A sensible COVID-19 exit strategy for the UK

By Nic Lewis

The current approach

A study by the COVID-19 Response Team from Imperial College (Ferguson et al. 2020[i]) appears to be largely responsible for driving UK government policy actions. The lockdown imposed in the UK appears, unsurprisingly, to have slowed the growth of COVID-19 infections, and may well soon lead to total active cases declining. However, it comes at huge economic and social costs, and substantial COVID-19-unrelated health costs.

Worse, the lockdown is merely a holding strategy, which offers no long term solution to the COVID-19 problem. The eventual total number of deaths for COVID-19 are not reduced relative to any less restrictive policy that likewise avoided the health system being overwhelmed. Deaths are merely spread over a longer period, assuming that eventually restrictions are lifted and people’s lives return to normal.

Vaccinating the population against COVID-19 is unlikely to be achieved for 15-18 months at best. A repurposed existing drug might be found to work on a shorter timescale, but a sensible strategy cannot rely on that hope. Developing and testing a successful new drug would likely take longer. Worse, there is no guarantee that a vaccine or drug effective against COVID-19 will be found in the foreseeable future.

Ferguson et al. illustrates an adaptive cyclical on-off triggering of suppression strategies – involving lockdown approximately two-thirds of the time – extending to the end of 2021. But by that time their model implies that under 2% of the population has been infected and acquired immunity, whereas 80+% of the population needs to have been infected in order to achieve herd immunity in the absence of any restrictions. It would take of the order of 70 years living under an on-off lockdown regime to achieve that level.

A sensible approach

Clearly, the Ferguson et al. illustrated on-off lockdown strategy is not appropriate. A more intelligent approach is needed. Fortunately, there is an obvious solution. The key is to remove restrictions from those segments of the population that are at low risk of death from COVID-19 infection. Age is a key factor here. However, another key factor is whether a person suffers from various chronic health conditions, the most prevalent of which are hypertension, diabetes, cardiovascular disease, atrial fibrillation, obstructive pulmonary disease, and renal failure (“relevant health conditions”).

Over half the population are under 70 years old and do not suffer from any chronic health conditions that are associated with a much elevated infection fatality rate (IFR). The IFR that I estimate for that segment of the population is only 0.03%. So is the estimated IFR for people under 30 years old who have one or more relevant health conditions.

I estimate that there are over 41 million people who are under 70 with no relevant health conditions, or have such conditions but are under 30. Allowing them to resume normal life, subject to some precautions, should lead to around 87% of them being exposed to COVID-19 and, if susceptible to it, infected, over the next few months. Because the IFR for these groups is very low, the resulting likely number of deaths would be relatively modest – slightly over 10,000. That would represent under 2% of the expected total deaths in the UK during 2020. And if the IFR estimates that Ferguson et al. are using turn out to be too high, as looks increasingly likely, there could be substantially fewer deaths.

Assuming that these 10,000 deaths were spread over six months, on average slightly over 2,000 ICU beds would be occupied. The extent of precautions taken could be varied over time to achieve an even ICU bed occupancy level. If it turned out that a significant proportion of the population was already not susceptible to COVID-19 infection, the number of deaths could be substantially lower.

During the period of about six months during which the non-vulnerable population was exposed to COVID-19 infection, vulnerable groups (people over 30 year olds with any relevant health condition, and all over 70 year olds) would need to remain fairly isolated from other people who remained susceptible to COVID-19. By the end of that period approximately 54% of the population would no longer be susceptible to COVID-19. That is sufficient to provide herd immunity if the reproduction ratio is below 1.5.

The fact that daily new cases of COVID-19 have not been increasing in Sweden since the end of March 2020 strongly suggests that the relatively limited measures taken there have reduced the reproduction ratio to well below 1.5, despite that being totally at variance with the much smaller reduction that the Imperial College Response Team’s modelling in another study (Flaxman et al 2020)[ii] implies. Therefore, weaker measures than those in force in Sweden at that time should be adequate to prevent any resurgence of COVID-19 infections in the UK if 54% herd immunity is achieved.

My proposed exit strategy would enable over 60% of the UK population to immediately resume something close to normal life, with the other, more vulnerable, groups being able to do so, subject to some precautions (which could be on an advisory rather than mandatory basis) within six months.

In contrast, the current policy in the UK, which aims for all parts of the population to avoid exposure to COVID-19, will – until and unless an effective vaccine is available – take multiple years to achieve a sufficient level of herd immunity for relatively limited measures to be effective in preventing a resurgence of infections.

The IFR estimates that I use are based on those given in another paper by the same team at Imperial (Verity et al.2020 [iii]), on which the Ferguson et al. assumptions were based, and on other published findings. The ICU bed occupation estimates that I use are based on the assumptions in Ferguson et al. Further details of my results and the data and assumptions involved are available here.

Nicholas Lewis                                               26 April 2020

Originally posted here


References and Notes

[i]  Neil M Ferguson et al., Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand, Imperial College COVID-19 Response Team Report 9, 16 March 2020, https://spiral.imperial.ac.uk:8443/handle/10044/1/77482

[ii]  Flaxman, Seth, et al. “Report 13: Estimating the number of infections and the impact of non-pharmaceutical interventions on COVID-19 in 11 European countries.” (2020). https://spiral.imperial.ac.uk/bitstream/10044/1/77731/9/2020-03-30-COVID19-Report-13.pdf

[iii]  Verity R, Okell LC, Dorigatti I, et al. Estimates of the severity of COVID-19 disease. medRxiv 13 March 2020; https://www.medrxiv.org/content/10.1101/2020.03.09.20033357v1.

270 responses to “A sensible COVID-19 exit strategy for the UK

  1. How does this analysis tally with the Wuhan experience ?

    • jungletrunks

      You’ll never get complete transparency out of China, ever; worse, you will never be able to ferret out propaganda, from half truths, from truth. China is useless as a model to anything.

      • Victor Adams

        “China is useless as a model to anything”: yes, except as a model of seamless transition from feudalism to one party rule State capitalism and on to Fascism (the Chinese variant). “Seamless” is sarcasm for Mao’s Cultural Revolution that killed millions.

    • We’ve no idea, as the official data from China, is unverifiable. The real total maybe 10 times the official. Then again, it may not be.

      • Adam
        I read an article that cellphone disconnects for whole of China for March was 21million. The number was higher than last year and previous months. An unusual high number. Factoring in usual reasons to disconnect, they couldn’t account for six million.
        Who knows ??

  2. If the palliative measures (social distancing, self-quarantine, etc.) reduce the intensity of exposure so that more people join the immune herd rather than dying, then deaths are avoided. This doesn’t remove the need to balance the measures’ benefits against negatives such as suicides, domestic assaults, loss of income, etc.

  3. I agree completely.
    Up here in Canada the policy looks like lock down until a vaccine is found. Antibody testing is being discounted because there is no evidence that “presence of antibodies prevents reinfection”.
    Got that, vaccines are the solution yet having antibodies is not important.

    • Yesterday Canada’s Prime Minister started hinting at a lockdown exit strategy, probably because he was told we can’t all stay at home for 18+ months. And there may never be a successful vaccine, just like with SARS (no vaccine to date). Even if a vaccine is found it may be only partly effective, and may take years to ramp up production for all 7.5 billion people on Earth.

      Here is a long but highly informative video on the subject: https://www.youtube.com/watch?v=cwPqmLoZA4s&fbclid=IwAR2BBcZbOXqQMnIrMEb462aMoMyJp5B6up2aHZvG_0aYNTdm4P-clB0Ftoc

    • Enns:
      What other corona family virus has a vaccine for humans ?

      My research says none !

      • I agree, it is a mistake to depend on a vaccine to end the crisis.
        I am saying something else here. The very basis of a vaccine is that it prompts the human body to create antibodies. So if Dr. Theresa Tam, our chief health officer, believes that the presence of antibodies does not guarantee prevention of reinfection how can she believe that a vaccine will help.

  4. Robert Clark

    DATE NEW CASES INCREASE % # TESTS
    4/17/2020 31,790 -3,068 -55 148,690
    4/18/2020 29,564 -2,226 -7 168,397
    4/19/2020 27,354 -2,210 -7.4 139,511
    4/20/2020 28,249 895 3.2 183,117
    4/21/2020 32,037 3,788 13.4 138,451
    4/22/2020 19,554 -12,483 -38.9 143,549
    4/23/2020 32,124 12,570 64.2 158,486
    4/24/2020 39,887 7,763 24.1 465,986
    4/25/2020 36,342 -3,545 -8.8 251,263
    The way to lower active cases is shown on the 24th. Increase testing and get to those in work force not showing symmptoms. You have the fast tests now. Go all out and find those unknowing and tell them. They showed they can do it. The scientists have given you the MOAB. Now drop it!!!!

    • Robert Clark: The way to lower active cases is shown on the 24th. Increase testing and get to those in work force not showing symmptoms. You have the fast tests now. Go all out and find those unknowing and tell them.

      I would agree if we could do the testing much faster. Right now it looks as though there are not enough test kits and trained testers to get the antibody+ workers back to work in time (to prevent famine? to prevent many more bankruptcies? whatever your goal priorities are.)

      My recommendation would be to let everyone go back to work who is symptom-free, while increasing as fast as possible the rate of testing. Health care professionals and care providers should be tested first to avoid spreading the virus through care of vulnerable people. Maybe food handlers also high on a priority list. But factory workers, builders, landscapers, bankers? I don’t see good reason to keep them home any longer as long as they are symptom-free.

  5. charles d weller

    This is an important and eloquent call for more intelligent approaches to the Covid-19 crisis. I suggest another approach, the same approach to that applies so powerfully against the manmade climate warming theory: applying basic scientific method. Medicine in the United States has widely adopted randomized controlled trials as the gold standard, replacing fundamental concepts of scientific method like Richard Feynman’s: does the theory work with the facts and, if not, throw out the theory.
    Specifically, Dr. Thomas Frieden, a former director of the Center for Disease Control, explains in an 2017 NEJM article:
    • “RCTs have substantial limitations” that “affect the use of RCTs for urgent health issues,
    • “such as infectious disease outbreaks” and
    • “Many other data sources can provide valid evidence for clinical and public health action.”
    Now there is an urgent opportunity stop using RCTs exclusively and apply the “many other data sources” to evaluate hydroxychloroquine and other treatments to stop soon the thousands of deaths; loss of livelihoods, employers, nonprofits and the economy; and horrendous government spending.

    • Charles D Weller: Now there is an urgent opportunity stop using RCTs exclusively and apply the “many other data sources” to evaluate hydroxychloroquine and other treatments to stop soon the thousands of deaths; loss of livelihoods, employers, nonprofits and the economy; and horrendous government spending.

      Lots of approaches are being used in parallel. So your recommendation has been largely implemented in practice. However, RCTs are the fastest way to learn the answers to the two most important questions. (1) in this population, with this infection, does hydroxychloroquine improve survival rate? (2) in this population, with this infection, does hydroxychloroquine produce adverse reactions?

      Those question can’t be answered without RCTs, and the longer they were to be postponed the longer we would remain in ignorance.

  6. The estimated cost for the UK lockdown is £2.5 billion per day! I have no idea about the continued sustainability of this expenditure. All the eggs have been put in to a single COVID basket. One government minister said they expect some increase in the number of divorces, and then ignores the emotional scaring of the children. The number of self-harming has increased together with domestic violence by 10%, I expect this to go up as the lockdown continues. No consideration for those with mental health issues, nor the elderly in their own homes who depended on relative, and with now normal dispersal relative can no longer visit and check up on them, These elderly depend on local authority social care which was well over stretched before COVID. Many small firms, and shops etc. which may have belonged to families for generations have gone. The press has been presenting lockdown as a cure. Us troglodytes come out of lockdown and the virus is no longer there – but this is not true, the evil day has just been postponed. The biggest killer of all is poverty, its not just the lack of work and income, it’s the sense of despair and hopelessness. I fear the consequence of this lockdown will be inter-generational.

  7. Victor Adams

    Here comes WHO in a scientific brief dated Friday, 4/24/2020: “There is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection.”. I hope (and pray) that they are wrong, again.

    • Robert Johnson-Taylor

      The thing is having no antibodies present in the blood stream at some point in time after an infection does not mean that an individual cannot have an immune response when in contact with the antigen on subsequent occasion

    • “Here comes WHO in a scientific brief dated Friday, 4/24/2020: ‘There is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection.’”

      If that were true then we would have no faith in a vaccine, either. It’s well-known that a certain percentage of people who are vaccinated don’t mount a sufficient antibody response.

    • This is neither right nor wrong as it is meaningless. The key word is “evidence”.

      For there to be such “evidence” there must be extensive specific testing of an adequate sample size of tested cases. The reason there is no evidence yet is because it is too soon for there to be such evidence.

      We have not yet had a second wave of infections following the opening up after the lockdown. Neither have we had extensive testing of people who have recovered and (i) have not been reinfected or (ii) been reinfected but had no symptoms or only minor symptoms. It would be highly speculative, even has testing been done, to decide whether those who had not been reinfected were not reinfected because they did not come near a source of reinfection or because, although they came near such source, they were protected from reinfection by their antibodies.

      The WHO statement as worded gives the impression that the presence of antibodies is useless. I would reword the WHO statement as follows:

      With currently available information there is as yet no way to measure or estimate the percentage of people who have Covid-19 antibodies who will not get a second infection or, if reinfected, the severity of that second infection. All other things being equal, the presence of antibodies will provide greater protection than the absence of such antibodies.

  8. morpheusonacid

    I think this is the most rational analysis I have read or heard. I would have liked some background on Nic Lewis. Get him in the daily briefings ASAP.

  9. Hi. Many good points there. What the lockdown does is buy time, and capacity. One thing time gives is an opportunity to observe other countries and see how they are working out. Another is to get data, to observe the key characteristics for modelling. Time also allows us to put together capacity and plans for things like the testing programmes and support of schools, care homes and building up supply chains for PPE and other critical supplies.

    One of the key concepts is separation. Primarily, separation of at-risk groups from the rest, and I would suggest separation of the very least at risk too..

    • (darn, erroneous enter key :-) ). One of the terrible costs of this lockdown is the suspension of normal medical procedures, so I would have thought they will be looking at how to segregate Covid from normal parts of the medical services – including staff. If so, one would think that they would have lower risk groups working on Covid only, and not mixing them up – where feasible. So for instance, we know males are at risk, age is a factor and ethnic background. (My understanding is that ethnicity is highly likely to be influenced by Vitamin D levels. Low Vit D leaves you susceptible to respiratory infection and darker skin, even in UK summer leads to deficiency). It is also suspected that nicotine is protective. So, if you go for treatment for non-Covid treatment you could be expected to be treated by older, non-smoking staff of non-white ethnicity. For the Covid treatment you would look forward to young, blonde, female vapers :-)

      Generally, though, my main thrust is Vitamin D deficiency at the population and group level. I’ve read up on studies showing the link with respiratory immune function and Covid outcomes. The correlation is clear. For instance, one study shows that 46% of the US population is deficient, 70% of Hispanics and 84% of Afro Caribbean!

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356951/
      http://www.jarlife.net/703-the-global-epidemiology-of-vitamin-d-status.html
      https://www.grassrootshealth.net/blog/first-data-published-covid-19-severity-vitamin-d-levels/

      Click to access Alipio-Vit-D-COVID-Severity-Preprint-04-22-2020.pdf

      From that last paper from (I think) the Philippines :

      Of all COVID-19 cases:

      49 (23%) cases were categorized as mild, with an average vitamin D level of 31 ng/ml (78 nmol/L)
      59 (28%) were categorized as ordinary, with an average vitamin D level of 27 ng/ml (68 nmol/L)
      56 (26%) were categorized as severe, with an average vitamin D level of 21 ng/ml (53 nmol/L)
      48 (23%) were critical, with an average vitamin D level of 17 ng/ml (43 nmol/L)
      86% of all cases among patients with normal vitamin D levels were mild, while 73% of cases among patients with vitamin D deficiency were severe or critical
      For each standard deviation increase in vitamin D level, the odds of having a mild case compared to a severe case were 7.94 times more, and the odds of having a mild case compared to a critical case were 19.61 times more
      All outcomes were statistically significant

      You are normally classified at deficient at less than 30 ng/ml as I understand it, although there appears to be some disagreement as to what constitutes normal.

      If you look countries with low levels of deficiency – such as Scandanavia (due to diet and supplementation) or Thailand and put that together with largely white-skinned populations in summer such as Australia and NZ, there appears to be a pattern. Italy, surprisingly has high levels of Vit D deficiency.

      Addressing this through supplementation, particualy of at risk groups such as darker skinned folks as we come out of lockdown would be far from a bad idea !

      • Great correlation. What is the causation? Else you have classic correlation does not equal causation.

      • Robert L Johnson-Taylor

        In my mind diet plays an important part in the bodies response to infection, things like Vit C, Vit D and Zinc have a significant role. I just did a quick search and came up with this link.
        https://www.hsph.harvard.edu/nutritionsource/2020/04/01/ask-the-expert-the-role-of-diet-and-nutritional-supplements-during-covid-19/

      • Hi Bigterguy. Yes, of course. I guess Covid could be shown to correlate with many things, such as the inverse of average altitude of goats or something :-). However, there are very good scientific reasons to suggest there is something specific about the role of vitamin D deficiency in inhibiting the immune systems ability to fend off the cytokyne storm that is the most critical phase of the disease.

        If you look at the latest literature there are plenty of studies looking at the ACE2 receptor – which is the front door into the body for the virus. But of course, this is a multi-variate situation and Vitamin D is not the magic bullet. Being male is a big risk factor, 70% of deaths in some countries. And even nicotine seems to have a protective effect, which also seems ACE2 related.

        This is an interesting paper that looks at both the male/female issue and vitamin D. Published April 22nd from Italy

        “Some studies suggest that low vitamin D levels may increase the risk or severity of respiratory viral infections, and interventional studies have shown that low levels are associated with increased expression and secretion of pro-inflammatory cytokines and chemokines. Interestingly, vitamin D administration decreases the inflammatory response to viral infections in airway epithelium without jeopardizing viral clearance. This suggests that adequate vitamin D levels would contribute to reduced inflammation and less severe disease in respiratory syncytial virus-infected individuals”.

        https://www.mdpi.com/1422-0067/21/8/2948/htm

        So, I will say it again, Vitamin D supplementation at the population level would seem no bad thing as long as people keep to the recommended dose. And especially for cohorts known to be more at risk of deficiency, such as darker skins and older folks – and males.

  10. There is another sensible strategy – which is working already in Australia, New Zealand, South Korea and Taiwan. It is also that planned for the US.

    It is to use the “lockdown” to drive case number way down. Then, using lots of testing, and only moderate social distancing, keep the case numbers way down – even driving them to extinction in many areas. That approach opens up most of the economy sometime in the next few months, depending on the status of the local area.

    That is the approach planned for the US. I fear, however, that it will fail because people will refuse to go along with adequate measures for the remaining month or two required.

    One problem with Lewis’ approach is the severe difficulty of segregating the at-risk from those at very low risk. It would involve splitting up households. A high percentage of the population would need to be in sterile isolation. It would require lots of sanitation, and delivery of all needs. Sterile isolation would end up being broken for medical care and routine home maintenance. The experience with care homes shows that this is not likely to work.

    • Your comment is in error. South Korea and Australia used lots of testing very early on in the outbreak, they did use lock down first and lots of testing second strategy. The schools in Australia have not even been closed.

      • Schools in Australia have essentially gone online, with parents who could keep children at home taking mass action well in advance of government advice. Children of ‘essential’ workers etc can go to school, and be babysat while they do the online school like everyone else. My primary school child will continue school from home for some weeks yet.

      • It is you who are in error, Bob.

        Aus (I live there) did not use “lots of testing early on” – we simply didn’t have the test kits.

        The schools in two States did not close. Those are in regions with very, very low population densities. The remainder of the country is still arguing over closed schools re-opening, April 29th.

    • mesocyclone | April 26, 2020 at 12:22 pm | Reply
      “There is another sensible strategy – which is working already in Australia, New Zealand, South Korea and Taiwan. It is also that planned for the US.”

      Can you cite a source for this being “planned for the US.”

    • mesocyclone | April 26, 2020 at 12:22 pm | Reply
      “There is another sensible strategy – which is working already in Australia, New Zealand, South Korea and Taiwan. It is also that planned for the US.”

      Can you cite a source for this being “planned for the US.”

      • Bob – South Korea had a lot of cases early on. But even with Australia – when we push the number of cases low on a case per million basis, why wouldn’t Australia’s approach work? And yes, we can push the number low if people are careful – if you reduce transmission to where Rt < 1.0, the number of cases will drop. We are near or past that threshold already in the US.

        PMHinSC – The source is the federal plan announced by the White House a week or so ago. When they announced it, they discussed the goal of being able to use classic contact tracing and isolation. That's why the phases are dependent on lowering infection rates, and robust testing.

    • Steven Mosher

      “That is the approach planned for the US. I fear, however, that it will fail because people will refuse to go along with adequate measures for the remaining month or two required.”

      yes the US will fail.

      1. the ‘lockdown” was applied too late and was not stringent enough.

      2. Compliance with lockdown is varied and weak.

      3. Testing is still limited to the sympomatic.

      4. Even the simplest measures of contact tracing are not used.

      5. There is no isolation.

      The data from new Zeeland, Korea, ex Hubei China, all show that
      IF you do a lockdown PROPERLY and if you have adequate
      testing AND isolation of the sick, that you can reduce R0 to
      less than 1 in ~12-20 days.

      But if you are , say New York, and, for example, send the sick home
      to isolate, it can take more than twice as long to suppress R0

  11. Nick ==> Positivity Testing in many areas is showing very much higher levels of Covid infection than previously thought. Previous testing showed maybe 13-14% — three days ago, results in NYC showed over 20% — mostly asymptomatic or unrecognized mild symptoms.

    Does this apparent ubiquity of infection alter your calculations?

    Has Covid already swept through nearly the entire population, infecting those susceptible? This is what happens regularly with the other influenzas — do we have reason to believe Covid is or is going to be different just because it is new?

    • Kip, more evidence that the infection is more advanced than testing shows.
      In four U.S. state prisons, nearly 3,300 inmates test positive for coronavirus — 96% without symptoms. Now talk about lockdowns!
      https://mobile.reuters.com/article/amp/idUSKCN2270RX?

      • I should mention that the linked article emphasizes the fear factor that asymptomatic people could be carriers, while ignoring the good news that many who get the virus don’t get the disease.

    • I think it is possible that in some major cities at least the population may be well on the way to reaching sufficient herd immunity for the reproduction number R to fall to one or lower, at least if quite limited social distancing measures are employed until infections have shrunk further. This is a key issue that needs to be answered as a matter of urgency. It is difficult to disentangle the effects of lockdowns and of rising herd immunity. Maybe data from Stockholm will provide an answer before long.

      Note that the proportion of the population that end up being infected would be higher than the level at which R falls to one, with the final level of R being well below one. E.g, if R_0 (when no one has been infected) is 2.4, R would fall to 1 when 58% of the population had been infected (or is otherwise not susceptible), but ultimately 83% of the population would have been infected and R would be only 0.41.

      • niclewis ==> From positivity testing data pouring in day after day and the discovery of Covid infections on the West Coast of the US as early as February, it is looking more and more likely that Covid had already reached a deep penetration — sprinkled lightly but far more wide-spread — into the US population by the time lock-downs were mandated.

        Isaac Ben-Israel may well be right in his recent paper: “The end of exponential growth: The decline in the spread of coronavirus”.

        At least in the US, it appears that we acted to protect the wrong people. We should have concentrated solely on the old and ill and left everyone else busy producing and creating the wealth and materiel necessary to treat them.

        The future will perform a brutal “postmortem” on the overall world and national responses to SARS-CoV-2.

  12. jungletrunks

    Nic Lewis, What you describe is the only practical approach. The younger with no pre-existing conditions go back to work, those 60+ continue to work from home. Nursing homes, any institution dealing with the elderly remains in lock-down mode. Use differing strategies; allowances based on region, population density, etc.; continue developing best practice approaches.

    The initial lock-down has allowed industry to ramp-up throughput for needed supplies of: ventilators, masks, testing instruments, etc., this production will continue to ramp, but we’re far enough along today with protocols, and equipment; enough measures are in place to serve as a stop gap to keep hospitals from being overwhelmed.

    It’s a science experiment that must be played out in real-time, a trail and error approach. Weed out approaches that don’t work, double down when they work, share data globally. There’s no perfect solution that will eliminate deaths. Using the science we have, our wits, and grit to pragmatically navigate the path the virus will win the day.

  13. 1. Case numbers in Sweden do actually show a positive trend since the start of April, although the data is *very* noisy.

    2. There is no guarantee the same measures here will have the same effect on public behaviour and therefore Ro as they have in Sweden (they certainly did not in the week before lock down)

    3. This “strategy” allows for 10,000 deaths of younger people, which is promptly justified as only 2% of total expected deaths for the whole population, an apples and oranges comparison.

    4. It seems very unlikely that we will actually be able to shield the vulnerable in the way suggested.

    5. The degree and duration of immunity conferred by infection is as yet unknown.

    That’s not to say this strategy may not be the best one; there are no pain free ways forward. But the case put forward here is very weak.

    • Nice try VTG, but your arguments are much weaker than Nic’s.

      1. Wikipedia has a much less noisy official source of data for Swedish deaths and case numbers. Worldometer is probably initial daily reports and failing to update them when officials correct them. The actual data seems to show that Sweden has peaked. In any case, their deaths per capita is lower than the UK and most other European countries. Pretty hard to explain if lockdowns are really really effective.
      2. True but so what. All public policies depend on some level of voluntary compliance. Those who choose not to comply are taking on some additional risk.
      3. OK perhaps its 4% if these people are half the UK. That’s not a significant difference and is way way less than traffic accident deaths. Perhaps you want us all to ride bicycles, eat only healthy foods, and get daily cancer screenings too so as to prevent 600K deaths a year. Your quibble is nit picking.
      4. How would you know? Governments could focus on delivering essentials to these individuals and offer them support while in isolation. There could be parks set aside for this class of person, special hours for them at stores, etc.
      5. That’s untrue. Like everything its uncertain but virtually all experts believe that this will be like other corona viruses and flu and that there will be a significant period of conferred immunity. I’ve seen numbers of a year or two. There is even some evidence that immunity to common cold viruses offers some protection against covid19.

      • Dpy, allowing the politics of your determination to “defeat the managerial state that Woodrow Wilson wanted to substitute for the Constitution and that Eisenhower warned about.” really does seem to blind you to the most basic facts.

        Go check your traffic death stats. Be sure to report back.

      • I know VTG you can’t dispute what I say so you try to imply I’m politically motivated. That is a classic smear tactic used slimy politicians who themselves are politically motivated. And it will be obvious to anyone else reading this that this is what you are doing.

      • As I said dpy,

        Your facts are wrong.

        Still waiting for those traffic stats you claimed.

        Waiting…

  14. Robert Clark

    DATE NEW CASES INCREASE % # TESTS
    4/18/2020 29,564 -2,226 -7 168,397
    4/19/2020 27,354 -2,210 -7.4 139,511
    4/20/2020 28,249 895 3.2 183,117
    4/21/2020 32,037 3,788 13.4 138,451
    4/22/2020 19,554 -12,483 -38.9 143,549
    4/23/2020 32,124 12,570 64.2 158,486
    4/24/2020 39,887 7,763 24.1 465,986
    4/25/2020 36,342 -3,545 -8.8 251,263
    4/26/2020 39,806 3,462 9.5 256,441
    4th of July maybe. The 24th was better. MOAB to me is 1,000,000!

  15. This is the same thing Dr. David Katz said long ago. I applaud. https://www.linkedin.com/pulse/coronavirus-mortality-reality-check-david/?trk=portfolio_article-card_title

    We cannot keep people locked down; people are already getting antsy and people are rightly worried that this is government overreach for some nefarious purpose.

    The IFR is very close to that of a bad flu, as many have argued, and a bad flu doesn’t justify shutting down the entire economy. However, the WHO from the start argued that the IFR (confused with the CFR) was close to 3.8% (since walked back I believe) but there was no solid evidence for that, especially since we knew back on February 19 that the CFR for the Diamond Princess data was about 0.1% even for a cruise ship that we can presume had primarily retirees on it. Furthermore, half of those cases were asymptomatic. https://www.niid.go.jp/niid/en/2019-ncov-e/9407-covid-dp-fe-01.html After February 24, however, the WHO reported, “Asymptomatic infection has been reported, but the majority of the relatively rare cases who are asymptomatic on the date of identification/report went on to develop disease. The proportion of truly asymptomatic infections is unclear but appears to be relatively rare and does not appear to be a major driver of transmission.” https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf This seems to be inaccurate and we should have expected asymptomatic cases from the very start. I trust readers are familiar with recent studies that find a high number of asymptomatic cases and a high number of mild cases among the pool of people who are infected with Covid.

    Not to suggest that this is a manufactured crisis, but we do have to be somewhat suspicious that the good Dr. Ferguson was the very same individual who gave us wildly inflated figures for fatalities for the swine flu in 2009, and who at the time sat on WHO’s emergency committee for that outbreak. https://www.dailymail.co.uk/news/article-1180731/Swine-flu-infect-worlds-population-detailed-study-virus-predicts.html

    What else? Plenty. But for now I rest my case and lend support to the idea that this lockdown should be discontinued as soon as possible by referring readers to a video put out by two doctors from California: https://www.youtube.com/watch?v=xfLVxx_lBLU

  16. Curious George

    “The eventual total number of deaths for COVID-19 are not reduced relative to any less restrictive policy that likewise avoided the health system being overwhelmed.”
    I am unaware of such a a less restrictive policy available 4 weeks ago. An obvious candidate is “quarantine the sick only”. The precondition for that one is an ability to identify the sick. By testing? With a long incubation period, we would have to test everybody several times. Technically, not doable right now.

  17. “ The eventual total number of deaths for COVID-19 are not reduced relative to any less restrictive policy that likewise avoided the health system being overwhelmed. Deaths are merely spread over a longer period, assuming that eventually restrictions are lifted and people’s lives return to normal.”

    THIS! Until about 60% of the population has had it, or a vaccine is found, the number who will eventually get it is fixed at about 190 million in the USA. By all continuing voluntary best practices, the old and compromised can protect themselves. The rest should be free to go about their business, voluntarily assuming the associated risks.

    Places where the curve has been flattened should start opening up in measured ways, and advanced rapidly.

  18. Ala verytallguy above…

    Many of my points about whether/to what degree the Swedish approach should be a guide for Meriden policy-makers, it seems to me, should apply to using the Swedish model as a guide for other countries:

    1) it assumes that even if you slow spread down, you won’t develop effective treatments and/or a vaccine and/or an effective surveillance system that are effective enough to really prevent basically “herd level” prevalence.

    2) assumes you really can protect the vulnerable. Like you, I doubt that true in Sweden let alone this country .

    3) ignores the disparate impact to higher risk communities, such as minorities. Assumes we have no responsibility to prevent disparate impact because of healthcare disparities.

    4) assumes facts about immunity which may be probable but still unproven. As such, basically avoids dealing with highest impact risk of fast total spread with no immunity.

    5) assumes what would work in Sweden will work in the US.

    6) assumes healthcare system won’t be overwhelmed by fast spread or that at least healthcare system being overwhelmed won’t result in higher fatality rate.

    7) assumes that we don’t have a responsibility to healthcare workers to prevent them from dying or getting sick due to lack of resources, due to faster spread.

    8). Assumes certainty of low fatality rate.

    Now imagine the following scenario: (1) Immunity turns out to not be a best case – either it doesn’t happen or it takes a long time to develop or it doesn’t last very long. (2) in 2 months, someone develops an effective therapeutic that significantly reduces fatality rate.

    Considering that, how much should be bet on the differential economic benefit, and health outcome benefit from things like being less cooped up, from policies based on the idea of potentially letting the virus infect people more quickly and more widely, so as to keep a hobbled economy and national psyche limping along for those 2 months?

    • Josh, I just think you have the burden of proof wrong. It’s the advocates of lockdown who need to prove their case given the huge economic and human costs of lockdown. I think everyone realizes that and wants to get back to normal as fast as possible.

      I think the problem your position will have is that many companies like Boeing have already reopened. Amazon is following suit. As a practical matter governors will have little choice if companies have good plans for distancing, contact tracing, etc. Your previous point about federal contract tracing notwithstanding, companies will do this themselves and do a better job than Federal or State governments.

      • All joshie needs to cause him to change his tune and offer up a thousand reasons for ending the lockdown, is POTUS Trump deciding to extend indefinitely.

  19. Nic is spot on. Knowing the demographics of the dead – age, sex, pre-existing conditions, location, race, eye color, handedness, etc. is vital. The info is out there, to see who might get sick vs who is at risk of dying. As an example- and I admit to missing baseball- my instinct says few if any pro athletes- 20-40 yo, good health, etc. will die. NHL and NBA players got Wuhan and recovered. We have -or should have- good data from Japan, S Korea, Europe and North America to confirm trends from ~ independent data sets. The lock down avoided surges and bought time; use what we have learned, work the problem, and let most get back to work very soon.

  20. Nic, You make a good case. It’s the strategy that should have been used from the beginning.

    I would personally find it interesting if you would rework your Diamond Princess analysis using updated fatality numbers. Something that would be a great analysis is a meta analysis of the growing number of serologic testing datasets.

  21. Peter Davies

    There are some weaknesses in Nic’s approach.

    It is almost impossible to keep the over 70s and those with comorbidities separate from the rest of the population. Just look at the number of infections there have been at care homes in New York and just about everywhere else, which were supposed to be isolated. Further, most of the over 70s in the UK that I know have been going out from time to time, especially as we have had mainly warm and sunny weather since the lock down was announced. Just try persuading older people that they can’t do something everyone else is doing!

    Also, the low death rates for people under 70 rely on hospital treatment being available to those who require it. Hospitalisation requirements apply to younger age groups as follows:-
    – 20s, 1.0%
    – 30s, 3.4%
    – 40s, 8.2%
    – 50s, 11.8%
    – 60s, 11.8%

    The average throughout the six months matches the available beds. But because of the uncontrolled nature of the peak, hospital capacity will be exceeded at that time. So people in the younger age groups die needlessly, even if the over 70s are not exposed.

    To stand a chance you would have to find some way to control R throughout the six months. Ferguson’s on-off scheme was designed to ensure the capacity of hospital beds in total and intensive care beds in particular, was not exceeded at any time.

    Sacrificing some otherwise-healthy under 70s is a huge gamble to take, given that a) there may well be a treatment found or c) vaccines may work and there may be a vaccine available in a shorter time scale than suggested.

    Ferguson’s approach was just a straw man. The eventual plan may morph into getting the number of cases down low enough to start with, and the volume of testing up high enough that rigorous chasing by an army of chasers can prevent a rise in cases even though most people are back at work etc. Certainly the UK is putting together modelling of infections and contact strategies to determine the likelihood of success of various strategies, which seems like a good place to start.

    • A number of vague statements here. Past experience with viral vaccines and antiviral medications has been very poor. Expecting something soon enough to make a difference is wishful thinking.

      It’s hard to argue that modeling is accurate enough to rely on for policy options with the high level of uncertainty even about basics of how this spreads.

      Getting lost in the weeds or trying to “overfit” policy only results in errors in judgment. Regardless of what we do, its likely that only herd immunity or a civil rebellion and collapse of the banking system will stop this thing.

    • “Herd immunity is achieved through vaccination programmes, anything else is individual immunity. And the mythical Herd immunity is nothing more than confinement of a condition by artificial means, i.e. vaccination.”

      Once enough people get an infectious disease it doesn’t spread until another crop of youngsters who aren’t immune grows up. This is what happens every flu season when the flu variants that the vaccine doesn’t cover (happens all the time) get the flu and then the flu spikes and then the flu dies down. Problem is that the flu constantly mutates. If everyone in the population got natural measles (assuming no vaccine) and there were no new children born, everyone would be immune to the measles: herd immunity.

      It’s very questionable whether we can even get a vaccine for a coronavirus. It hasn’t happened yet, and wishful thinking won’t make it so. If it does, great: everyone get vaccinated. Until then we’re fools if we continue to cower in fear.

      Four million people die each year of acute respiratory infections. Get over it. We should be grateful that this thing largely leaves children alone.

    • “The average throughout the six months matches the available beds. ”

      You are assuming that ICU capacity is fixed. But it is growing. And UK hospital occupancy is at an all time low: there is a huge surplus of hospital beds. And there would be an ability to vary social distancign measures during the ~6 month period to even out ICU usage, with a only a moderate delay in effect.

      Healthy under 70s would not be in any way compelled to put themselves at risk. If they preferred to self isolate indefinitely they would be able to do so. My guess is that most such people would not make that choice.

      • UK hospital occupancy, is at an all time low, for a number of reasons.
        15,000 people were discharged quickly, as ordered in https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/880288/COVID-19_hospital_discharge_service_requirements.pdf
        Off the ward within an hour of being identified as fitting the discharge category & out of the hospital within 2 hours after that.
        Out where? Many of these would be elderly & they’d be discharged to a care home.
        Were these patients tested & Covid-19 free when discharged? Were they hell! This act sent infected patients into care homes, to infect others, both residents & staff. There’s no official figures for Covid deaths in care homes, estimates are that 7,500 have died so far.
        Secondly, hospitals cancelled all non-urgent admissions, to free up capacity.
        Thirdly, who in their right mind, is going to voluntarily go to a hospital, full of infected patients & staff?
        The biggest mistake that’s being made, is to treat the Nightingale Units as overspill, rather than as dedicated treatment centres for Covid patients.
        Get them out of the DGHs, get the DGHs back to treating non-infected patients.
        Once that’s in place, it’s removed a big source of infection from the community.
        We also need a good system for testing & quarantining, not this centralised mobile phone based system, that the governments trying to push on us.

      • adam

        you are correct. i understand that one way or another 40000 beds have become available.

        To that can be added that admissions to A and E have fallen dramatically thereby freeing up staff and resources. Hopefully the large numbers of people going there without good reason can be permanently sorted out.

        The nightingales should treat covid patients only, that they were set up to do. treatment in other hospitals needs to be resumed on other cases both urgent and non urgent, and care home patients coming into hospital should be tested and kept in an appropriate hospital until they are clear. releasing them back into a closed environment of a care home when infected is crazy

        tonyb

    • “It is almost impossible to keep the over 70s and those with comorbidities separate from the rest of the population.”

      If that’s true, then it must also follow, as the night the day, that you can’t keep the uninfected separate from the infected. What is the justification for locking everybody down? Take a week and get back to us.

      • “If that’s true, then it must also follow, as the night the day, that you can’t keep the uninfected separate from the infected. ”

        One point of the lockdown is to reduce the percentage who are infected, at which point failures in the separation become far less deadly.

        But the main point is to reduce the probabilities of spread, which is very different from your absolutist attempt to create a paradox. If you reduce the probabilities enough, then the epidemic dies out. That’s a fundamental fact of epidemiology. Put in mathematical terms, get Rt < 1.0 and it will die.

      • Herd immunity is a fundamental fact of epidemiology. Hundreds of millions of people prevented from going about their daily lives is a fundamental tragedy.

        We have had the lockdown. We have had it up to here with the lockdown. It’s time to end it, before irreparable harm is done. Those who prefer lockdown are welcome to lock themselves down, as long as they can stand it.

    • stevenreincarnated

      My understanding is the nursing homes in NY wanted to test recovering residents for CV-19 before they were allowed to come back to the home and weren’t allowed to do so. It’s tough to keep infections out when you aren’t trying.

      • Peter Davies

        It is indeed tough to keep out infections when you aren’t trying. But even those countries who do appear to be trying to keep infections out of care homes are struggling. The best defence is a low level of infection in the underlying population.

      • stevenreincarnated

        It only takes one. Perhaps a better strategy would be to test all employees at the beginning of their shift and all visitors. That would be a much more practical use of the tests than testing random people and trying to trace contacts as far as I’m concerned.

      • There was a low level of infection in the underlying population early on, when the nursing home in Washington state got wiped out. The virus is already out of the barn. Everybody knows that nursing homes are vulnerable.

        There are relatively few people in nursing homes. We know where they are. If nursing homes can’t be effectively isolated from the general public, then nursing homes will continue to suffer large numbers of fatalities. This is on local officials.

  22. I quit reading after the contention that 80% represents Herd Immunity.

    Perhaps I should have read on, but that statement made my blood boil.

    Herd immunity is achieved through vaccination programmes, anything else is individual immunity. And the mythical Herd immunity is nothing more than confinement of a condition by artificial means, i.e. vaccination.

    At 95% ‘Herd immunity’ any condition has a tiny pool of victims and a very limited ability to mutate. Move that up to 20% and the condition has enormous opportunity for mutation and re-infection of an entire nation.

    I’m afraid Roosevelt (it was Roosevelt wasn’t it?) was right. We have allowed the world of science to be overrun by establishment science, as evidenced in Climate science, and now witch doctors are invading the pandemic space.

    Science is tough, that’s why it was useful. Now, even the left wing editor of the Lancet tells us 50% of medical science is junk, Bayer put that number at 75%!

    Continue the way we are going and no one will be safe from ‘science’!

    • Peter Davies

      Herd immunity is just sufficient individuals having individual immunity that each person infected with the virus passes it on to less than one other person, on average. It doesn’t matter whether the individual immunity is achieved through having had the disease, or having been vaccinated.

      There seems to be some evidence that some people who have had the disease are not immune afterwards. I find it difficult to imagine that no-one who has had the disease will be immune after testing (and maybe retesting) negative for it, and believe that most people will develop immunity after throwing off the infection, at least for some months.

      If, without anyone being immune, each infected individual would infect, say, 3 others (also known as R=3), then more than 66% immunity is required so that it dies out through herd immunity. 80% immunity corresponds to R=4. 95% corresponds to R=20, which is way more than the average, though a few super spreaders have certainly got that high.

      R depends on both the degree of social distancing, and the average level of individual immunity.

      Due to social distancing measures, the UK R is estimated at R=0.7, which means that each infected person passes it on to 0.7 people on average. Hence it slowly dies out. At the moment the contribution of individual immunity to the R value is too small to be significant, because the number of cases hasn’t been high enough. But in NY City, antibody testing some 20%

      With draconian measures, Wuhan got R down to 0.3, so the community transmission died out pretty quickly, having few mechanisms left other than to infect others in the same household. New York is estimated at 0.8, which will lead to a slower reduction than in the UK, and northern New York State is at 0.9, which means it will take around three times as long to achieve reduce by the same percentage as in the UK, and about eleven times as long as Wuhan.

      Whether 50% of medical science is not correct is a topic up for grabs. However, the 50% that is not correct doesn’t include any of the core principles of epidemiology, because that is basically a combination of common sense and statistics. Using such principles, humans have already completely eliminated the scourge of smallpox. Polio is well on the way to extinction, though the necessity of switching vaccines in the latter stages makes it more tricky to achieve final elimination than smallpox.

      Not much was known about COVID-19 early on, but more is becoming known very rapidly over time. Within a couple of weeks we will be witnessing NY use testing and epidemiology to walk a thin line to keep the R value between 0.8 and 1.2. The chances are that, at some point, some aspect of opening up will increase R values too much, and we will then all be observing the direct consequences of epidemiology in action, leaving very little room for doubt as to how effective it is.

      • Peter –

        > , and northern New York State is at 0.9,…

        Where did you get that stat?

      • Peter Davies

        Joshua,
        R=0.9 for the northern sections of NY State was in Cuomo’s talk and foils during his NY briefing yesterday (Sunday 26 April).

      • I love it when people play with numbers.

        It does nothing more than make my point, especially when another comes along and plays with other numbers.

        And just like any scientific environment, epidemiology claims to be immune from bias and corruption. Believe that at your peril.

        The moment any organisation or profession claims not to be part of the replication crisis is the moment we should all pick them apart bit by bit.
        50% success is the best we have. The toss of a coin as to whether ant particular scientific study is worth considering or not.

        Perhaps if we applied the same conditions of Herd immunity to the scientific community, there would be little room for criticism.

        But we don’t.

      • Peter Davies

        HotScot, the guys doing the modelling don’t disagree much about what is happening. Someone gets infected, they interact with a set of people depending on the rules in place, some of these people get infected. If someone is infected, depending on age, comorbidities, level of fitness, and probably some factors we don’t yet know, they may need hospitalisation, or even ventilation, and may die. All these things get parameters.

        For the initial models there are large uncertainties, although the full set of Diamond Princess testing constrains some of the parameters. The progress of epidemics in various countries starts to constrain the uncertainties, so we start to get R values with lower uncertainties. People’s behaviour becomes quantifiable. Then comes accurate antibody testing, or at least antibody testing with a consistent false positive rate which can be allowed for. The models get more accurate again. Now they become more useful in predicting what will happen as lockdowns are lifted.

        Eventually the models and R values get more precise, and uncertainty reduces, and there is now real predictive power.

        While you can argue with the objectivity and value of the early models, your position that none of them are worthwhile is slowly going to become boxed in as they are used to predict and control the course of the coronavirus epidemics in various countries. Numbers are going to win over words dismissing numbers. Watch the grip of the numbers tightening as time goes on.

  23. Nic Lewis, thank you for the essay. I think it’s good, fwiw.

    I think you are trying to be “too precise” in a situation where not much is known precisely, but it is known that almost all deaths result in people with pre-existing conditions, and at least a few percent of deaths were people who were “already dying”.

    To date, there have been a reported 203,000 deaths in 1/3rd of a year globally. That’s something not to ignore, and the case loads in some places strained the medical systems. In pre-vaccine days, measles caused about 1 million deaths per year globally, so COVID-19 is looking grossly like measles, with the important exception that COVID-19 preferentially kills people with other health problems (so, probably did measles, but careful case post-stratification was not done in most of the measles era.)

    We don’t know how many people will die or have died from unemployment and its impoverishing consequences, but we do know that the “lockdown” is not risk free.

    Now that we know a lot more than we knew at the end of January (a month during which much of the spread of SARS CoV-2 occurred without being accurately recorded — in fact, without hardly being noticed), why not treat it as we did measles back in the time of my youth (I had it twice, the second being “German” measles at age 18): protect the sick and elderly, quarantine the infected, let everyone else go back to work and play.

    • Good point about measles Matt.

      Freguson from Imperial estimates based on data that 2/3 of those who die from (or with) covid would have died within a year from their underlying medical issues. That’s probably a conservative estimate. The way to look at this is calculating “excess” mortality. Excess mortality is about 1/3 of total covid mortality. Just another way official statistics are badly badly biased and being used to scare people.

      • Yes – life-years extended appears to be the metric.

        And lockdown is taking livelihoods from the many young,
        in exchange for minimal life-years extended of the few old and sick.

        The old and sick are also the least likely to respond to vaccination.

      • And if we define quality-life-years extended,
        meaning we exclude cases where individuals survive COVID,
        but spend a year or two in suffering, disability, and pain,
        the benefits shrink even further.

      • Yes, I agree with this metric.

      • “Good point about measles Matt.”

        In the US before the measles vaccine millions were infected but only an estimated 500 died each year: a low CFR. Flu is a better comparison.

        Measles was highly infectious– much more so than Covid– but relatively benign. Covid isn’t as infectious as measles but appears to be more infectious than a normal flu (but we don’t know that for sure) and appears to have about the same IFR as the flu.

      • Here’s what Wikipedia says about the lethality of measles: Measles affects about 20 million people a year,[3] primarily in the developing areas of Africa and Asia.[7] While often regarded as a childhood illness, it can affect people of any age.[14] It is one of the leading vaccine-preventable disease causes of death.[15][16] In 1980, 2.6 million people died of it,[7] and in 1990, 545,000 died; by 2014, global vaccination programs had reduced the number of deaths from measles to 73,000.[9][17] Despite these trends, rates of disease and deaths increased from 2017 to 2019 due to a decrease in immunization.[18][19][20] The risk of death among those infected is about 0.2%,[5] but may be up to 10% in people with malnutrition.[7] Most of those who die from the infection are less than five years old.[12] Measles is not known to occur in other animals.[12]

        the figure I cited of a million dead per year globally is evidently too low.

        And: Complications Pneumonia, seizures, encephalitis, subacute sclerosing panencephalitis, immunosuppression[5][6]

        And: Even in previously healthy children, measles can cause serious illness requiring hospitalization.[38] One out of every 1,000 measles cases progresses to acute encephalitis, which often results in permanent brain damage.[38] One to three out of every 1,000 children who become infected with measles will die from respiratory and neurological complications.[38]

        COVID-19 is roughly comparable to lots of diseases, none of which requires a lockdown of society comparable to what has been required in some US states by some governors.

    • Matthew –

      > We don’t know how many people will die or have died from unemployment and its impoverishing consequences, but we do know that the “lockdown” is not risk free.

      Sure. But neither is a rapid lifting of government mandated social distancing.

    • mrm: I think you are trying to be “too precise” in a situation where not much is known precisely

      I think that might convey the wrong message. I do support the systematic and disciplined use of the best available data. As Nic Lewis did well.

  24. > The eventual total number of deaths for COVID-19 are not reduced relative to any less restrictive policy that likewise avoided the health system being overwhelmed. Deaths are merely spread over a longer period, assuming that eventually restrictions are lifted and people’s lives return to normal.

    This ignores huge uncertainties. Slowing the rate of deaths could lead to fewer deaths to the extent that more effective treatments might be developed, it would help ease the pressures on overwhelmed healthcare personnel who lose efficiency when overwhelmed, as just two obvious examples.

    • The shutdowns were sold to the public based on ‘flattening the curve’ and now the goalposts are being moved to ‘save even one life.’

      The curve has been flattened. The integration under the curve may, or may not, have been changed, but certainly not by much. This tells us the virus is not as bad as initially portrayed. And that 20% of New Yorkers already have it tells us that the death rates have been overestimated.

      It’s time to have a phased withdrawal of all shutdowns. Start with the least infected places – sparsely populated counties – and least interactive businesses, and continue. Those who choose to isolate to stay safe are free to do so, and those who do not want to are free to take their chances.

      • Guy –

        > It’s time to have a phased withdrawal of all shutdowns.

        There is one. The Trump administration has laid out a set of criteria. Although some governors look to be ignoring those criteria, they look reasonable to me.

        Which criteria do you think are overly-burdonsome?

  25. > However, it comes at huge economic and social costs, and substantial COVID-19-unrelated health costs.

    Uncertainties in all directions should be considered.

    Economic harm going forward does not follow a binary forking path from the existence of government mandated social distancing.

    For example, consider the uncertainty of whether, if there are spikes in rates of infection and deaths in conjunction with rapid lifting of government mandates, that there might be equally devastating economic harm, or even worse economic harm, as compared to a more gradual approach.

    Once again, uncertainties in all directions should be considered.

  26. So, who should remain locked down? There are some obvious targets and some less obvious so here are two sets of facts;

    Fact 1;
    The BAME community has far higher rates of death from CV than the indigenous population.

    “Currently the number of people diagnosed with diabetes in the UK is estimated to be 3.5 million. The Muslim population in the UK from BAME ethnic backgrounds (the majority of South Asian Origin) suffer from diabetes at a rate six times higher than that of their Caucasian counterparts.

    Three million people in the UK have Chronic Kidney Disease (CKD) of which BAME communities are five times more likely to suffer from CKD in comparison to other groups, due to a higher rate of diabetes and high blood pressure …..

    This combined with lower life expectancy, high rates of poverty, overcrowding and …..naturally low Vitamin D.”

    Fact 2

    In the US a shocking 40% of Adults are obese and a further 32% are overweight. In the UK the figures are 28% and 36% respectively.

    The scientific journal Nature stated on April 2nd: “Type 2 diabetes mellitus and hypertension are the most common comorbidities in corona virus.” These are often a direct by product of being obese or overweight

    To this can be added that age also loads the odds against you, as does having asthma. I note that in the UK some 30000 people a year are said to die from diabetes.

    So we have several obvious target groups for continued lockdown

    Firstly; All in the BAME community over 75
    Secondly; All Others over 75 with severe health conditions
    Third; All those in the BAME community who are over 45 with diabetes who are obese or have a BMI of 27.5 or more
    .
    Fourth’ All members of any community who are over 45 who have diabetes and are obese etc

    I am not in the over 70 age group myself but there was a recent report that showed a shocking number of over45’s had more severe health problems than many over the over 70’s, so judging this on purely age is medically wrong and extremely ageist . No doubt the BAME community would react as violently on being singled out.

    It is extremely critical that people get back to work. A devastated economy will cost far more lives than Covid 19 ever will, as well as jeopardising everyone’s quality of life and opportunities.

    Locking people up causes infections to circulate within the family group,. people are best outside. With sensible social distancing, masks and hand washing, most businesses can reopen

    We are not robots and not willing to be imprisoned for a further six months unless genuinely highly vulnerable..

    tonyb

    • Why lock down those at risk? They have the freedom to self-isolate if they desire, as do the rest of us. We now have learned the appropriate defensive techniques – gloves, masks, hand-washing, physical distancing – and everyone interested in staying safe can practice those, or not.

      Let my people go!

      • Xactly. We are losing trillions of dollars that we will never get back. We could buy gold plated space suits for all the comorbid old folks, who are dumb enough to go for a stroll among the asymptomatic infected and we would save our economies and our sanity.

    • Evening Tony,

      Would it surprise to to learn that I found myself agreeing with Andrew Neil not so very long ago?

      However I find it much more difficult to agree with Nic on this occasion. By way of many examples please see:

      I am certainly no robot, but according to the ToryGraph the recently risen Messiah (AKA) BoJo is going to “ease the lockdown” this week. My thoughts on that prospect?

  27. I’m curious as to which criteria Trump says we should use to determine whether business should re-open, critics of mandated social distancing think are over-burdensome?

  28. Stephen Anthony

    Nic,
    Have been arguing for something very similar to what you espouse here, in the UK on another board.No need to have a shutdown, when the vulnerable can work from home and or isolate,
    Do you have a UK connection? Wondering why the UK is the choice of country for the article. Most governments in Europe seem to be on lock down with the happy exception of Sweden. Less deaths over there and you can still go the pub. What’s not to like?

    • Stephen – Yes, I live in the UK. Agreed that COVID-19 seems to be being tackled in a much better, more rational, way in Sweden than in the UK, although it is too early to be certain that the Swedish approach will continue work well.

    • Perhaps it’s helpful to look at some “R”-developments over the last month: https://i.imgur.com/aJGdVwH.jpg

      • The R(t) of the UK is quite interesting:

        It was huge in the beginning and now it’s in the Germany ( D) ballpark.

      • Afternoon Frank,

        Where did you get the underlying data for your R graph?

        Have you seen James Annan’s Covid-19 projections, for the UK at least?

      • Good afternoon Jim, of course I saw the approach of James almost in real time. He deduces from the counted deaths on R with a model. I used the case data from worldometer and calculated the 7 days-changes. This implies the uncertainty due to the “dark number” when there were too less tests, however for Germany it worked well in coincidence with other sources (Helholz institute). It seems to be that after the beginning of april my values are well in the ballpark of James modell , my last R (t) is 0.73 for UK. A very high increase in the beginning points to some difficulties in the health/testsystem of the country IMO, see UK and US.
        best Frank

      • Matthew R Marler

        frankclimate: Perhaps it’s helpful to look at some “R”-developments over the last month:

        Good idea! Most interesting.

    • Abstract
      We present a simple operational nowcasting/forecasting scheme based on a joint state/parameter estimate of the COVID-19 epidemic at national or regional scale, performed by assimilating the time series of reported daily death numbers into a simple SEIR model. This system generates estimates of the current reproductive rate, Rt, together with predictions of future daily deaths and clearly outperforms a number of alternative forecasting systems that have been presented recently. Our current (14th April 2020) estimates for Rt are, respectively, UK 0.49 (0.0 – 1.02), Spain 0.55 (0.33 – 0.77), Italy 0.90 (0.74 – 1.06) and France 0.67 (0.40 – 0.94) (mean and 95% credible intervals). Thus, we believe that the epidemics have been successfully suppressed in each of these countries, with high probability. Our approach is trivial to set up for any region and generates results in a few minutes on a laptop. We believe it would be straightforward to set up equivalent frameworks using more complex and realistic models, and hope that some experts in the field of epidemiological modelling will consider investigating this approach further.

      https://www.medrxiv.org/content/10.1101/2020.04.14.20065227v1

  29. The people who are at high risk, know who they are. If they are smart, they are staying at home. The rest of us can get back to doing what we do.

    Of course, somebody needs to tell the Cuomo-De Blasio syndicate to stop sending infected old folks back to nursing homes.

    • PS: And to either stop subway service, or put on more trains so people aren’t packed in like sardines.

      • Don –

        > Speaking on CBS News’ “Face the Nation” on Sunday, Gottlieb said that he doesn’t think doctors should be using hydroxychloroquine “outside of protocols at this point, given the fact that we’ve had now accruing evidence demonstrating really no benefit and some indication that it could be causing harm.”

        Former head of the FDA. Former member of the Trump administration (for two years). Resident fellow at a prominent conservative think tank.

        Does he also want all his friends and family to die so that Trump can look bad for a few days before winning in a landslide in November?

        Let’s hope he’s overreacting about HDQ – but maybe it’s time to stop saying that anyone supports a cautious approach is deranged?

      • “Speaking on CBS News’ ‘Face the Nation’ on Sunday, Gottlieb said that he doesn’t think doctors should be using hydroxychloroquine ‘outside of protocols at this point, given the fact that we’ve had now accruing evidence demonstrating really no benefit and some indication that it could be causing harm.'”

        I’m getting really tired of this. If you don’t think, or don’t know, or wonder, if the hydroxychloroquine/azrithromycin/zinc sulfate protocol of someone like Dr. Zelenko works (with near-100% cure rate) then here’s what you do: you ask, say, 1,000 doctors to administer the protocol and you tell them that the US government is in an emergency so will request all treatment records for this and will supply all participating doctors with the medications and the exact protocol and will make Dr. Zelenko available on the government’s dime so that those 1,000 doctors can test this and tell us in their honest opinions whether or not it’s working. You will stress to them that objectively and strict adherence to the protocol are necessary for the good of the country. You do this because we don’t have time to wait for double-blind placebo controlled trials, in case no one has noticed. You ask the doctors to communicate immediately with the government physicians monitoring this if any adverse effects are showing up,

        There. How hard was that? It was too hard because the government of the richest and (supposedly) most capable country in the world can’t get it done.

      • What reports is he talking about, joshie? The VA retrospective ? Did you ever read that? Did you ever look at table 2? Nah. You wouldn’t get it, anyway.

        I would say that Gottlieb is ill-informed, or he is of the school that it isn’t a legit treatment, until it has gone through years of blah blah blah clinical trials. Thousands of docs who are actually treating patients are using it as their first line intervention. One world famous doc; 2500 patients treated with 10 fatalities. The VA Secretary has said VA has been getting good results with patients, who don’t already have one foot in the bag. There are dozens of HDQ trials ongoing. Have you heard of any being stopped? (Trick question) Univ. of Minn is doing a trial testing HDQ as a prophylaxis and morning after pill, and reporting what look like good results to my highly educated eye$. I made a boatload of money analyzing drugs in trials, joshie. And on startups, before they ever got to phase I.

        Do you know why lupus and RA patients have had problems getting their HDQ from pharmacies, joshie? Of course you don’t.

        You get all giddy when you run across negative tidbits like this, joshie. You could be the head cheerleader for Cornonavirus U. I am sure you will be very proud of yourself, in the less than likely event that HDQ proves to be of no use against your favorite virus.

  30. You got it Nick– it all has nothing to do with keeping people alive let alone keeping old folks from dying in nursing homes. We’re all forced to deal with a virus that humanity has never faced before and there’s nothing more we will accomplish, and all we can really do, than keep those, picking up the pieces in hospitals, from being completely overwhelmed.

    Something that’s as unstoppable as the common cold and also has a targeted lethality can have some utility. For instance – the Chinese may well be traveling to see Kim Jong-un to make sure he’s infected…

  31. Which epidemiologist do you believe?
    The appeal of Johan Giesecke or Neil Ferguson is about more than just an assessment of the facts
    https://unherd.com/2020/04/which-epidemiologist-do-you-believe/

    Lifting lockdown could cost 100,000 lives, says Neil Ferguson of Imperial
    https://www.thetimes.co.uk/article/lifting-lockdown-could-cost-100000-lives-by-end-of-year-says-leading-epidemiologist-neil-ferguson-tv72gjld9

  32. Compare urbanization in Sweden with Italy: only 3 cities in Sweden would make it in Italy’s top 30. Where is social distancing easier considering space (or cultural habits)?

    The big difference between metropolitan vs rural areas for virus spread is not taken into consideration enough all around.

  33. There’s an assumption in this post behind the estimated number of ICU beds needed that seems odd:
    “Assuming that these 10,000 deaths were spread over six months, on average slightly over 2,000 ICU beds would be occupied.”

    I don’t believe we should expect that the number of deaths and the number of ICU patients are the same. Presumably the latter exceeds the former: some ICU patients recover. There’s probably some data on this. And the proportion who recover may be increasing as doctors learn about treating ICU patients. (By the same token, of course, the rate at which patients are Admitted to the ICU may decrease.)

    Revising the ICU occupancy upward may not change the overall logic of the recommendations here, which I am generally sympathetic to. But thought I would raise the question.

    • I use the Imperial College (Ferguson et al) model estimate of each patient in ICU staying there for 10 days on average. So 2,000 ICU beds over 6 months would, at 100% occupancy, service 36,500 patients. More than 10,000 deaths (27%) would be expected from 35,000 ICU patients. Ferguson et al. assume a 50% death rate for COVID-19 patients who need ICU treatment. On their assumption, average ICU usage would be closer to 1,000 than to 2,000 beds. So, if anything, my 2,000 ICU beds looks too high rather than too low.

  34. ‘Presumably the latter exceeds the former: some ICU patients recover. There’s probably some data on this.’

    Around 35% recover in the UK but some of them will find their health impaired

    tonyb

  35. Why is nobody talking about taking measures to improve the personal and environmental health of the population? The human immune system is THE most advanced disease fighting machine.

    Click to access sec08_2007_Evidence_%20Effects_%20Immune_System.pdf

    • ptor

      Correct. Viruses and germs mutate and we can help our immune systems to fight them. Todays huge health concerns will be tomorrow’s old news.

      In order to write my articles about historical climate I like to read a lot of material that provides background and context which often contains unexpected climate references and insights. In this context i thought this observation by Ian Mortimer relevant to todays Covid 19 pandemic as described in his excellent, densely researched and referenced book ‘The Time Travellers guide to Medieval England.’

      “There are myriad other diseases in medieval England which you may end up catching. Many of them will cease to exist before the advent of the modern world. Several ailments described by the chronicler Henry Knighton do not correspond with anything known to modern medical science. Similarly there are afflictions such as ‘Styche’ and ‘Ipydyme’ which have no modern equivalent.

      Some diseases have simply become less common; malaria is endemic in marshy area, such as Romney Marsh in Kent and the fens of Lincolnshire and Norfolk. On the other hand fourteenth century England is free from a number of disease which affect us in later centuries ; you will not find cholera or syphilis. In some cases this is due to barriers of travel. In others it is because our vulnerability to specific infections alters with our living conditions.

      Diseases change as they circulate around the pool of humanity. Rodent carriers of disease are replaced by different rodents carrying different diseases. Certain illnesses which are initially lethal grow progressively less dangerous as the decades go by.”

      So ailments change as they ‘circulate round the pool of humanity’ and time and geography changes. Consequently we should not be surprised in the modern world that different groups of humanity should react differently to covid 19 and reaction will be modified by the way people live, their health record-past and current, their lifestyle choices which might encompass obesity, smoking and excessive drinking, their medical services, natural immunities, their personal robustness, age profile, their diet etc

      One over-riding lesson of looking at the past is that this day and age is the best in history for ordinary people to live in; that we are currently at the peak of human civilisation and any action by govt. that deliberately or inadvertently pushes us back to the living and health conditions of previous centuries through the devastation of our economies, with all the knock on effects that entails. should be strongly resisted.

      tonyb

      • Thanks for your words Tony.
        Even without a ‘pandemic emergency’ condition, most modern doctors (and in this case governments that pretend to care about us) still treat symptoms and not the cause or underlying weakness that allowed proliferation of ‘the disease’. As you mention, the modern world of processed food, diminished excercise and natural contact, urban pollution (the references for pandemic style metal toxicity are out there) and types of emf smog stacking up on one another…not to mention emotional and mental stress induced by civilization’s crumbling morality and there’s a great recipe for disaster. Reminds me of a criticism of Gates’ ‘efforts’…African’s can’t eat vaccines.
        However, due to the fact that we don’t publicly (read status quo) even know our own history…I cannot agree with you that we are at any peak of human civilization (well…’peak’ is relative too :-) ). Regardless, the hypocrisy of keeping smoking legal which kills 700,000 europeans annually against the backdrop of the reality of the present situation says it all…in my opinion.

      • ptor

        your comment about 700,00 European deaths from smoking and the apparent willingness of the public to accept drastic curtailments on their liberty, makes me wonder if we might see much more drastic action by governments to curtail ‘bad’ lifestyle choices, from smoking to over eating, to over drinking to lack of fitness, to the acceptance of an annual flu cull of 17000 on average in the UK

        In the UK according to the Govt we have 140,000 ‘avoidable deaths per year. If the govt want to save lives that dwarf those lost to CV they could start here, then move on to banning smoking then impose compulsory flu vaccinations

        If we are not at ‘peak’ civilisation for the mass of people, in terms of wealth, health, longevity, education, life opportunities, rights, climate etc etc perhaps you can tell me when there has been a better peak?

        tonyb

      • Tonyb
        Good comments about the best of times. I spent part of my chemical engineering career cleaning up hazardous waste sites. Basically abandoned in favor of carbon scrubbing schemes from the air.

        Good news is rivers and lakes cleaning than in history. Air pollution down in USA. Lots to do in the world. Canada NW territories shooting 80% of wild wolves from the air to reduce nature balance with Carribou. Lots of important environmenental issues being placed on hiatus.
        Scott

      • Govt shouldn’t be involved in those things. I personally resonate with Dominic Frisby’s ‘After the State’. Everybody should know by now that flu vaccines don’t work and stacking vaccines just toxifies the body and suppresses natural immunity which summarizes my whole initial point that the focus should be on natural health of humanity. The resources spent on the futile attempts at allopathic remedies could already have completely revamped the population into a healthy situation.
        Furthermore, if everybody’s so ‘too many people on the planet’ why is everybody kicking and screaming against the weak stepping out of the game if they can’t deal with ‘the virus’. All these environmentalists are actually closet eugenicists but now when the opportunity for ‘nature’ to downsize arises they run the other way and want to protect everybody from dying by engaging the classic ‘orwellian’ nightmare. Fear eh! Unless…if it’s in effect actual warfare by the international cabal of Chinese Nazis that would then need to be addressed as the MO of govt.s for ‘protecting’ the people…which it has not been …despite certain evidence of ‘the virus’ having been manufactured…and having not admitted this govts would then be liable for the complicity in playing out a classic ‘problem-reaction-solution’ ruse.
        Then one also has to step back and ask the question ‘what is nature?’ and is it even possible to step outside of it in any way despite the abominations created by humanity that are deemed un-natural.
        Last ‘peak’ as you call it was appx 10,500 BCE before the flood reset humanity and there were probably better ones before that cannot be judged by what we collectively call either advanced or successful from this temporal perspective. Plato was not making things up about palaeolithic high civilization.

  36. Good morning Nic (UTC),

    The once Great British MSM consensus seems to be that BoJo did not announce an imminent easing of the Covid-19 lockdown in his speech this morning?

    A “sensible exit strategy”? Or not?

  37. nobodysknowledge

    Death rate is falling in country after country. The effect of lockdown can be exaggerated. And the effect of voluntary behaviour change can be greatly underestimated. I think this is what we see in Sweeden. People avoid and keep distance out of fear of becoming ill. I don`t think it is either – or. When lockdown is lifted we have to effectivily test and trace, and find the optimal distance measures.

    • nobodysknowledge

      And we need really skilled logistics to organize transports and rush hour, so strange people stop bumping into each other.

  38. There is no evidence that lockdowns affected the trajectory at all. In fact, the epidemic appears to have the same trajectory irregardless of the measures taken.

    https://www.timesofisrael.com/top-israeli-prof-claims-simple-stats-show-virus-plays-itself-out-after-70-days/

  39. Mandated lockdowns made a lot of sense in cities, but the big problem was people fleeing the cities and spreading the infection. Rhode Island is a case in point.
    Quarantine cities as well as elderly people.
    There are dozens of examples in the news of NYC residents moving to Airbnbs, summer homes, lake houses, their parents’ or other relatives’ suburban homes. Even the media “stars” and staunch lockdown supporters accepted it only after they exited to the Hamptons.
    Unfortunately, we have national lockdowns because the people in the epicenters of the disease won’t stay in their town. This is no minor issue. I live about 5 miles from a beach with rental cottages- we had people from New York and New Jersey show up in March and as they “open” we’ll have more.

    So here’s my proposal- you can “open up,” but stay in your town.

  40. https://thehill.com/opinion/healthcare/494034-the-data-are-in-stop-the-panic-and-end-the-total-isolation

    “The tragedy of the COVID-19 pandemic appears to be entering the containment phase. Tens of thousands of Americans have died, and Americans are now desperate for sensible policymakers who have the courage to ignore the panic and rely on facts. Leaders must examine accumulated data to see what has actually happened, rather than keep emphasizing hypothetical projections; combine that empirical evidence with fundamental principles of biology established for decades; and then thoughtfully restore the country to function.

    Five key facts are being ignored by those calling for continuing the near-total lockdown.”

  41. Robert Clark

    DATE NEW CASES INCREASE % # TESTS
    4/18/2020 29,564 -2,226 -7 168,397
    4/19/2020 27,354 -2,210 -7.4 139,511
    4/20/2020 28,249 895 3.2 183,117
    4/21/2020 32,037 3,788 13.4 138,451
    4/22/2020 19,554 -12,483 -38.9 143,549
    4/23/2020 32,124 12,570 64.2 158,486
    4/24/2020 39,887 7,763 24.1 465,986
    4/25/2020 36,342 -3,545 -8.8 251,263
    4/26/2020 39,806 3,462 9.5 256,441
    4/27/2020 23,095 16,711 -41.9 216,029
    positive down 41% tests down 15%
    going the right direction, need more tests
    we will see tomorrow.

    • Robert Clark

      The explanation of 4/24/2020.
      I think someone said “fill up the bucket with all the tests you can find and throw it at the wall.” They did that. They then checked to see where the 7,000 gain in positives was. They then began going after those individuals. They were also low on test kits. From here they will no longer be treading water.
      I will see in a couple of houes.

  42. niclewis ==> You might read the latest paper from James M. Todaro, MD (Columbia MD), Joey Krug, Moshe E. Praver, MD (Columbia MD) and Vladimir Zelenko, MD: “A two-step strategy to reopen America” (23 April 2020).

    A pre-print [?] from their group at Columbia [?] and a follow-up to their 13 March 2020 paper; “An Effective Treatment for Coronavirus
    (COVID-19)
    ” [.pdf].

  43. https://www.itv.com/news/2020-04-22/60-000-cancer-patients-could-die-because-of-lack-of-treatment-or-diagnosis-oncologist-on-coronavirus-dilemma/

    “In a usual April, we would normally see around 30,000 people diagnosed with cancer. I would be surprised if that number reaches 5,000 this month.

    Coronavirus will steal the headlines, but cancer kills 450 people a day in the UK – there is no peak and the numbers aren’t coming down. Unless we act urgently, that number will rise. A group of oncologists, including myself, estimate that 60,000 cancer patients could die because of a lack of treatment or diagnosis.”

    https://www.kimt.com/content/news/30000-Mayo-Clinic-employees-facing-furloughs-or-reduced-hours-569876701.html

    Madness!

  44. Yet more evidence of why all this certainty about the implications of epidemiological analyses of COVID 19, and the mortality rates in particular, are waaaaay premature and more a reflection of confirmation bias than anythjnf else:

    > In the early weeks of the coronavirus epidemic, the United States recorded an estimated 15,400 excess deaths, nearly two times as many as were publicly attributed to covid-19 at the time, according to an analysis of federal data conducted for The Washington Post by a research team led by the Yale School of Public Health.

    https://www.washingtonpost.com/investigations/2020/04/27/covid-19-death-toll-undercounted/?arc404=true

    Let’s have a little respect for uncertainty folks, isn’t that a mantra of this blog’s proprietor?

    Isn’t that the mantra of climate “skeptics?”

    Where is the due skeptical diligence?

    Paging Mr. Monster. Mr. Uncertain T. Monster, please pick up line #1!

    • All this certainty about the mortality rate when we don’t even know yet how many people have died from COVID 19?

  45. I have been providing guest post commentary, now 7, over at WUWT.
    Some observations pertinent to Nic’s article, with which I generally agree.

    When hard (UK, NYC) and soft (Sweden) lockdowns began, it was because of the horrific situations in Hubei China and Lombardy Italy. At the beginning, we did not know most fatalities would be over age 65 and/or with comorbidities hypertension, diabetes, and obesity. (The 1918 flu killed disporportionately young healthy adults via cytokine storm.) The intent in the US was originally just 15 days to ‘bend the curve’, extended perhaps incorrectly to a recommended 45 days nationwide as the NYC metropolitan area Lombardy like situation unfolded. Whitmer in Michigan panicked. Noem in South Dakota did not.

    President Trump acted early (Jan 31) to ban China travel at the same time Fauci said would NOT be a major US problem, for which PT was roundly criticized at the time as zenophobic. Then he took the advice of ‘experts’ based on then unknowably faulty models (Imperial, IHME) to bend the curve. Then he tackled ventilators and PPE shortages and ICU bed shortages because the curve was not bent enough in NY/NJ thanks to their subway system. Had he not done so, he would have been mercilessly criticized (Schiff is anyway).

    Now he is tackling phased reopening on a sensible sub-state geographic basis, placing the governors in charge because they, not he, implemented differing state by state rules based on his task force general recommendations. And, we now know who to protect (seniors, comorbidities) and who not. Why I agree with Nic now, with the new knowledge we now have.

    The hydroxychloroquine plus possibly zinc Trump therapy suggestion based on ‘anecdotal’ but statistically significant patient groups SHOULD have been immediately tested in vitro by Fauci’s NIH team. It wasn’t. I will offer two speculative reasons why not. First, Fauci is a vaccine guy; I know from personal experience with him on the 2009 swine flu pandemic. Second, there is no money in old generic therapies for pharma; there is in vaccines.

    Fortunately, there is now a proper U. MN/McGill in vivo study underway. It appears promising as they have just cut the number of designed enrollees and now expect to report results end May, at least 6 weeks early. 3 arms: control, HCQ, HCQ+Zn. Two cohorts: exposed prophylaxis against infection, positive infection therapy.

    May will be a very interesting CoViD-19 month in both UK and US.

    • This is ridiculous nonsense.

      We knew from early on experience in China that elderly and medically compromised would be most affected. What we didn’t know was that many seemingly healthy people would also be affected. Young people with almost no symptoms are having strokes.

      Fauci NEVER said CV would not be a major US problem. If you are looking at that same misleadingly edited video that Don tried to present, then Fauci was talking about a single isolated case of someone from China not being a major problem.

      Trump’s travel ban with China was gap riddled and allowed thousand of people to come into the county from China. He stopped travel from European hot spots far too late to make any difference.

      Trump isn’t tackling anything. He is passing the buck so he can blame whatever goes wrong on the governors and claim whatever goes right for himself.

      Forget hydroxychloroquine. If it works at all, it’s not a panacea and it’s not going to affect the outcome for the country in any significant way.

      • “Fauci NEVER said CV would not be a major US problem. If you are looking at that same misleadingly edited video that Don tried to present, then Fauci was talking about a single isolated case of someone from China not being a major problem.”

        Oh, yes he did:
        “On the basis of a case definition requiring a diagnosis of pneumonia, the currently reported case fatality rate is approximately 2%. In another article in the Journal, Guan et al. report mortality of 1.4% among 1099 patients with laboratory-confirmed Covid-19; these patients had a wide spectrum of disease severity. If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%. This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.”

        https://www.nejm.org/doi/full/10.1056/NEJMe2002387

        Fauci then turned around and told Congress that this was 10x worse than the flu.

      • What you cited was written at the end of March after it was already showing potential to be a major problem and says this:

        “As in two preceding instances of emergence of coronavirus disease in the past 18 years2 — SARS (2002 and 2003) and Middle East respiratory syndrome (MERS) (2012 to the present) — the Covid-19 outbreak has posed critical challenges for the public health, research, and medical communities.”

        Even your own quote compares it to severe seasonal influenza or a pandemic influenza. Either one would be a major problem.

        But it does show that the earliest studied cases showed more impact on older people:

        “Nonetheless, a degree of clarity is emerging from this report. The median age of the patients was 59 years, with higher morbidity and mortality among the elderly and among those with coexisting conditions (similar to the situation with influenza); 56% of the patients were male. Of note, there were no cases in children younger than 15 years of age.”

      • We all know what Fauci said. Your TDS is showing, jimmy. You have zero cred. You remind us of a disingenuous despicable CNN talking head. Try to come up with something that isn’t anger driven drivel. Take a week off and think about what you are doing here.

      • “This editorial was published on February 28, 2020, at NEJM.org.”

        This is at the bottom of the referenced article that was then apparently in hard copy on March 26.

        https://www.nejm.org/doi/full/10.1056/NEJMe2002387

      • Don,

        None of that changes the fact that Fauci never said it wouldn’t be a major problem. But the fact he knew it was going to be as bad as a severe seasonal influenza or a pandemic influenza is actually proof that he recognized it was going to be a major problem.

      • “None of that changes the fact that Fauci never said it wouldn’t be a major problem. But the fact he knew it was going to be as bad as a severe seasonal influenza or a pandemic influenza is actually proof that he recognized it was going to be a major problem.”

        Wait a minute: a severe flu is a major problem. This has happened before but let’s be clear that this isn’t the Spanish flu, which happily carried off young and old alike, and lots of ’em. Covid-19 doesn’t do that: witness the huge proportion of victims with mild or no symptoms.

        Covid-19 is a major problem to be dealt with, yes. It’s not an almost-unbearable catastrophe whose solution is to lockdown free citizens and shut down the world economy, meanwhile destroying trillions of dollars of wealth, hitting those at the bottom of the economic ladder the hardest, and seriously unraveling a social fabric we’ve spent centuries building up.

        Sense of proportion, or what?

      • “None of that changes the fact that Fauci never said it wouldn’t be a major problem.”

        Prove it. He said numerous times that it wasn’t a major problem. Not to worry. You know that. Google it. You are an amateur propagandist grinding a TDS ax. Not fooling anybody here.

      • Quit trying to find a scapegoat. The buck stops at the top.

        On Jan. 18, Health and Human Services Secretary Alex Azar first briefed Trump on the threat of the virus in a phone call, the New York Times reports. Trump made his first public comments about the virus on Jan. 22, saying he was not concerned about a pandemic and that “we have it totally under control.”

        On Jan. 27, White House aides met with then-acting Chief of Staff Mick Mulvaney to try to get senior officials to take the virus threat more seriously, the Washington Post reports. Joe Grogan, the head of the White House Domestic Policy Council, warned it could cost Trump his re-election.

        On Jan. 29, economic adviser Peter Navarro warned the White House in a memo addressed to the National Security Council that COVID-19 could take more than half a million American lives and cause nearly $6 trillion in economic damage.

        On Jan. 30, Azar warned Trump in a subsequent call that the virus could become a pandemic and that China should be criticized for its lack of transparency, per the Times. Trump dismissed Azar as alarmist and rejected the idea of criticizing China.

        Also on Jan. 30, the World Health Organization declared the coronavirus a global health emergency. WHO has only done so five times since gaining that power in 2005.

        On Feb. 5, senators urged the administration in a briefing to take the virus more seriously and asked if additional funds were necessary. The administration made no requests at the time for emergency funding.

        On Feb. 14, a memo was drafted by health officials in coordination with the National Security Council that recommended the targeted use of “quarantine and isolation measures,” per the Times. Officials planned to present Trump with the memo when he returned from India on Feb. 25, but the meeting was canceled.

        On Feb. 21, the White House coronavirus task force conducted a mock exercise of the pandemic. The group concluded that the U.S. would need to implement aggressive social distancing, even if it caused mass disruption to the economy and American lives, per the Times.

        On Feb. 23, Navarro doubled down on his warnings in another memo, this time addressed to the president, stating that up to 2 million Americans could die of the virus.

        On Feb. 25, director of the National Center for Immunization and Respiratory Diseases Nancy Messonnier publicly warned of the virus threat and said “we need to be preparing for significant disruption in our lives.” Trump reportedly called Azar fuming that Messonnier had scared people unnecessarily and caused the stock market to plummet, per the Times.

        https://www.axios.com/trump-coronavirus-warnings-46ea8006-2e19-4810-82c1-0f10f4f9aa97.html

      • It’s a little ridiculous James to blame Trump for delaying acting when we are not sure the lockdown has really helped much. (Sweden vs. England). In any case, Fauci said that Trump acted immediately on his and Birx’s recommendations for action. So he followed the best scientific advice he had. It’s a sign of OMBS (orange man bad syndrome) to blame Trump.

        From the moment China allowed international flights out of Wuhan while shutting down domestic flights out of Wuhan we were doomed to take a hit. It’s been bigger than seasonal flu but perhaps comparable to the Hong Kong flu in the 1960’s. Based on Miami-Dade testing results (which are in the middle of the pack of the 4 such datasets we have), I’m estimating 5% – 20% excess mortality in 2020 if everyone got infected. If we protect the vulnerable only, we are talking less than 5%. It’s a large number, but not something to cause a Depression over.

        Please stop the blame game. It just reveals your biases.

      • First of all, Trump is playing the blame game. Blame the governors. Blame China. Blame WHO. Blame Obama. He’s already said he’s not responsible for anything.

        But this doesn’t even relate to the lock down/no lock down issue!

        Trump did nothing. He didn’t prepare for testing, for PPE, for ventilators, for tracking and containment. He did none of things which were needed if we were not going to have a lock down.

      • You are working hard, jimmy. But it ain’t working. How are you going to be able to exist in Trump America for another 4 years and eight months?

      • “ James Cross | April 28, 2020 at 8:41 am | Reply
        This is ridiculous nonsense”

        Thanks. I might have wasted time reading your gibberish without your helpful warning.

    • Steven Mosher

      “When hard (UK, NYC) and soft (Sweden) lockdowns began, it was because of the horrific situations in Hubei China and Lombardy Italy. At the beginning, we did not know most fatalities would be over age 65 and/or with comorbidities hypertension, diabetes, and obesity.”

      wrong. data from Korea showed the age dependency early on

      • Steven Mosher: data from Korea showed the age dependency early on

        Weren’t the results from S. Korea suspect because of the strong association with a religious cult?

  46. First, my caveat. I think that cross-country comparisons are invalid unless there’s careful control of variables.

    To prove my point, in contrast to what people are writing here, I’ll give you the following stats from another comment thread: (Copied from somewhere else).

    > Sweden has 2.5 times the case count per capita as Finland, despite only doing 75% the testing per capita of Finland. Hard to square that with them having the same death rate outside elder care facilities, unless elder care is an absurd percentage of their courses or they’re for some reason seeing a much lower infection fatality rate than their numbers.

    • First, my caveat. I think that cross-country comparisons are invalid unless there’s careful control of variables.

      But to prove a vague and surely bogus point, I will pretend I didn’t say what I said above and proceed to make a cross-country comparison, without even a passing thought in my pointy little head about careful control of variables. Variables schmariables.

      You know, Finland. They drink a lot. And Sweden. What I could tell you all about Sweden. Blondes. Get me?

      • Don –

        My point is that the comparisons without controls are useless because you can always find some to confirm whichever bias you have. And so I gave an example.

      • What you proved is not what you wanted to prove, joshie. But don’t worry. You didn’t reveal anything we didn’t already know.

  47. It is sad to see people overcome with panic, fear, and power lust, debate and consider which “policies” should be adopted – i.e., what control should be imposed on the lives and liberties of other people. Feel free to provide people with the best information as to what [you think] they can do to protect themselves and others, then respect their rights to decide how they choose to live. No one and no group of people have the right to interfere with such free choice.
    Collective decision making which determines whose lives and liberties should be curtailed or sacrificed, is just wrong.

  48. UK-Weather Lass-In-Earnest

    Had the UK a realistically and properly resourced front line NHS service from day one of the epidemic then we should have been okay going Swedish style. But the Government knew they didn’t have a strong front line and simply panicked into inappropriate actions costing much, much more money than ever would have been necessary to produce that NHS solid front line.

    Where do we go from here? Who knows? I am pretty sure the Government don’t have a clue.

  49. Covid19 in the UK is doubling the weekly April death rate from a (normal) 11,000 to 22,000:

    https://www.rt.com/uk/487097-highest-death-toll-uk-1993-coronavirus/

    The highest weekly death rate recorded since systematic data from 1993.

    So much for the argument “covid deaths are a insignificant and lost in the noise of flu deaths”. Not so much.

    • phil

      apples and oranges here

      ‘The ONS said it had recorded 21,284 fatalities that mentioned the coronavirus disease on the death certificate as of April 17;’

      That is the total figure since the pandemic began in late February not just for April. As always it must be said that due to WHO guidelines if somebody does WITH CV they are deemed to have died OF it.

      A fair comparison can only be made\ with other countries where their care home figures are also included, most don’t

      There are a striking number of additional deaths from other sources as treatment for other serious illnesses are put on hold and people for instance don’t present at hospital for a heart attack.

      Last but not least, the aggregated figurers are fom1993, worse weeks for deaths occurred at times before this, notably in 1970 plus the severe flu epi8demics of the 50’s and 60’s. Which is not to say it hasn’t been bad but there is a lack of context in the report and it is deaths overall for 2020 that will need examination when CV is unlikely to figure in the top 5 causes of deaths. ‘Avoidable’ causes of deaths-a govt definition- will be by far the worst category at some 140,000 annually

      tonyb

      • Mornin’ Tony (UTC),

        A “lack of context” in an RT report? Surely not!

        We’re going to have to deal with a large pile of apples and pears and oranges for quite a while. 20:20 hindsight will be invaluable?

        You sound as though you are defending our (in)glorious Government’s response to the current “Coronavirus Crisis”? Even after this?

        https://en.wikipedia.org/wiki/Exercise_Cygnus

    • Tony
      The article refers to total deaths of all causes per week (normally 11,000, now 22,000), not deaths from coronavirus.

      The implication is that the excess – a full doubling of 11,000, is due to the covid19 virus. Since flu deaths are currently low (partly due to the lockdown – the irony!)

      In any case the point of covid19 measures is not the number of deaths per se. It’s the “sharp tail”. The tiny percentage of covid19 infectees that develop severe pneumonia, a third of whom die, and which overloads intensive care units in hospitals. No amount of statistical analysis of numbers alters this fact in hospitals.

  50. Afternoon Frank,

    Thanks for the information. I am forced to agree with you regarding the (ill) health systems here in the UK and over the pond in the US.

    Sticking with the UK for the moment, BoJo waxed lyrical about his “5 tests” yesterday. However his glorious Government seems to have totally failed to grasp the “Test, Trace, Isolate” nettle?

    Meanwhile over said pond:

    • If old Larry Tribe wants a monument here, he must think they should roll out the guillotine in France, Belgium, Sweden, Switzerland, Italy, Spain, Netherlands, etc etc etc.
      And maybe he can build his new memorial after they finish the one from the influenza that killed over 80,000 Americans just two years ago.
      What Laurence Tribe really wants, of course, is for everyone to ignore the fact that the US pandemic was almost entirely in NYC, New Orleans and Detroit- ie millions are out of work in places where Covid-19 was minor because big cities are terrible places to live in pandemics.
      Plus he deeply needs you to look the other way from China’s culpability and the politics of the elite that ensured the WHO went beyond merely ineffective (at outrageous cost) and became actively dangerous. Heaven help the establishment if the proles are allowed to stew on that.

      • Larry is a living monument to shyster political bias and ethical malpractice. He would flamboyantly defend the coronavirus in court, pro bono.

      • Meanwhile on this side of the pond I’m astonished to find myself agreeing with another “living monument” once again:

      • stevenreincarnated

        About half way to the death toll of the Asian flu when the US population was 170,000,000.

      • Jim

        Under Obama, flu and pneumonia deaths were over 12 Million, many times more than the American losses in the Civil War, Spanish American War, WWI and WWII, and the Korean War, combined. Should we be considering retroactive impeachment against Barry?

      • Afternoon Ceresco,

        Course not, but perhaps I should remind the assembled throng of denizens that ostensibly this article is specifically about the “COVID-19 exit strategy for the UK”.

        Bearing that in mind, we should absolutely posthumously impeach Maggie Thatcher (AKA “The milk snatcher”).

      • “…I should remind the assembled throng of denizens that ostensibly this article is specifically about …”

        Who was that fellow who brought up Vietnam?

        As for covid exit strategy, it should be drawn on the science which tells us:
        This thing is a killer in densely packed cities, not so much elsewhere.
        The jury is still out on the efficacy of lockdowns, but it doesn’t look good.
        Elite globalist institutions performed worse than poorly- they were actively dangerous. With well over 100,000 dead in the EU and 58,000 in the US, plus millions unemployed on both sides of the pond, even Larry Tribe and Andy Neil won’t be able to pretend otherwise.
        There’s no coherent argument why the anti-semitic socialist of the UK or the Chappaqua grifter in the US could have performed better in this pandemic and both objective and subjective evidence to the contrary: Hillary wanted us to be just like Belgium or the Netherlands. Yikes. We’d be hurting badly if the economy hadn’t been so strong when this happened.

      • Evening Jeff,

        Did you see my link to “Exercise Cygnus” above? If not please see:

        https://judithcurry.com/2020/04/26/a-sensible-covid-19-exit-strategy-for-the-uk/#comment-915727

        Therein you will find this reference:

        Click to access board-paper-300317-item-10.pdf

        Perhaps if the UK Government had taken on board the lessons concerning “challenging work around the management of surge and escalation decision making processes” from that exercise many fewer of our citizens would have perished in the most recent “pandemic influenza outbreak” to make its way across the English Channel?

      • Shock News!!! from the virtual House of Commons:

      • Hi Jim,
        Thanks for noting your affinity for the Green Party, which absolutely nobody recalls advocating for blowing the public’s money on stockpiling for a once a century pandemic.
        We do recall however, the Green Party’s affinity for the EU, based in Belgium, with a death toll so far of 66 per 100k population- far, far worse than the UK (39 as of this afternoon) and the absolute worst in all of Europe.
        As I’ve typed elsewhere, if your politics demands muttering that the UK and the US are “a shambles,” you must be advocating regicide elsewhere in Europe.
        But, of course, you aren’t. You’d like to go back to ensuring Britain enjoys the fruits of enlightened professional government of Belgium, where we dare not declare “shambles.”

      • Mornin’ Jeff (UTC),

        Would you care to comment on my “affinity” for Andrew Neil and the House of Commons Public Administration and Constitutional Affairs Select Committee while you’re at it?

      • Hi Jim,
        What about it? I say, when you’ve hung the government of Belgium, let’s talk about Boris.
        Meanwhile, nobody – and I do mean not one person on the planet – sincerely believes there is any evidence Labour wold have handled this better. Especially under Corbyn – but feel free to show us his position papers on preparing for pandemics from early last year.
        Meanwhile we’re all getting nauseous watching leftists selectively pin blame on politicians – the government in the US and Britain are culpable, but oddly no government in harder hit countries are.

      • Peter Davies

        I don’t know how you get up to 12m deaths from ‘flu and pneumonia between 2008 and 2015. According to https://www.statista.com/statistics/184574/deaths-by-influenza-and-pneumonia-in-the-us-since-1950/ there was an average of just under 16 death per 100,000 between 2008 and 2015, for a total of 16 x 8 = 128 per 100,000. Assuming a population of 320m, that makes it less than half a million deaths, not 12m. Do you have some source for your figure I could not find?

  51. Robert Clark

    DATE NEW CASES INCREASE % # TESTS
    4/22/2020 19,554 -12,483 -38.9 143,549
    4/23/2020 32,124 12,570 64.2 158,486
    4/24/2020 39,887 7,763 24.1 465,986
    4/25/2020 36,342 -3,545 -8.8 251,263
    4/26/2020 39,806 3,462 9.5 256,441
    4/27/2020 23,095 16,711 -41.9 216,029
    28-Apr 22,840 -255 -1.1 179,755
    It looks to me they are having trouble getting resupplied with tests after what they did on the 24th.
    We will see tomorrow. To me it looks like a 4 letter word is necessary
    WOWW!!!

  52. Nice, nice article, thanks. From the moment lockdowns were discussed my first question was who will decide when and how the lockdown will be terminated.
    More people will be harmed by the recent lockdown than the virus. Countries without lockdown are confirming this.
    There is life and there is death, but the longer term suffering of hunger, unemployment and social dislocation will be forgotten or ignored. These peoples rights or futures are not really being considered. End all lockdowns, the cost is greater than the problem.

    A study in Shenzen just released for your interest may alter your perception.
    https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30287-5/fulltext

  53. “We hear so much about the vital importance of flu shots that it will come as a nasty surprise to learn that they increase the risk of illness from noninfluenza virus infections such as rhinoviruses, coronaviruses, RS viruses, parainfluenza viruses, adenoviruses, HMP viruses and enteroviruses. This has been shown in at least two studies that have received little attention from public health authorities…”
    https://www.bmj.com/content/368/bmj.m626/rr

    I wouldn’t be surprised to find out that flu shots increased the risk of covid-19 positive tests and deaths. Primum (non?) nocere.

  54. These folks partying in Chiraq have already implemented their exit strategy.
    Don’t be judgmental, several of them are wearing masks. I’ll say no more about that:

    https://www.tmz.com/2020/04/28/another-packed-chicago-house-party-features-stripper-coronavirus-pandemic/

  55. Nic: I like the really clear thinking in your post. Here in the US, we pay little attention to the annual seasonal flu pandemic that infects an average of 30 million Americans (1 in 11), sends about 1 in 3 of those infected to their doctor, and 1 in 60 of those infected to the hospital, and 1 in 600 of those infected to their graves. If you can design a system that will limit our loss of life to something comparable to this, you have excellent precedent for claiming this is a pragmatic solution the populace should be willing to tolerate.

    The USS Theodore Roosevelt provides a model for what might occur in your scenario since there are few vulnerable people on an aircraft carrier. Nevertheless, the US Navy “chickened out” on trying your scenario, because Navy regulations demanded that sick crew members be quarantined – an impossibility given the number of ill crew members on the ship. Out of about 5000 crew, I think there were about 100 diagnosed cases when they began evacuating and something like 700 cases several weeks later with one death, one in intensive care and five others hospitalized. The captain’s reasoned analysis of the stark choices that he face that he sent to his superiors was leaked to the San Francisco newspaper and created a political mess on this side of the Atlantic. This episode throws cold water on the likelihood that rational analysis will prevail.

    However, your analysis ignores the fact that we can’t separate younger, safer people from older vulnerable people. I have a 90 year old family member who needs attention every few days, preferably every day, so we can’t afford to run any unnecessary risk that one of us gets COVID-19. We’ve discussed whether wearing a face mask around that family member would be appropriate or mis-understood. So, you are correct when you say that we could open up the schools and workplaces at perhaps a sensible cost – but this will inevitably increase the risk that vulnerable people come into contact with infected younger ones. (There are unpleasant inevitable outcomes under most scenarios.)

    Wuhan, South Korea and other places demonstrate that it is possible to nearly stamp out COVID-19 with appropriate measures and contain outbreaks. Clearly this is the best solution. However, I don’t see the discipline and organization needed to accomplish this in the United States. We can’t even mandate the use of face masks and hand-sanitizer in public locations (to protect others) and arrange for adequate convenient tests and contact tracing. IIRC, they had 9000 people doing contact tracing in Wuhan, but our local governments postponed tax deadlines and have no money to spend and are partially shutdown. (Our Congress is mostly on recess and unwilling to accommodate to remote meetings and voting.)

    • Frank, I accept that some people would need to continue to self-isolate in order that they could safely care for older relatives. But there would be relatively few such people, and they would be free to do so of their own choice.

      Regarding reopening schools, I’m not sure there is evidence that children -who seem to be unaffected by COVID-19 – can, if they have been exposed to it, infect adults. And even if they can, that would only be an issue if they live with a vulnerable person, which most won’t.

      • > Frank, I accept that some people would need to continue to self-isolate in order that they could safely care for older relatives. But there would be relatively few such people, and they would be free to do so of their own choice.

        The notion that these populations can effectively be isolated for any significant period of time is highly dubious. Since you like to use Sweden as an example, look at how effective they’ve been at isolating the older relatives – and they’re as well set up to do so as anyone.

        Many older people cannot effectively isolate. And you’re advocating for a policy whereby tons o’ people will be wandering around with a very high infection rate. It’s just unrealistic to think that all those people can be well separated from older people or people with comorbidities.

        And you’re also effectively just saying that the SES factors that are associated with ability to isolate are irrelevant. You’re tacitly accepting a factor that will exacerbate the already existing higher fatality rate among those with lower SES.

        And you’re likewise saying to accelerate the infection rate over the short term – irrespective of the impact that will have on the real heroes here – front line medical workers.

        As for schools, there seems to a general view among epidemiologists that closing elementary schools for more than 8 days as a negligible impact on spread – although again with the bird’s eye view there you’re obscuring the greater impact on teachers.

        Also, those data are generated from examples where that one effect is isolated – and not considered in a context like the current one, where other interventions are being taken concurrently.

      • Nic: Thanks for the reply. I looked for info on viral loads in asymptomatic, but infected children, but didn’t find much information. Since asymptomatic adults (who may or may not later show symptoms) can infect other adults, it is certainly possible that asymptomatic children can infect adults. An April 15 review asserted that the role of children in spreading infection is unknown.

        https://doi.org/10.1016/j.jped.2020.04.001

        Discussing family care of vulnerable populations was a dubious approach on my part because situations vary so much. Let’s consider nursing homes and assisted care facilities. There are 1.4 million extremely vulnerable Americans in nursing homes requiring an average of 4 hours/day of nursing and nursing aide care. Let’s guesstimate that an equal number of people are needed for cooking, cleaning and other services. In a nursing home, you have a population that is roughly 50% extremely vulnerable people and 50% people who spend their non-working hours with people who will be acquiring “herd immunity” under your proposal. Some of those staff inevitably will be in close contact with a dozen or more vulnerable elderly people on days when they are infectious, but asymptomatic. (We know that viral loads are usually highest when symptoms first begin and in a few cases know that viral load have been even higher for at least a day before symptoms begin. Some people never show symptoms, but are infectious.) That puts immense pressure on perfect hygiene. In hospitals, healthy staff are getting sick caring for patients they know or strongly suspect are infectious. In nursing homes, asymptomatic staff who don’t know they are infectious will infect residents. If asymptomatic nursing home staff are not allowed to work for 14 days after being in contact with an infected person away from the job, we are likely to run out of staff.

        It may be that most of our vulnerable populations will – sooner or later – be exposed to significant cumulative risk from coronavirus whether we have a sharp peak in infections or flatten the curve. The official death toll (mostly elderly) in Wuhan at the end of March was about 2,500. Even if the true number of deaths were 25,000, an elderly person might be better off in Wuhan (20 million) than the NYC area (also 20 million) with a current death toll above 20,000 (that may be underestimated by a factor of two) and still rising. Nothing beats stamping out a pandemic – if you have the resources, discipline, organization and technology to do so.

        Consider polio, which has an R0 of 4-5 and is asymptomatic in most patients. There were 60,000 cases of paralytic polio every summer in the 1950s, but we didn’t combat that disease with a “herd immunity” strategy. Since there were annual outbreaks, perhaps herd immunity did play an important role in ending seasonal outbreaks. And “measles parties” for children were a strategy for keeping that infection away from them as vulnerable adults.

        Click to access 0bf10519e512c0975325a93d5d0c8211a56e.pdf

  56. https://docs.google.com/document/d/e/2PACX-1vT4I4Ls6RAsDqSaKBVIdLPIKFNs7tbWWzZ3eP1NrNltiiZqmUHK-rPDLxeN2qvt0es1S-v6jP29S_T1/pub

    The above document is a two-step strategy to reopen America proposed by Dr. Zelenko and others. Dr. Zelenko earlier reported on a near-100% cure rate of Covid by using his protocol early. The protocol is hydroxychloroquine, azithromycin, and zinc sulfate given early– before hospitalization. The claim is that this therapy prevents hospitalization.

    The two stages are: 1) early (important!) treatment with hydroxychloroquine, etc, and 2) age-selective self quarantine.

    A lot of information is coming out that points to Covid-19 acting by breaking up hemoglobin. Here is one of the original pieces postulating this; it was posted in a medical blog and shortly thereafter taken down without explanation. But, he’s an (unedited) copy: https://www.freerepublic.com/focus/f-news/3832703/posts

    Chloroquine is used to treat malaria, which disrupts hemoglobin.

    A post was put up that refuted the theory that Covid was attacking hemoglobin, but interestingly many of the comments to that piece rebutted the rebuttal. For example, we were given links to this: https://croachmd.wordpress.com/2020/04/06/covid-hemoglobin-hypothesis/ and to this: https://osf.io/4wkfy/ and to this https://chemrxiv.org/articles/COVID-19_Disease_ORF8_and_Surface_Glycoprotein_Inhibit_Heme_Metabolism_by_Binding_to_Porphyrin/11938173

    The papers supposedly refuting the hydroxychloroquine treatment didn’t follow the protocol as set forward by Dr. Zelenko. If someone would like me to explain the protocol to them, I’m available, but also they might want to read this extensive and highly-technical document (sarcasm alert) that explains it in detail: https://docs.google.com/document/d/1SesxgaPnpT6OfCYuaFSwXzDK4cDKMbivoALprcVFj48/preview

    No one has asked 1,000 doctors to test this protocol in an outpatient setting (not in the hospital while they’re gasping for breath!) and report back on results. Is this because we’re prejudiced, or because we don’t want to know if it works, or because we want people to die, or because we’re completely incompetent and can’t muster the necessary steps to fight this war? Is it because Trump mentioned the treatment and therefore it must be wrong? Those who argue that we have to wait for rigorous clinical trails must be thinking of something else rather than of saving lives and finding a practical solution to the problem of Covid-19.

    • “Zelenko’s claims, however, rest solely on taking him at his word: He has published no data, described no study design, and reported no analysis”.

      “Regardless, making an assertion in a blog post or in a YouTube interview that neither describes the study design nor provides the actual data used to reach a conclusion about efficacy cannot, in any way, be critically evaluated. As such, this claim is rated Unproven”.

      https://www.snopes.com/fact-check/zelenko-669-coronavirus-patients/

      Do you have actual results and study design?

      If it is an outpatient protocol, then there is a good chance that most of the patients aren’t going to ever get sick enough to need to go to the hospital whether they receive treatment or not. Was there follow up done on all treated patients to determine if they died or had to go to the hospital?

      Do we have enough capacity to monitor every outpatient presenting with COVID-19 for heart complications from the treatment?

      • James Cross says: “Do you have actual results and study design?

        “If it is an outpatient protocol, then there is a good chance that most of the patients aren’t going to ever get sick enough to need to go to the hospital whether they receive treatment or not. Was there follow up done on all treated patients to determine if they died or had to go to the hospital?

        “Do we have enough capacity to monitor every outpatient presenting with COVID-19 for heart complications from the treatment?”

        Dr. Zelenko reports: “As of today my team has tested approximately 200 people from this community for Covid-19, and 65% of the results have been positive. …

        “Since last Thursday, my team has treated approximately 350 patients in Kiryas Joel and another 150 patients in other areas of New York with the above regimen.

        “Of this group and the information provided to me by affiliated medical teams, we have had ZERO deaths, ZERO hospitalizations, and ZERO intubations. In addition, I have not heard of any negative side effects other than approximately 10% of patients with temporary nausea and diarrhea.”

        I find the argument that Zelenko had no study, and therefore his strategy is unproven, to be wholly unconvincing, immature, and reeking of grade school science.

        What would step number one be if such a claim as Dr. Zelenko’s were made in light of an emergency situation? It would be to test this protocol in a clinical setting. Let me spell this out. It would mean that someone like, for example, a Dr. Fauci would request 1,000 doctors to administer the protocol to outpatients according to the following, straight from Dr. Zelenko’s protocol:

        “Given the urgency of the situation, I developed the following treatment protocol in the pre-hospital setting and have seen only positive results:

        1. Any patient with shortness of breath regardless of age is treated.
        2. Any patient in the high-risk category even with just mild symptoms is treated.
        3. Young, healthy and low risk patients even with symptoms are not treated (unless their circumstances change and they fall into category 1 or 2).

        My out-patient treatment regimen is as follows:

        1. Hydroxychloroquine 200mg twice a day for 5 days
        2. Azithromycin 500mg once a day for 5 days
        3. Zinc sulfate 220mg once a day for 5 days”

        (/end Zelenko protocol)

        If any patient shows up at a clinic that’s testing the protocol and falls into category 1 or 2 above, then they’re treated. And, they’re tested for Covid-19, but they’re treated before test results are in, as per the protocol. If they test negative, then either we discontinue treatment and we still continue to follow the patients or we continue; doctor’s discretion (false negatives?) but all of this must be recorded. We then follow up on the treatment outcomes, and we figure out if this treatment seems to be working. Will we have controls? Maybe, but that would mean enlisting 1,000 doctors who don’t agree with the protocol and seeing what happens if patients come in and are in category 1 or 2, and are not treated with the protocol. Would it be double-blind placebo controlled? No. Would we have data? Yes. Even without controls, we could simply take a tally of hospitalizations of Covid-positive cases and measure this against the general population. If, as Dr. Zelenko reports, nearly 100% of those patients who get this aren’t hospitalized, and if we find that some significant portion of the patients that Dr. Fauci is going to test (not) did indeed have Covid, then we have some good information.

        What about side effects? Doctors will naturally monitor, record, and report back on all side effects.

        Of course, Dr. Fauci would request that all physicians participating in this study do so with the utmost objectivity, for the good of the country, and those collating and interpreting the results would do so with the utmost objectivity as well, for the good of the country.

        Or, since Snopes said that “this” is all unproven, we could just leave it at that.

      • No much in any of this in the way of science.

        Seems to be something like this.

        “I treated some people. Looks good to me. Nobody’s died so far. Let’s roll it out and make it a national strategy.”

      • James Cross says:
        “Not much in any of this in the way of science.

        Seems to be something like this.

        ‘I treated some people. Looks good to me. Nobody’s died so far. Let’s roll it out and make it a national strategy.'”

        That may be what you think Zelenko said, and it may be what you think I said. Please recall, however, that I suggested that we test this in the best manner that we can given that we don’t have time for rigorous trials. I’m certain that that was what Dr. Zelenko would have expected. Probably what he didn’t expect was to be ignored, and to have his supply of the medications cut off thanks to an order by the Governor to pharmacists.

        You don’t seem to understand my position, Mr. Cross, so let me spell it out for you. I don’t know if this will work. It might. It might not. Since there are a number of physicians out there whose clinical experience is telling them that this works exceptionally well if used early, then I would’ve expected the authorities to have tested this by requesting designated and willing doctors to test the exact protocol and report back. Because then, you see, we’d have more evidence by way of clinical experience, and if it didn’t work, then we could say so, and if it did seem to work, then that’s good news.

        I’m not pushing for Zelenko, necessarily. I’m saying, what’s wrong with us that we don’t even bother to figure out if this is something worthwhile when it’d be the simplest thing in the world to do? If it really does no good, then that’d be nice to know, wouldn’t it? Since I’m of somewhat of a cynical bent of mind, my guess is that it does work, and therefore no one in authority wants it to be tested at even the most down-to-earth and relatively quick clinical level. Because then, you see, we’d all stop being scared half out of our minds, and that is NOT in the program. The program is for us all to be scared witless and then begging for surveillance (we have to track those without proven immunity, no?) and the government will be happy to comply and we’ll be one step closer to government opacity and individual transparency, which is probably what the founding fathers intended anyhow. So, it’s all good.

        Anything else?

    • Even his own letter he wrote to Trump has enough information in it to give pause. I quote:

      “As of today my team has tested approximately 200 people from this community for Covid-19, and 65% of the results have been positive”.

      Just 65%. What is the rate of recovery without treatment? I would imagine at least 65%.

      Then another point in the letter.

      “Since last Thursday, my team has treated approximately 350 patients in Kiryas Joel and another 150 patients in other areas of New York with the above regimen”.

      He reports positive results from this group but he is writing the letter on Monday and so the results of earliest treated patients are from four days of treatment. They haven’t even completed the full course and we should probably assume many of the patients have just barely started.

      • “Since last Thursday, my team has treated approximately 350 patients in Kiryas Joel and another 150 patients in other areas of New York with the above regimen.”

        You’re assuming that he meant that he treated all these patients since last Thursday, while it’s more likely that he meant that “as of” last Thursday, about 500 patients had been treated. It makes little sense that he could conclude anything if results had been tallied before the five-day course of treatment even concluded.

        And no, he did not say that 65% of patients recovered. He said that 65% of patients tested positive for Covid-19.

        Anything else?

  57. “under 2% of the population has been infected and acquired immunity, whereas 80+% of the population needs to have been infected in order to achieve herd immunity”

    Larger test samples from various countries show around 10-15% of people have been infected, the same goes for ships where everyone on board was tested. Is 80+% infected a real possibility?

    • 80+% is what the finally infected proportion would be with a reproduction rate R of ~2.4. But herd immunity starts to kick in much sooner, and R would fall below 1 (so that the number of new cases starts declining) when 59% had been infected. Given the accumulating evidence that relatively few changes in behaviour and activities would be needed in order to reduce R to well below 2.4, herd immunity would start to take effect when a considerably lower proportion of people had been infected. And if those changes were continued until a vaccine were available, well under 80% of the exposed population would end up being infected.

      • That is assuming that 80+% could be infected. What if only 10-15% become infected despite most being exposed to it?

      • I agree that the possibility that a significant proportion of the population may from the start effectively not be susceptible to COVID-19, in the sense of displaying negligible symptoms and an undetectable COVID-19 specific antibody response upon being exposed, should not be dismissed out of hand. That would be very good news. But I think it is only a speculative possibility at present.

      • It does not have to be ‘an undetectable COVID-19 specific antibody response’, it could be saliva types, something in the diet, or even smoking which could provide a hostile environment to the virus.

  58. “However, another key factor is whether a person suffers from various chronic health conditions, the most prevalent of which are hypertension, diabetes, cardiovascular disease, atrial fibrillation, obstructive pulmonary disease, and renal failure..”

    The top two underlying conditions according to UK sources are heart disease and dementia. A fair proportion of which I suspect is drug induced, with anti-inflammatory medications and heart disease, and benzodiazapines with dementia, plus benzos are immunosuppressants.

    “benzodiazepines may quadruple the likelihood of pneumonia and increase mortality more than 20-fold in people with influenza-like illness”

    https://www.pharmacymagazine.co.uk/benzodiazepines-increase-flu-risk

    • Ulric

      To that must be added that a prime cause of many of those health problems you cite is obesity and generally being overweight.

      To that must be added age. There are a staggering 50% more males and 125% more females over 80 than there were in 2005.

      tonyb

  59. Robert Clark

    DATE NEW CASES INCREASE % # TESTS
    4/22/2020 19,554 -12,483 -38.9 143,549
    4/23/2020 32,124 12,570 64.2 158,486
    4/24/2020 39,887 7,763 24.1 465,986
    4/25/2020 36,342 -3,545 -8.8 251,263
    4/26/2020 39,806 3,462 9.5 256,441
    4/27/2020 23,095 -16,711 -41.9 216,029
    28-Apr 22,840 -255 -1.1 179,755
    4/29/2020 29,025 6,185 27 259,856
    On the 24th we showed we can do 500,000 tests a day.
    It looks like if we did that every daay we would get ahead of the growth.

    • Trump says we can do 5 mil.

    • Robert Clark

      The many millions of us doing this social distancing are the only ones that can keep the progress we have made against the virus. As they open up the country keep the doctor’s rules. As the testing increases they will continue to eliminate the ASOMETRIC VIRUS CARRIERS. As the silent carriers self isolate, those mingling in public volenterilly get tested, the government keeps virus carriers from entering the country the numbers will go down. It is up to us to win the war.

  60. Steven Mosher

    Unfortunately this is at odds with the largest dataset from New York.

    • That dataset is wack. We are going to be sensible and build a wall around the NY-NJ Empire run by the inept buffoon Cuomo-De Blasio syndicate.

  61. Steven Mosher

    How is your state doing

    https://rt.live/

    • Here, being at the bottom of some current standings for Michigan because of the Bobby Layne curse might be a good thing. But having a Deaths per Million rate for Detroit that is 60,000 times that of Ethiopia is of little consolation. The damage has already been done.

  62. The battle at the heart of British science over coronavirus | Free to read
    The UK government has been accused of paying too much attention to epidemiologists over other experts
    https://www.ft.com/content/1e390ac6-7e2c-11ea-8fdb-7ec06edeef84

    Why is the Government trusting the word of this ‘genius’, says FREDERICK FORSYTH
    AMONG the many foolish vanities to which Mankind subscribes is the belief he can foretell the future. He has been trying since time immemorial. First there were chicken entrails, then animal bones, progressing to the stars, palms, crystal balls, tarot cards and tea leaves. All methods were consistent to 90 per cent – they were all bunkum and remain so. Now overtaking them all is the pseudo-scientist/boffin.
    And out in the lead here seems to be Imperial College, London, and its pre-eminent guru Professor Neil Ferguson. He was the genius who, on the issue of swine flu, confidently forecast global deaths at four million. The worldwide total turned out to be 18,500. In 2005, Ferguson said that up to 200 million people could die from bird flu. Between 2003 and 2009, just 282 people died worldwide from the disease
    https://www.express.co.uk/comment/columnists/frederick-forsyth/1270245/coronavirus-neil-ferguson-sars-bird-flu-deaths

    The Ferguson effect
    https://www.powerlineblog.com/archives/2020/04/the-ferguson-effect.php

  63. It seems to me the answer is simple. Send vans down every street and test everybody. Everybody! Isolate everyone who tests positive. Repeat this a few times. Then open up the economy.

    • Afternoon Donald (UTC),

      That is pretty much what yours truly has been advocating:

      Simples! Or toeing the UK Green Party line that Jeff disapproves of so much?

    • “Send vans down every street and test everybody. Everybody! Isolate everyone who tests positive. Repeat this a few times. Then open up the economy”

      That is the answer and that is what the experts say is the answer. The problem is we don’t have the testing capability and have not planned for the tracking and isolation parts of the solution. There is nobody to do it and no one is even working on a plan to do it.

      • Robert Clark

        Look at the above. The 24th says we have the capability. We just need the test kits. Since the 24th they have been over 200,000 tests withn one exception.

    • Yup. Our lack of testing/contact tracing/isolating in the US is criminal and insane.

      Can only hope that things will improve. It’s what would really facilitate economic improvement.

      Of course, some people say that “Anyone who wants a test can get a test.” And some people are enablers for lying politicians.

  64. Robert Clark

    DATE NEW CASES INCREASE % # TESTS
    4/24/2020 39,887 7,763 24.1 465,986
    4/25/2020 36,342 -3,545 -8.8 251,263
    4/26/2020 39,806 3,462 9.5 256,441
    4/27/2020 23,095 -16,711 -41.9 216,029
    28-Apr 22,840 -255 -1.1 179,755
    4/29/2020 29,025 6,185 27 259,856
    4/30/2020 28,117 -908 -3.1 -194,323
    Only down 3%. need more tests.
    Tracing those found positive not necessary.
    This is the USA! They will self quarentine and those need notification will be notified by them.

  65. Nic –

    BTW, the logic here extremely flawed:

    > The fact that daily new cases of COVID-19 have not been increasing in Sweden since the end of March 2020 strongly suggests that the relatively limited measures taken there have reduced the reproduction ratio to well below 1.5, despite that being totally at variance with the much smaller reduction that the Imperial College Response Team’s modelling in another study (Flaxman et al 2020)[ii] implies.

    The rate of identified new cases is largely a function of the amount of testing. Sweden is considerably behind other comparable countries in per capita testing. They tend to only test peple who are healthcare workers and peple with symptoms.

    That is why the cases per capita cases is only of dubious value and should not be used in a facile manner to prescribe policy recommendations.

    • Bring out the data on rates of testing over time, and you might have a point. And if you want to compare Sweden to other countries, which is a bad idea anyway because of all the potential confounds, at least account for the relative rates of testing.

  66. I think the sensible strategy is to have the President (or PM) declare a national emergency, and under some sort of War Powers Act, force the major elements of the national manufacturing industry to shift over to production of test kits, and provide funds to immediately expand lab facilities for test analysis, and do this immediately with great haste. At the same time, shift the military (if necessary) and co-opt the delivery services to deliver tests to almost every realm of the country, and in the space of about a month or so, test almost everyone. And keep testing.

    • Donald –

      We may not agree on much, but we agree on much of what you just suggested.

      Inwoikd recommend, also, an intensive effort to tsrfe resources on contact tracing.

      Once all that infrastructure is in place, lifting government mandates for social distancingske so much more sense.

      • And despite all the abstract mathematics that might lead one way or another, the simple fact is that if you (1) identify and segregate all those who have it, and (2) prevent new entries without test confirmation, then you conquer the virus. The group that corresponds on this blog leans toward models, mathematics, and complex solutions, but maybe common sense is missing?

      • > but maybe common sense is missing?Well – it’s not missing in places like S. Korea.

        A country of this size and you have to allow for logistical obstacles. But when people insist that the problem is managed, that “Anyone who wants a test can get a test,” and that states asking for help are just looking for “bailouts” then it isn’t just a logistical problem.

      • stevenreincarnated

        There’s a real big problem with the asymptomatic carriers. If I were infected and I live in a lock down state and haven’t been all that bad, I have still been within 6 feet of at least 50 people and at least 20 of those have been within 6 feet of hundreds if not thousands of people. Then you have the things I have touched that have probably been touched by hundreds of people after me. You might be able to slow it down that way but I don’t give you any chance of eliminating it. Maybe if we were averaging 5 million tests a day or some other ridiculously large number.

      • Yes, we need a large number of tests per day. And that could only be achieved by operating under wartime conditions where the government takes over industry and makes it happen

      • > There’s a real big problem with the asymptomatic carriers.

        If you track positive testing ratios out of surveillance with representative samples you get a signal as to where the asymptomatic carriers are circulating. Then you can target more uniform and widespread testing and get more out of your resources.

        It’s not like there aren’t examples where this improves infection rates significantly. There are. Scaling it to this country will be difficult, and it will never be perfect. But the point is that we can vastly improve on where we are now. And if people resist improvement, perhaps because they’re not willing to accept imperfect improvement out of unrealistic expectations, we’re worse off.

        As long as leaders lie and say we have it under control and that “Anyone who wants a test can get a test,” and supporters enable those liars, we’re on a bad path.

      • I’m the US we are the 14th worst country in cases per million and 44th best in testing per million. Imagjne where we’d be in cases per million if we were closer to the top in tests per million.

        It’s a travesty.

        If I were conspiratorial, I’d say there’s a reason why the tesrknf isn’t better – as it would make the failures of our response to COVID just all that much more obvious.

        But I won’t go there. Don’t attribute failure to malignant intent when simple incompetence can suffice as an explanation.

      • stevenreincarnated

        Whatever you want to believe. No telling how many people I just infected over the last 2 weeks without ever knowing I was sick. Hypothetically of course.

      • Steve –

        Right. No telling. But invariably some of them would have become symptomatic of tested otherwise if we had a functional system. And if contact tracing were in place you would likely be identified as a spreader and others you were in contact would have been identified. And you could know to isolate and so would they. And a “hot spot” would be identified as needing a concentration of resources, and the chain of transmission could be at least partially broken.

        No, it wouldn’t be perfect. It doesn’t have to be to have a net beneficial effect.

        There’s plenty of evidence of this if you take the time to look. Just Google some stuff in Korea and compare outcomes there to countries that have failed in the testing, the contact tracing, and the isolating.

        Or ignore it for some odd reason. Do as you’d like.

      • Don Monfort

        He lives sad and alone in a dingy little studio apartment in the cheapest part of Queens. He was just genning up the courage to go outside for the first time in months and the underboss of the Cuomo-De Blasio syndicate has suddenly decided, after presiding over the worst virus carnage on the planet, that the police should actually start enforcing the lock down rules. Now he’s planning to move to Texas, if he survives the Cuomo-De Blasio syndicate’s simple-minded catastrophic anthropogenic incompetence. But still he vows never to give up believing in the correctness of left loon ideology.

      • stevenreincarnated

        By the time they identified me as a carrier I wouldn’t be a carrier anymore if they ever even manged to do so. It would be a fruitless effort to find me individually. Typhoid Mary would be worth while. Me, no.

      • > By the time they identified me as a carrier I wouldn’t be a carrier anymore if they ever even manged to do so.

        There’s no valid reason to make that assumption. It’s all a matter of how well the testing and tracing infrastructure is developed. And it wouldn’t be just you, it could be the person you infected the last day you were infectious, and the person that person infected the last day he/she was infectious.

        Check out Korea. Go ahead, check. Just because we have no effective contact tracing here, now, doesn’t mean that it doesn’t work nor that we can’t get it together….well, at least at the state level if not at the federal level.

  67. Jan ,"Cough" Lindstrom

    It may seem that Sweden (where I live) is closer to the approach suggested by Lewis. However, one should bear in mind that the restrictions taken in Sweden is what the country can manage. We simply cannot put out the 100000 police and military necessary to enforce a lockdown. We don’t have these numbers available. Also, the social distancing policy is not a problem in Sweden, because that is how it works normally. It is more than a joke when quoting the swedish reaction to the distancing rule of 2m: “that close?!!”. We don’t adress or greet strangers. Chit-chatting about nothing in public is not heard of except from the large immigrant minorities and the occasional “boomer” missing the good old days of demonstrations for some obscure communist guerilla, made up of three letters…We are fullfilling the demands of social distancing without effort.

    • I am going to guess that like in NYC, Sweden’s large immigrant minorities are contributing more than their fair share to the fatality count.

    • > Also, the social distancing policy is not a problem in Sweden, because that is how it works normally. It is more than a joke when quoting the swedish reaction to the distancing rule of 2m: “that close?!!”.

      Funny.

      Sums up well how knuckle-headed these cross-country comparisons are.

      They mostly just function as a method for confirmation bias.

  68. Don Monfort

    Another pre-print, this of an elaborate study of lock down vs. let it rip:

    Click to access 2020.04.24.20078717v1.full.pdf

    “Extrapolating pre-lockdown growth rate trends, we provide estimates of the death toll in the absence of any lockdown policies, & show that these strategies might not have saved any life in western Europe”

  69. Nobel prize winning scientist Prof Michael Levitt: lockdown is a “huge mistake”

  70. Nic, have you seen this study. https://www.medrxiv.org/content/10.1101/2020.04.27.20081893v1 this has been my concern for some time, that the epidemic would be “front-loaded” and early infection and death rates would not be representative of the entire population. the implications are enormous, including that the supposed effects of the lockdowns were actually occurring anyway. Anyway be interested in your informed perspective.

  71. By contrast, Gov Newsom’s policy makes no sense:

    https://www.realclearpolitics.com/articles/2020/05/02/gov_newsom_puts_politics_over_data_in_california_shutdown_143100.html

    Closed beaches (and surf), with open marijuana dispensaries. Staff laid off from hospitals that have 98% of beds open.

    Speaking of hospital staff: they are tested annually for TB antibodies; it seems past time to start testing them for SARS CoV-2 antibodies or live virus.

  72. Kevin: Below is the abstract of the article you linked:

    Abstract: “As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreads, the susceptible subpopulation is depleted causing the rate at which new cases occur to decline. Variation in individual susceptibility or exposure to infection exacerbates this effect. Individuals that are frailer, and therefore more susceptible or more exposed, have higher probabilities of being infected, depleting the susceptible subpopulation of those who are at higher risk of infection, and thus intensifying the deceleration in occurrence of new cases. Eventually, susceptible numbers become low enough to prevent epidemic growth or, in other words, herd immunity is attained. Although estimates vary, it is currently believed that herd immunity to SARS-CoV-2 requires 60-70% of the population to be immune. Here we show that VARIATION IN SUSCEPTIBILITY OR EXPOSURE to infection can reduce these estimates. Achieving accurate estimates of heterogeneity for SARS-CoV-2 is therefore of paramount importance in controlling the COVID-19 pandemic.”

    The authors do so by adding a fudge factor “〈𝑥〉 is the mean susceptibility factor at epidemic onset that varies within the population to the standard equation for R0. Prior to the epidemic, susceptibility is described by a probability density function 𝑞(𝑥) with mean 1 and coefficient of
    variation (CV) to be explored as a parameter”. If the coefficient of variation were 0.2, 95% of the population would have susceptibility ranging from 0.6 to 1.4, a 2-fold range in susceptibility. If the coefficient of variation were 0.3, 95% of the population would have susceptibility ranging from 0.4 to 1.6, a 4-fold range in susceptibility. If the coefficient of variation were 0.4, 95% of the population would have susceptibility ranging from 0.2 to 1.8, a 9-fold range susceptibility. If the coefficient of variation were 0.5, 95% of the population would have susceptibility ranging from 0 to 2.0, an infinite range in susceptibility. The authors model coefficients of variation ranging up to 3 and 4. As best I can tell, this means some people have negative susceptibilities, an absurdity.

    Whatever the authors may actually intend, is it at all likely that humans vary so dramatically in their susceptibility to infection by coronavirus (in the absence of immunity acquired by infection)? I think we better wait to see if this paper survives peer review.

    In the real world, there is no way to distinguish between variation in susceptibility and exposure. R0 changes during epidemics because the behaviors of people and policymakers change exposure. It is hard to imagine good experiments that can distinguish between a person’s innate susceptibility to become infected and behaviors that change a person’s exposure to infection. Our ability to mount an immune response (an antibody response) to infection is limited in both the young and old; and it is BALANCED by a need to prevent infection and cancer without excessive auto-immune diseases and life-threatening allergic responses. Can adults really differ dramatically in their susceptibility to viral infection without being prone to cancer or auto-immune diseases?

    It takes about one week for the immune system to produce a maximal amount of antibody in response to infection and about half that long before antibodies can be detected. In cell culture, a virus can infect a cell and produce a million progeny in a day. That’s potentially 10^18 viruses from one virus before antibodies can get to work in a healthy adult. Until then, interferons may provide the only defense against viral infection. They slow down protein synthesis and other processes in cells near infections so that viral replication is slower when these cells are later infected. Coronavirus makes a variety of proteins that interfere with the immune response.

    The fact that most children have few symptoms from coronavirus is obviously not due to their superior ability to respond to viral infections. The high death toll during the 1918 pandemic influenza was associated with an immune response in the lungs that was too strong and drown patients.

    https://royalsocietypublishing.org/doi/10.1098/rspb.2014.3085

  73. Kevin Roche

    Kind of hard to know where to start on that. Medrxiv does have a fair number of drive-by papers, but this certainly isn’t one. I always look at the authors and their backgrounds. This is an absolutely stellar international team. The composition of the team tells you that they have worked together before and this was an important effort for them.

    The underlying concepts in the paper are absolutely standard epidemiology. Many, if not most infectious diseases are characterized by both variable susceptibility to infection and variable course of disease after infection. The authors reference that in the paper and any epidemiology textbook covers it as well. So there is absolutely nothing novel in the concept. The variation in susceptibility may be due to gender, age, health conditions, biological factors or other factors.

    I don’t know why you are generalizing about children’s susceptibility to viruses. That is also not an accurate characterization of the state of knowledge generally about pediatric infectious diseases, and certainly in regard to this virus. I don’t think there is anyone who would say that children are nearly as susceptible as adults to coronavirus infection or disease. If you look at a couple of blog posts I have written, http://www.healthy-skeptic.com, in the last couple of days, you will see references to a meta-review making exactly this point, that children are less likely to be infected, that they are less likely to be agents of transmission and that they have a less serious course of illness. I also referenced a recent study in Science using Chinese data which finds exactly the same thing, a very wide difference in susceptibility between children and the elderly in particular.

    And if you look at the CDC data on cases and deaths, you see the same thing. It is amazingly striking actually. There are more than 104 million people in the US under the age of 24. In that entire cohort, there have been less than 60 deaths. (CDC data is lagged, but the relative pattern will remain) At the other end, there are about 22 million people over 75 and that group has experienced over 21,000 deaths. And if you understand SEIR models of epidemics, they are fundamentally built on contact models. Of all age groups, children have the highest rates of contact and the elderly the lowest, yet look at the case and death pattern. So there is simply no serious question that coronavirus affects children very little, and the elderly very heavily. Another note is that Italy had not one death of a child.

    I can’t understand where you are coming up with the negative susceptibility concept, the formulas don’t in any manner appear to work that way to me and perhaps you are confusing the contact portion of the model with the succeeding phases. I am sorry to suggest this but I think your math is just in error. But I will leave it to Nic to address that, his statistical skills are beyond mine.

    I also am pretty sure some of your comments about variation in susceptibility, exposure, and infection are in error as well. They simply aren’t consistent with either physical functioning or epidemiology. You seem to think that virus specific antibodies are the only defense against an infectious agent, which is simply not true, in fact those typically arise during the course of the infection. Other parts of the immune system play a more significant role in deterring infection and fighting infectious agents in the early stages of disease.

    And susceptibility to one infectious agent, like influenza viruses, has very little to do with susceptibility to another unrelated one. Most infectious agents follow different pathways to enter cells and that is certainly true of influenza and coronavirus.

    so thanks for the reply, but I really can’t follow much of the reasoning.

    • Keven –

      > And if you look at the CDC data on cases and deaths, you see the same thing. It is amazingly striking actually. There are more than 104 million people in the US under the age of 24. In that entire cohort, there have been less than 60 deaths. (CDC data is lagged, but the relative pattern will remain)

      What is the relevance of deaths to infection rate?

      > Of all age groups, children have the highest rates of contact and the elderly the lowest, yet look at the case and death pattern. So there is simply no serious question that coronavirus affects children very little, and the elderly very heavily. Another note is that Italy had not one death of a child.

      • kevin roche

        May not have been clear enough, if you look at the CDC data on cases and deaths by age group, you will see that in both cases the young are very underrepresented.

      • Well, number of cases doesn’t exactly translate to infectiousness (going in either direction) although along with connectivity it might be predictive.

        I’ve been looking at this under the precautionary principle that children are superspreaders of coronaviruses, even if asymptomatic. I certainly hope I was wrong about that w/r/t COVID

        Related:

        https://www.google.com/amp/s/www.cbc.ca/amp/1.5552099

        Also, modelers here discuss the view that past 8 days the closing schools doesn’t have a signal in spread (with the caveats, they have no explanation, it’s counterintuitive, and we don’t have much information with concurrent interventions as we have now).

        About 8 minutes in:
        https://meaningoflife.tv/videos/42714

    • Kevin: Thanks for the reply. In the abstract, I highlighted the phrase “variation in susceptibility and exposure”. AFAIK, conventional epidemiology and R0 are all about exposure – how likely it is that a droplet from one sick person gets into the respiratory track of another healthy person. Exposure depends on the number of viruses in the respiratory track of a sick person, how much that sick person coughs, sprays, produces aerosolized viruses, blows his nose and otherwise contaminates surfaces multiplied by the number of people in contact with the sick person and the personal hygiene to those contacts. I assume that R0 takes all of those factors into account.

      After reading this paper, it appears as if the authors have added variation in susceptibility to standard epidemiology models. AFAIK, susceptibility means how likely a person (without neutralizing antibodies) is to get sick when a typical droplet with virus is deposited on a mucus membrane. The requirement for a balance in immune response and the universal nature of that response (discussed below) suggests to me that big differences in susceptibility are unlikely. How big a difference does this paper explore? I hope peer review results in more clarity about exactly what they have done. They model a coefficient of variability (standard deviation divided by mean) up to 4, which appears huge. Above I calculated the range in susceptibility as I interpreted it – a normal distribution in susceptibility with a mean of 1 and a standard deviation of up to 4 (which is absurd, of course). However, their results are meaningless unless they have chosen a REASONABLE RANGE of susceptibility and can justify why that range is relevant. This is why I suggested waiting to see if peer review will make the significance of this work more apparent.

      Our immune systems need to be carefully balanced. If immune responses are triggered too easily or respond too strongly, we come down with auto-immune diseases and deadly allergies. During lung infections, some patients die from a “cytokine storm” produced by an immune response that is too strong. On the other hand, if our immune system responds too sluggishly, we die of infections or cancer. So it would be surprising to see that one particular normal individual could be say 10X more likely than another normal individual to not get sick when a coronavirus droplet lands in their nose.

      Furthermore, everyone has the same defenses except towards infections that have been previously encountered. Antibody and other responses that require cells to divide are limited by a maximum rate of one division/day. No one can produce antibodies twice as fast as normal (about 7 days for peak production), though the elderly and immuno-suppressed do respond slower than normal. If I understand correctly, antiviral responses that occur faster than antibodies are mediated by interferons, which temporarily turn off protein synthesis in nearby cells so viruses can’t makes use of that machinery when they invade. Release of interferons is stimulated when molecules release by infection bind to receptors. There are drawback to too much interferon. Coronavirus proteins are released that suppress the interferon response.

      Have the coronaviruses that cause common colds left behind neutralizing antibodies in a significant fraction of the population? This could cause a significant variability in susceptibility. It would also mean the antibodies in many people’s plasma could be used to treat severe coronavirus disease – just like the plasma from survivors.

      • kevin roche

        Okay, still not sure I understand or agree with most of your comments, as they are not consistent with my knowledge of either epidemiology or infectious disease but that’s okay. Transmissibility as expressed by R, and R naught is transmissibility only at the very start of an epidemic with a fully susceptible population, it is R e thereafter, which is more important, and ever-changing as the epidemic proceeds, but I digress, transmissibility formulas typically do not take the kinds of characteristics that these authors are discussing into account, which is why they wrote the paper. The dose of virus needed to infect a given individual obviously will vary, and some people clearly aren’t getting infected after exposure. But I am not aware of, and you can imagine the ethical problems of, a virus dosing study, and that is probably the only way you would begin to establish those parameters. And an observational study isn’t really possible either, as it is very difficult to measure the amount of virus being deposited at any one time or over time into a person’s body. So you do inferential work like this study–if children are exposed but aren’t getting infected as much, and when you see the clear age gradient in both case loads and serious illness, something is going on.

        The early immune response to any previously unencountered infection is not by antibodies. A just published paper on Medrxiv dealt with the Tcell response, which is typically earlier. And interestingly there does appear to be evidence of Tcell cross activity against covid 19. There have been a couple of studies trying to ascertain coronavirus antibody cross-reactivity, but while one found some activity, it seems pretty inconclusive, which would be consistent with the prevailing view that seasonal coronavirus antibodies are generally weak, largely because the infection isn’t serious. People have been way too focused on antibodies, and not other aspects of the immune system, so it is good to see people now looking more seriously at those other aspects. This research is prompted by the wide gulf in apparent susceptibility and seriousness of illness by age. An analysis of the first 12,000 deaths in the UK was just release today, zero deaths in children under 15, 83% of all deaths in people 70 or over.

      • Feank –

        Seems that as yet, there is unxsrtjntyb5im the evidence:

        > study released by Germany’s chief virologist Christian Drosten and others this week backs Zerr’s skepticism. Here’s what they found: “Analysis of variance of viral loads in patients of different age categories found no significant difference between any pair of age categories including children,” the researchers wrote. “In particular, these data indicate that viral loads in the very young do not differ significantly from those of adults.”

        https://www.google.com/amp/s/www.vox.com/platform/amp/2020/5/2/21241636/coronavirus-children-kids-spread-transmit-switzerland

        The article I excerpted is linked at the above URL, where the uncertainty in the evidence is discussed broadly.

      • … Uncertainty in the evidence…

    • Kevin and Joshua: Thanks for taking the time to write thoughtful responses.

      Kevin, you are at least partially correct: I did under-emphasize the role of the innate immune system (other than interferon) that responds to all infections independent of antigens and antibodies that are unique to each organism. The latter response is the adaptive immune response. In the case of viruses, however, T-cells (natural killer cells?) can only attack and kill cells that have already been infected and are beginning to release viral progeny. AFAIK, viruses themselves are much too small a target for white blood cells. And T-cells can’t distinguish “self” from “infected self” until changes are apparent at the cell surface. Finally, one infected cell can produce extremely large number (thousands?) of viral progeny before the infected cell disintegrates (or is killed). Since it takes one day to grow a new T-cell vs one day to grow thousand of new viruses, a limited standing army of T-cells need to keep ahead of exponential growth of viruses. (Once an antigen has been presented and processed, one cell can produce many RNA copies for producing antibody and hundreds of antibodies molecules are made from each RNA.)

      You are right that we can’t do many experiments with people, but the most enlightening experiments are often done in animals or cell culture. There is a ferret model used for influenza and COVID-19 that allows the entire course of the disease to be monitored from a standard dose of virus. After infection, viral RNA levels keep growing despite the innate immune response until significant levels of antibodies are observed (after about a week), but the ferrets have only mild symptoms. This is exactly what we see with the vast majority children and perhaps more than 50% of adults too. We now know that people are infectious beginning about 2 days before symptoms appear (about 5 days on average) – but most patients aren’t tested until symptoms appear and often not until they are hospitalized, when viral RNA is falling. I suspect we will find that most infected people build up a large amount of viral RNA despite the innate immune system, but some later event determines the severity of the illness that results. Perhaps that event is the establishment of a serious infection outside the upper respiratory system before antibodies are available to assist the innate immune system. If I understand correctly, seriously ill COVID-19 patients often die from a cytokine storm (the innate immune system) in their lungs that obstructs breathing.

      The above may be a gross over-simplification from a scientist who used to work with relatively simple experiments that often gave unambiguous answers. Things got much messer in animal studies, but progress was impractical in the absence of a hypothesis as to what caused the messiness. So I probably place to much value in such hypotheses.

      Big differences in people are due to “immunological memory” that keeps a low level of antibody to a particular virus circulating and which can be ramped up in much less than the week required after an initial infection. There may be other differences, but I was skeptical how big they might be because an overactive immune system produces auto-immune disease. I really wish I understood how big a difference in susceptibility the Gomes paper was proposing and what mechanism might be causing such variation in susceptibility. To me, herd immunity comes from immunological memory, so that shouldn’t be their mechanism for decreased susceptibility. The paper could be clearer after peer review. And I’m skeptical that a need for a new susceptibility term can be proven from the course of a pandemic that is producing huge changes in the behavior of people and policy.

    • Kevin: I just read that that 86% of the 2200 prisoners in Marion Correctional Institute (Ohio) have now tested positive for COVID-19. Due to the close quarters in a prison, it isn’t clear that one should expect herd immunity when 67% had been infected. However, it doesn’t look like a large fractions of this population was dramatically less susceptible to infection either. So far, the story has appeared in the new media at various times, but it may not have been the subject of a scientific paper. This link to a blog post has links to state data (but I don’t understand the source all the numbers cited by the blog).

      https://www.emptywheel.net/2020/05/06/an-update-on-the-human-experiment-in-marion-prison/

    • Kevin and Frank –

      Don’t know if you’ll see this….

      More on that article/levels need to reach herd immunity

      https://mobile.twitter.com/CT_Bergstrom/status/1256828515942449153

  74. Ferguson’s ‘modelling’ should not be referred to: he has proven time and again that his modelling is worthless.

    Policy should not be made relying on him as a witness, as he does not have relevant expertise.

    All he is is a computer geek who gets paid a lot for pushing Bill Gates’ agenda.

    • Peter Davies

      On the contrary, Prof. Neil Ferguson (OBE) is one of the most qualified experts there is in the field of epidemiological modeling. He is the director of both J-IDEA and the UK Medical Research Council Centre for Global Infectious Disease Analysis, groups which both contain a wealth of skills and experience in infectious diseases.

      And he has cut his teeth on the UK foot and mouth animal epidemic and vCJD (BSE), where he provided information to enable standing down what might otherwise have been a huge UK response (final outcome was only 170 cases). Oh, and SARS and MERS. Most of these are zoonoses (animal diseases which can become contagious between humans, as COVID-19 did). There are few people worldwide coming anywhere close to that level of experience.

      You can be well assured that, when he raises the alarm, there is indeed a crisis coming, if no-one changes their behaviour. Fortunately, there has indeed been a huge behaviour change worldwide.

      The trick going forward will be to fine tune the social distancing response and thus R value to allow opening up of the economy to the maximum extent possible, while ensuring exponential growth does not resume. That is going to rely on increasingly more accurate models, as more is learned about COVID-19 itself, and human behaviour relating to COVID-19 transmission. Models from Ferguson’s groups and other centres of expertise will be instrumental in optimising the path through this pandemic until a suitable treatment or vaccine becomes available, or herd immunity is finally achieved, without huge loss of life.

  75. Due to the fact that no one knows how to overcome this virus, there is no vaccine. There is also a version about the artificial creation of this virus … Therefore, what is the exit strategy for COVID-19 will be correct, I think no one knows.

  76. Gove Newsom announces next relaxation of CA shutdown.

  77. Don Monfort

    Neil “The Putz” Ferguson resigned:

    https://www.telegraph.co.uk/news/2020/05/05/exclusive-government-scientist-neil-ferguson-resigns-breaking/

    Exclusive: Government scientist Neil Ferguson resigns after breaking lockdown rules to meet his married lover

  78. UK-Weather Lass- In-Earnest

    There was a period in the days before lock down was officially announced and enforced where SARS-CoV-2 had the perfect environment to spread efficiently and rapidly as people literally fought in shops for supplies. Was the UK Government culpable for making greater spread more likely at that stage and should that have been a valuable lesson for all involved about distancing and common sense playing important roles in control of infectious disease?

    And so it is with any lifting of the lock down relying upon distancing and common sense as we all slowly get back to some kind of normal. Without reliable and comprehensive testing for antigens we are still, all of us in the UK, risks to others, and will remain so until those tests are in place and trusted.

    A lot of people, including politicians, medical advisers, and expert professors of epidemiology, misjudged this disease, and acted as they did for fears of overwhelming our NHS. My question is simply how on earth did we allow our NHS to be so exposed to collapse when we had been warned many times about expected arrival of a pandemic from 2012 onward? And can those same people who allowed our NHS to be so exposed to collapse be trusted to have learned from their earlier mistakes? I don’t believe so.

    Whatever happened to quality leadership and expert assertiveness in guiding those leaders and however have we managed to have so many disastrously inept computer models, unreliable testing results, not to mention shortages of essential equipment? Whatever happens next must include a full inquiry into negligence at the very top of all our professional disciplines..

    • weather lass

      “My question is simply how on earth did we allow our NHS to be so exposed to collapse when we had been warned many times about expected arrival of a pandemic from 2012 onward? And can those same people who allowed our NHS to be so exposed to collapse be trusted to have learned from their earlier mistakes? I don’t believe so.”

      Any ‘product’ that is free at the point of supply will be overwhelmed, none more so than free health which has come to mean everything from transitioning to cancer treatment.

      Add in a health system that has seen the number of 85 year olds double in 15 years and have seen a doubling of associated diseases including obesity and diabetes.

      A refusal to charge people from overseas who believe it is the\International free health service doesnt5 help

      Stir in 10 million more potential patients since 1975 (five million of those since 2003) and you have a system regularly overwhelmed’

      There are a variety of solutions as the nhs will swallow any amount of money shovelled down its throat. With some 150000 ‘avoidable’ deaths every year, expecting people to take much better\ care of their own health and insisting people pay for certain treatments that are not essential might be a start.

      tonyb

  79. Pingback: When does government intervention make sense for COVID-19? | Climate Etc.