally posted by: Phage
a reply to: incoserv

The reason for the emphasis is on "flattening the curve" is to prevent our health care system from being overwhelmed by too many hospitalizations too rapidly.

Here's a good read:
COVID PDF

So, ultimately the idea is not so much to reduce the number of infections, but to stretch them out over time and so as to lessen the impact on the health care system?

I can see that.

Flattening the curve also reduces the number of people who will die during the process of achieving herd immunity.

Right now, about 5% of those infected are hospitalized; about 20% of those die, leading to an effective Infection Mortality Rate (IMR) of about 1%. If the hospital system gets saturated and can’t accept any new patients (as is happening in Italy) then every new case that needs hospitalization but can’t get it will have a higher probability of dying. In some of the cases that are currently being modeled by the public health organizations, the need for hospital beds could be only 1/10 of what’s needed, at the peak of the epidemic. That could push the IMR to 2% or more for those periods of time. Recent research appears to indicate that nearly 100% people who survive COVID-19 infection do have immunity to reinfection for probably at least a year or two. That means that if more of the infected are dying because there are no hospital beds available, there aren’t as many immune people going back into the population, so natural herd immunity takes longer to build up.

Also, the more you delay the occurrence of the peak, the more time there is to get medical interventions in play. There are already several trials of antiviral medications underway (Remdesivir, Hydroxychloroquine, Losartan) that could have results as early as next month and could possibly be administered a month after that. There are also vaccines already in clinical trials. The time to go from first infection to trial vaccine is now much faster than it was let’s say, 10 years ago. Public pronouncements by CDC and others that it might take 12 to 18 months to have a vaccine are probably worst case; I wouldn’t be surprised to see some available in half that time.

While I agree that flattening the curve will cause fewer deaths, are the current measures actually capable of functioning in the way intended? Do they actually have effect sufficient to flatten the curve?

Are we seeing the results of flattening the curve in Italy? We are seeing results now in China, but their response and constraints have been far more severe than elsewhere.

In China, they cut transport services and put people under virtual house arrest. But was the curve flattened much, or are we just at the end of the natural progression of the epidemic?

a reply to: chr0naut

What are our other options?

Italy responded very late and there are indications that the virus actually had arrived there months before it was recognized. I think Italy is an example of why the measures being taken should be taken.

In China, they cut transport services and put people under virtual house arrest. But was the curve flattened much, or are we just at the end of the natural progression of the epidemic?

Do you think the infection just goes away? Trump used to say something like that.

originally posted by: Phage
a reply to: chr0naut

What are our other options?

Italy responded very late and there are indications that the virus actually had arrived there months before it was recognized. I think Italy is an example of why the measures being taken should be taken.

In China, they cut transport services and put people under virtual house arrest. But was the curve flattened much, or are we just at the end of the natural progression of the epidemic?

Do you think the infection just goes away? Trump used to say something like that.

I am saying that the current recommendations are insufficient and are bourne from advisors trying to cut costs.

A person who has the virus will cough. Even with everyone masked up and washing hands is not going to prevent us from breathing the virus in if we are close enough.

Out of doors, the aerosolized virus can travel quite a distance and will survive for the 'travel time'. So a few meters of distancing, and "getting some fresh air" for those who self-quarantine, isn't good advice.

Also, the concept of self-quarantine for the symptomatic, where someone is on their own recognizance as to when they may require hospitalization, is a bad idea.

At what point does it go from bad cough to a life-threatening problem?

How, if your lungs are full of fluid and you can't get enough oxygen, are you expected to describe to someone the extent of your condition?

And what of the transportation services like ambulance and paramedical. How will they respond without compromising their own safety?

It is best to get ALL symptomatic people to come forward to monitored isolation under medical surveillance while they can do so. The rest of the community can also still self-isolate if they know they have been in the vicinity of someone who has become symptomatic. Even then, some may have caught the virus and be in such early stages that they are asymptomatic (usually about 14 days), so hand washing and other hygiene should still be practiced.

IMHO.

And the problem will not go away. However immunity to the virus will increase as more people get over it. If the virus doesn't mutate much further (unlikely) or if there are fewer hosts, it may die back a lot, but it is very unlikely that it will ever really go away.

a reply to: chr0naut

Yes, I am aware of the basics of epidemiology.

I am saying that the current recommendations are insufficient and are bourne from advisors trying to cut costs.

Insufficient to accomplish what, exactly? Start with that.

originally posted by: Phage
a reply to: chr0naut

Yes, I am aware of the basics of epidemiology.

I am saying that the current recommendations are insufficient and are bourne from advisors trying to cut costs.

Insufficient to accomplish what, exactly? Start with that.

Insufficient to slow the infection rate by enough to offset the exponential growth from those already infected and who may be asymptomatic.

The effect of current precautions is fairly linear. The infection rate is exponential. Only very early on does the linear curve exceed the slope of the exponential curve. Once the curve is going, the linear response won't change things. It is too late.

Isolation and containment would have been the ideal choice but:

The ChiComs #ed us on that and our inability to test early and often was the final nail

I don't think there is a Plan B

a reply to: chr0naut

Insufficient to slow the infection rate by enough to offset the exponential growth from those already infected and who may be asymptomatic.

I don't see how anything short of true quarantine could accomplish that. I don't see how true quarantine could be accomplished on a nationwide, or even statewide level. We are not China.

The rate of infection can be decreased, that's the best we can do. Indications are that decrease can prevent our healthcare system from being overwhelmed.

One line of thinking is that it may not decrease the number of people affected by the virus but if you flatten the curve, you stretch out the time frame and therefore help with the availability of hospital beds.

That way more patients who have the more severe form will have hospital beds.

So in the long run it should save lives

originally posted by: Phage
a reply to: chr0naut

Insufficient to slow the infection rate by enough to offset the exponential growth from those already infected and who may be asymptomatic.

I don't see how anything short of true quarantine could accomplish that. I don't see how true quarantine could be accomplished on a nationwide, or even statewide level. We are not China.

The rate of infection can be decreased, that's the best we can do. Indications are that decrease can prevent our healthcare system from being overwhelmed.

I think that this time, we were caught off guard, and we shouldn't have been. We know this kind of thing is inevitable and recurs all through human history.

There needs to be a safety net for humanity, we aren't just animals that suffer whatever nature throws at us. We have the ability to plan and defend against a whole slew of potential dangers that our ancestors couldn't.

We know that earthquakes, tidal waves, vulcanism, pandemics, wildfires, asteroids and all manner of things are going to recur. So let's be clever, and anticipate them instead of just hoping it won't happen and just trying to make hay while the sun shines.

We will survive this. At present, I think we are further up the slope and the current practices are futile. Thankfully, it looks like our governments are getting the message and the response is tuning itself. But we are not always taking the hard decisions necessary until it's too late. That too will pass.

originally posted by: chr0naut

originally posted by: Phage
a reply to: chr0naut

Yes, I am aware of the basics of epidemiology.

I am saying that the current recommendations are insufficient and are bourne from advisors trying to cut costs.

Insufficient to accomplish what, exactly? Start with that.

Insufficient to slow the infection rate by enough to offset the exponential growth from those already infected and who may be asymptomatic.

The effect of current precautions is fairly linear. The infection rate is exponential. Only very early on does the linear curve exceed the slope of the exponential curve. Once the curve is going, the linear response won't change things. It is too late.

If you really want the best discussion of this at the present time, it is here:

www.imperial.ac.uk...

It answers all the questions you are asking.

To summarize, there two basic strategies--mitigation and suppression. Mitigation attempts to slow the rate of exponential growth while still allowing it to be positive and suppression attempts to reduce the growth to a negative number.

Right now, the basic reproduction ratio of the epidemic is about 2.5. That means that every person who is infected transmits that infection, on the average, to 2.5 other susceptible individuals. That's why the infection of the US population is growing with a doubling time of about 6 days. You can see this clearly if you go to:

www.worldometers.info...

Simple but reliable epidemiology models show that if this doubling time is allowed to continue unmodified, about 60% of the US population would be infected in this first wave, which would probably peak in a couple of months. With an Infection Mortality Rate of about 1%, that means that about 2 million US residents would die in the next few months.

if you were to mitigate the outbreak by, let's say, cutting the reproduction ratio in half, to 1.25, that would result in only 20% of the population being infected during the first wave, so a factor of 3 reduction in near term fatalities. That's the power of exponential growth. That's the kind of mitigation you could achieve with non-draconian measures, like the kind that we are doing now.

However, the Imperial College study showed that even with that kind of mitigation program, the US and UK would still have the capacity of their hospital systems overwhelmed many times over.

In order to keep the hospitals from being overwhelmed, we would have to implement a suppression strategy. That would mean taking the same kinds of measures that China did, including forcible separation and isolation of family members, etc.

China and South Korea did actually successfully implement suppression strategies. If you go to the worldometers site and select China and South Korea you will see that they have actually bent the curve. Mathematically, that means that they have driven the reproduction ratio to less than 1. That means that the epidemic will die out.

However, if you relax the suppression measures, the epidemic will break out again and again, until the population has developed herd immunity or, more likely, developed a vaccine.

a reply to: Phage

Also lives can be saved from people delaying their infection while suitable treatment options are tested.

Best graphic I've seen for shelter in place

Shelter in Place

Sometimes a picture is really worth thousands of words

originally posted by: 1947boomer

originally posted by: incoserv

originally posted by: Phage
a reply to: incoserv

The reason for the emphasis is on "flattening the curve" is to prevent our health care system from being overwhelmed by too many hospitalizations too rapidly.

Here's a good read:
COVID PDF

So, ultimately the idea is not so much to reduce the number of infections, but to stretch them out over time and so as to lessen the impact on the health care system?

I can see that.

Flattening the curve also reduces the number of people who will die during the process of achieving herd immunity.

Right now, about 5% of those infected are hospitalized; about 20% of those die, leading to an effective Infection Mortality Rate (IMR) of about 1%. If the hospital system gets saturated and can’t accept any new patients (as is happening in Italy) then every new case that needs hospitalization but can’t get it will have a higher probability of dying. In some of the cases that are currently being modeled by the public health organizations, the need for hospital beds could be only 1/10 of what’s needed, at the peak of the epidemic. That could push the IMR to 2% or more for those periods of time. Recent research appears to indicate that nearly 100% people who survive COVID-19 infection do have immunity to reinfection for probably at least a year or two. That means that if more of the infected are dying because there are no hospital beds available, there aren’t as many immune people going back into the population, so natural herd immunity takes longer to build up.

Also, the more you delay the occurrence of the peak, the more time there is to get medical interventions in play. There are already several trials of antiviral medications underway (Remdesivir, Hydroxychloroquine, Losartan) that could have results as early as next month and could possibly be administered a month after that. There are also vaccines already in clinical trials. The time to go from first infection to trial vaccine is now much faster than it was let’s say, 10 years ago. Public pronouncements by CDC and others that it might take 12 to 18 months to have a vaccine are probably worst case; I wouldn’t be surprised to see some available in half that time.

There are already several trials of antiviral medications underway (Remdesivir, Hydroxychloroquine,Losartan)

Well, I'll be, it turns out one of the drugs their testing to cure coronavirus LOSARTAN I've been taking for quite some time.

And I rarely get colds. I had one in the week of January 20th, of this year, actually the very day the first US coronavirus was found in Washington.

Interesting


US testing two generic drugs as possible coronavirus treatments

Reuters reported that scientists at the University of Minnesota are testing two drugs, the malaria treatment drug hydroxychloroquine and the blood pressure drug losartan, to see whether either drug is effective in blocking the virus's reproductive processes.

I hope it works