Flatten the Curve or Eliminate the Virus?

[Mama Noodle]

The narrative on managing Coronavirus seems to be shifting to something way off from what was once "Flatten the Curve". Economies were shut down to do just that, flatten the curve. 

 

The objective was to flatten the curve so that hospitals don't get overwhelmed. At least in the USA that hasn't happened. Nobody who needed care was unable to get care. Flattening the curve meant the same amount of people will get hospitalized and possibly die, but over a longer period of time. 

 

Now the narrative is trying to be changed by some to be "Test and Trace" and "Testing Testing Testing" in order to open up economies and get things moving again, and I agree testing is a good tool but it shouldn't stop economies from opening up. 

As we know most people will not even need hospitalization, and the most venerable are the highest risk. 

 

It is interesting to me how people breathlessly and without even noticing have shifted to this narrative as well. 

If the objective is not to 'flatten the curve' but to 'eliminate the virus' then thats a whole different story and strategy altogether, which is also impossible and economic suicide. 

 

So which is it? What are we all doing? More people died in road accidents in ONE DAY in Thailand after the booze ban was lifted than ALL of the reported Covid deaths combined. And the economic fallout hasn't even hit people yet, thats gonna be weeks/months in the future. 

 

New York State has a population slightly less than the State of Florida, yet Florida has 1600 deaths VS New York's 20,800 deaths, but people are mocking Florida for allowing people to go to the beach and trying to open their economies up. 

 

Its really rather stupid when you consider a good baseline is 2017/2018 flu season where a suspected 60,000 - 80,000 people died in the USA alone and no one batted an eye - just that it was "A bad flu season". So upwards of 80k dead and the world keeps chugging along. The WHO estimates the flu kills 290,000 to 650,000 people per year, globally. No shutdowns. No one bats an eye. 

 

I am not denying that Covid 19 is bad, but is it really bad enough to plunge the world into economic ruin for the next couple of years? 

 

I suspect the 'keep it shutdown' crowd has no skin in the game and/or its being used by politicians for nefarious purposes. 

[CygnusX1]

Yes, exactly the same thing has happened in Australia. Sydney Morning Herald article on 16 March

https://www.smh.com.au/politics/federal/australia-prepares-for-50-000-to-150-000-coronavirus-deaths-20200316-p54amn.html

Objective was the much quoted “flatten the curve” so that hospitals wouldn’t be overwhelmed. Although Australia rapidly squashed rather than flattened the curve, with less than 100 deaths to date, the Government then completely changed the initial objective to that of virtually eliminating the virus. Hospitals here have thousands of unused ventilators. Despite this, Australia’s still under extreme lockdown, with restrictions only very gradually being eased, with resulting catastrophic damage to the economy. Extra suicides alone will be far more than China virus deaths.

[4MyEgo]

It's a tough call and closing down economies is not going to sort it I agree, but as soon as countries open up again, it will start to climb and take lives again IMO.

 

I don't have the answers, but if anything is to learn from this, is that governments need to inject big dollars in the area of cures for viruses and less in arms that destroy people in a different way.

 

 

[Moonlover]

There is an article that I came across this morning in the Lancet by a Dr. Johan Giestecke, entitled 'The Invisible Pandemic'. One passage from it really struck home to me.

 

'These facts have led me to the following conclusions. Everyone will be exposed to severe acute respiratory syndrome coronavirus 2, and most people will become infected. COVID-19 is spreading like wildfire in all countries, but we do not see it—it almost always spreads from younger people with no or weak symptoms to other people who will also have mild symptoms. This is the real pandemic, but it goes on beneath the surface, and is probably at its peak now in many European countries'.

 

We now know that Covid 19 was around in China from as early as mid Nov last year and that thousands of Chinese were still travelling to Thailand. It is highly likely that the virus has been spreading through the Thai community, undetected ever since. It wasn't until we got the 'heads up' from the WHO that we become aware of it.

 

In imposing the subsequent social lock down, the authorities have IMO inadvertently, but with the best of intentions, slammed closed the stable door, long after the horse as bolted.

 

I reckon we've already had our 'first wave' and are already well into our second one and 'lock down' is actually having little effect.

 

See the reference for the full article.

 

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31035-7/fulltext?rss=yes#

[Mama Noodle]

11 minutes ago, 4MyEgo said:

It's a tough call and closing down economies is not going to sort it I agree, but as soon as countries open up again, it will start to climb and take lives again IMO.

 

But you're missing the point. The goal was never to keep people from dying, the goal was to stretch those deaths out over time so that hospitals don't get overwhelmed. That was the goal. The area under the line has the same amount of sickness as the peak above it.

 

 

[4MyEgo]

6 minutes ago, Mama Noodle said:

But you're missing the point. The goal was never to keep people from dying, the goal was to stretch those deaths out over time so that hospitals don't get overwhelmed. That was the goal. The area under the line has the same amount of sickness as the peak above it.

I don't think I am missing the point, if hospital did get overwhelmed, more and more people would have been dying, including doctors and nurses who we need at the coalface.

[Relocated]

Growing up in the third world and spending the most of life in the first world, I see some common denominator in pandemic. Unusually high rate of chaos in mostly developed countries of the first world compare to the poverty ridden countries with filthy street with discharged sewer and people living in dense ghetto. 

 

I usually see a doctor or go to emergency room on weekend whenever I don't feel good. Why not? Insurance pays for it. They love to do all kinds of tests. I usually get some prescription for medicine which I get from pharmacy but usually never take, insurance pays for it. 

 

On the other hand, my father who was born before WWI, never had seen a doctor or went to hospital. He just never complained whether he is sick or not, and had no concept of seeing a doctor or going to hospital. But he lived long and passed away after 85th birthday. So he is not included in any medical statistics. 

 

The spoiled population of well-to-do in the first world combined with excitement of saving the world professions and breaking news hungry journalism might contributed this over hyped pandemic phenomena. It just simply don't ring the bell why all those place with filthy and nasty dwellings and environment has low epidemic result in statistics. 

 

I may be wrong though.     

[Mama Noodle]

5 minutes ago, Moonlover said:

There is an article that I came across this morning in the Lancet by a Dr. Johan Giestecke, entitled 'The Invisible Pandemic'. One passage from it really struck home to me.

 

'These facts have led me to the following conclusions. Everyone will be exposed to severe acute respiratory syndrome coronavirus 2, and most people will become infected. COVID-19 is spreading like wildfire in all countries, but we do not see it—it almost always spreads from younger people with no or weak symptoms to other people who will also have mild symptoms. This is the real pandemic, but it goes on beneath the surface, and is probably at its peak now in many European countries'.

 

We now know that Covid 19 was around in China from as early as mid Nov last year and that thousands of Chinese were still travelling to Thailand. It is highly likely that the virus has been spreading through the Thai community, undetected ever since.

 

I suspect the same thing, which is why in my opinion just testing for the virus itself is bordering on pointless if you don't test for antibodies as well. Thats the only way to really know just how much spread there is/was. Im itching for lockdowns to drop so I can drive to bangkok and pay for an antibody tests on myself. 

 

Its pure luck that Thailand wasn't as badly affected as western nations but I suspect theres a few reasons for that, which will become more clear as time goes on. 

 

Places like India for example. How the heck do they only have 1,895 reported deaths. India should be a breeding ground with the way people live over there and you'd think there would be mass graves everywhere, but there isn't. 

[Mama Noodle]

1 minute ago, 4MyEgo said:

I don't think I am missing the point, if hospital did get overwhelmed, more and more people would have been dying, including doctors and nurses who we need at the coalface.

 

But very few hospitals have been overwhelmed, thats the point. You originally said that if you open up, more people will die. Thats true, but was never the objective, and its also an impossible proposition for most countries because the virus is not going anywhere until there's a vaccine (which isn't even confirmed possible yet). So we've gone full circle from "Flatten the Curve" to "Eliminate the Virus". 

[Mama Noodle]

10 minutes ago, Retarded said:

The spoiled population of well-to-do in the first world combined with excitement of saving the world professions and breaking news hungry journalism might contributed this over hyped pandemic phenomena. It just simply don't ring the bell why all those place with filthy and nasty dwellings and environment has low epidemic result in statistics. 

 

I may be wrong though.     

 

There is some sort of logic here no doubt. Developed nations getting wrecked (apparently) yet developing countries and poor countries not so much (apparently). 

[4MyEgo]

9 minutes ago, Mama Noodle said:

But very few hospitals have been overwhelmed, thats the point. You originally said that if you open up, more people will die. Thats true, but was never the objective, and its also an impossible proposition for most countries because the virus is not going anywhere until there's a vaccine (which isn't even confirmed possible yet). So we've gone full circle from "Flatten the Curve" to "Eliminate the Virus".

Hospitals were starting to be overwhelmed in different countries around the world, not all, then we went into lock down, look at Italy, France, Spain, America, what happened there ?

 

By Flattening the Curve, we are not Eliminating the virus, I don't know who said that, we are maintaining the spread of it, as for how long these measures can stay in place is another thing, because economies will collapse, so what do they do, start it up again and hope that the hospitals are not overwhelmed and herd immunity kicks in, I have no idea, I am just sitting on the fence with the rest of the herd.

[Mama Noodle]

4 minutes ago, 4MyEgo said:

Hospitals were starting to be overwhelmed in different countries around the world, not all, then we went into lock down, look at Italy, France, Spain, America, what happened there ?

Yes, In some areas of those countries SOME hospitals were nearing being overwhelmed and lockdowns flattened the curve and relieved the stress. But most hospitals globally have not been anywhere near being overwhelmed. 
 

America has a huge landmass and large population. What happens in New York does not need to apply to Florida (for example). 
 

So what do we do. Thailand for example is wrecking its economy over 50-something deaths. Does that seem reasonable to you? Doesn’t to me. 
 

 

[yuyiinthesky]

46 minutes ago, Mama Noodle said:

 

But you're missing the point. The goal was never to keep people from dying, the goal was to stretch those deaths out over time so that hospitals don't get overwhelmed. That was the goal. The area under the line has the same amount of sickness as the peak above it.

 

 

Thanks so much for posting this. That is exactly the point.

 

The only reason for the measures was to "not overwhelm" the hospitals, and in many countries they were never overwhelmed. So all the lockdowns there were not needed. Making no difference whatsoever to the number of direct deaths, but a huge difference to the economic situation of the poorer part of the population.

[yuyiinthesky]

55 minutes ago, Moonlover said:

There is an article that I came across this morning in the Lancet by a Dr. Johan Giestecke, entitled 'The Invisible Pandemic'. One passage from it really struck home to me.

 

'These facts have led me to the following conclusions. Everyone will be exposed to severe acute respiratory syndrome coronavirus 2, and most people will become infected. COVID-19 is spreading like wildfire in all countries, but we do not see it—it almost always spreads from younger people with no or weak symptoms to other people who will also have mild symptoms. This is the real pandemic, but it goes on beneath the surface, and is probably at its peak now in many European countries'.

 

We now know that Covid 19 was around in China from as early as mid Nov last year and that thousands of Chinese were still travelling to Thailand. It is highly likely that the virus has been spreading through the Thai community, undetected ever since. It wasn't until we got the 'heads up' from the WHO that we become aware of it.

 

In imposing the subsequent social lock down, the authorities have IMO inadvertently, but with the best of intentions, slammed closed the stable door, long after the horse as bolted.

 

I reckon we've already had our 'first wave' and are already well into our second one and 'lock down' is actually having little effect.

 

See the reference for the full article.

 

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31035-7/fulltext?rss=yes#

That's it, yes, the virus went through Thailand already. 

It was also in France much earlier than they said, not end of January, but in December already -  just, as everywhere, nobody knew, nobody looked for it.
 

If the virus made it to France at that time already, of course it was already on a field trip in Thailand. 

As you said:

 

58 minutes ago, Moonlover said:

In imposing the subsequent social lock down, the authorities have IMO inadvertently, but with the best of intentions, slammed closed the stable door, long after the horse as bolted.

That's it what happened, all the measures had been after the fact, not really needed anymore, not really having much effect anymore, too late.

And any talk about eliminating the virus, containing it is far too late too. 

Nevertheless - we're still alive ????

 

 

[impulse]

Compare and contrast the "Daily Cases" curves for some of the different countries and it appears that some may have implemented the lockdowns after the fact, and others are just starting to see the virus taking off.

 

Select the country on the far left, then pull up the "Daily Cases" tab on the lower right.  Have a look at Russia, for example.  Scary...

 

https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

[JohnBZ]

I think most government do not know what they want to achieve.  I think the restriction should be applied to the point that hospitals will not be overwhelmed.  In a country like Thailand, it is safe to have 20000 active cases, no problem as Thailand has 60000 hospital beds.  Enough margin of safety to set the alert level at 20000.

 

Before that, business should go on as normal as possible IMHO

[Kinnock]

'Flattening the curve'

'Shelter at home'

'Social distancing'

 

I've had over 40 years of public health experience, and all these buzz words are just intelectual masturbation for people with no real experience of community infection control.

 

As soon as there's evidence of person to person spread in separate, multiple locations, plus reports of mild or symptomless cases, it's too late for effective controls.

 

You then to switch to public education campaigns and let the hospitals develop treatment strategies whist waiting for it to mutate to a milder form, or enough people catch it and develop immunity so it fades out.

 

Anything else is just causing economic damage for zero benefit.  Quarantine for healthy people just prolongs the pandemic and increases the chances of people losing their immunity and catching it again.  Before we all expected to be protected from everything, parents would have Chicken Pox or German Measels Parties so all the local kids could catch it at the same time and get it over with quickly.  They also knew that (like COVID-19), it's better to catch some diseases when you're young.

 

And in general, successful (for the virus) mutations tend to be to a milder form, as any mutations resulting in a more deadly illness will tend to self limit.

 

SARS faded out after mutations and/or herd immunity ..... I was working in HK and Taiwan at the time, and thrre's no way the government controls had any real impacts.

 

The panicking politicians should be held accountable for the misery they have caused through their negligent actions.  Mass unemployment will have greater health impacts than the virus

[Scott]

A post with unsubstantiated information has been reported and removed. 

 

[cmarshall]

8 hours ago, Moonlover said:

There is an article that I came across this morning in the Lancet by a Dr. Johan Giestecke, entitled 'The Invisible Pandemic'. One passage from it really struck home to me.

 

'These facts have led me to the following conclusions. Everyone will be exposed to severe acute respiratory syndrome coronavirus 2, and most people will become infected. COVID-19 is spreading like wildfire in all countries, but we do not see it—it almost always spreads from younger people with no or weak symptoms to other people who will also have mild symptoms. This is the real pandemic, but it goes on beneath the surface, and is probably at its peak now in many European countries'.

 

We now know that Covid 19 was around in China from as early as mid Nov last year and that thousands of Chinese were still travelling to Thailand. It is highly likely that the virus has been spreading through the Thai community, undetected ever since. It wasn't until we got the 'heads up' from the WHO that we become aware of it.

 

In imposing the subsequent social lock down, the authorities have IMO inadvertently, but with the best of intentions, slammed closed the stable door, long after the horse as bolted.

 

I reckon we've already had our 'first wave' and are already well into our second one and 'lock down' is actually having little effect.

 

See the reference for the full article.

 

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31035-7/fulltext?rss=yes#

You can find interviews with Giesecke on youtube.  He is exceptionally dishonest.

 

In the first place, Sweden failed to contain the virus.  They failed develop a pandemic response plan in the seventeen years since SARS.  They did not maintain surveillance of emerging viruses in China or Africa.  Therefore they missed the opportunity in December or January to initiate an aggressive containment plan to contain the virus which was successful with SARS and MERS.  Once containment has failed the state then faces the lockdown/no lockdown choice which is indeed a lose/lose proposition.  But it is entirely their own fault that they find themselves in that position.

 

Taiwan was the opposite.  They shutdown flights from China in January.  Although they never had a complete shutdown they stopped sports matches, closed brothels, required masks in public, etc.  The result that Taiwan with 28 million people has had 355 cases of Covid infection and six deaths.  S. Korea, with a population of 51 million has had 256 deaths.

 

So when we hear Giesecke attempt to explain away Sweden's much higher death rate compared to its Scandanavian neighbors by claiming that all countries will eventually have have the same death rate, we know that he is lying through his teeth. He also blithely claims that Sweden's policies are based purely on science and that herd immunity will eventually prevail.  Sweden's current policy is to throw up their hands and allow their old people to die, which they are doing rapidly in nursing homes for which the government has not provided additional protection.  This policy is based on the expectation that Covid infection will result in immunity.  But that is unknown at this point.  So Sweden's policy of maximizing deaths is not based on science at all.

 

Giesecke's lies are as vile as Trump's.

[thaibeachlovers]

10 hours ago, CygnusX1 said:

Yes, exactly the same thing has happened in Australia.

and in NZ.

[thaibeachlovers]

11 minutes ago, cmarshall said:

So when we hear Giesecke attempt to explain away Sweden's much higher death rate compared to its Scandanavian neighbors by claiming that all countries will eventually have have the same death rate, we know that he is lying through his teeth.

and you know that because.............................?

Only IF and WHEN a vaccine is developed, possibly 18 months, will people at risk cease to be, IF they can have the vaccine.

Lockdowns only delay infection; they do not eliminate it.

 

BTW, if a vaccine was the magic bullet, no one would die of flu, but thousands do.

[thaibeachlovers]

16 minutes ago, cmarshall said:

Taiwan was the opposite.

and only till they have to open up to save their economy. Delayed, but not eliminated.

 

Why do people think that because the infection rate falls during lockdown that the threat is eliminated?

[thaibeachlovers]

6 hours ago, Kinnock said:

Before we all expected to be protected from everything, parents would have Chicken Pox or German Measels Parties so all the local kids could catch it at the same time and get it over with quickly. 

As happened with me.

 

The real killer, polio, was feared till the vaccine was available. No one stopped their kids having it, and polio is unknown in the west now.

[Mama Noodle]

7 hours ago, impulse said:

Compare and contrast the "Daily Cases" curves for some of the different countries and it appears that some may have implemented the lockdowns after the fact, and others are just starting to see the virus taking off.

 

Select the country on the far left, then pull up the "Daily Cases" tab on the lower right.  Have a look at Russia, for example.  Scary...

 

But taking it in at "Daily Cases" isn't an accurate picture because as this progresses so does testing capacity. As testing becomes more available so do the confirmed cases. A more accurate metric would be to look at hospitalizations due to the virus. Most cases will not need hospitalization.  

[hotandsticky]

7 minutes ago, Mama Noodle said:

 

But taking it in at "Daily Cases" isn't an accurate picture because as this progresses so does testing capacity. As testing becomes more available so do the confirmed cases. A more accurate metric would be to look at hospitalizations due to the virus. Most cases will not need hospitalization.  

 

 

Russia is a classic case.

 

 

Rather than being "scary" as a previous poster said they simply reflect increased testing.... almost 5m tests, 187,000+ cases with almost 11,000 confirmed yesterday. BUT, only 1.723 deaths with a death rate of 12 per million of the population. 

[Mama Noodle]

42 minutes ago, cmarshall said:

Giesecke's lies are as vile as Trump's.

 

It would be nice if you could keep politics out of it and just stick with trying to maintain an objective discussion on Covid response. Not trying to make this a political thread, and when people bring politics in, the blinders go on. 

[Mama Noodle]

44 minutes ago, cmarshall said:

In the first place, Sweden failed to contain the virus.  They failed develop a pandemic response plan in the seventeen years since SARS.  They did not maintain surveillance of emerging viruses in China or Africa.  Therefore they missed the opportunity in December or January to initiate an aggressive containment plan to contain the virus which was successful with SARS and MERS.  Once containment has failed the state then faces the lockdown/no lockdown choice which is indeed a lose/lose proposition.  But it is entirely their own fault that they find themselves in that position.

 

Taiwan was the opposite.  They shutdown flights from China in January.  Although they never had a complete shutdown they stopped sports matches, closed brothels, required masks in public, etc.  The result that Taiwan with 28 million people has had 355 cases of Covid infection and six deaths.  S. Korea, with a population of 51 million has had 256 deaths.

 

So when we hear Giesecke attempt to explain away Sweden's much higher death rate compared to its Scandanavian neighbors by claiming that all countries will eventually have have the same death rate, we know that he is lying through his teeth. He also blithely claims that Sweden's policies are based purely on science and that herd immunity will eventually prevail.  Sweden's current policy is to throw up their hands and allow their old people to die, which they are doing rapidly in nursing homes for which the government has not provided additional protection.  This policy is based on the expectation that Covid infection will result in immunity.  But that is unknown at this point.  So Sweden's policy of maximizing deaths is not based on science at all.

 

Here we have 2 completely different approaches to Covid. Sweden and Taiwan. Sweden followed the logic of most western, developed nations that the virus is going to run its course. Taiwan felt that it could contain and eliminate the virus. These 2 approaches are completely different so comparing them is a false equivalence. 

 

SARS and MERS petered out on their own before a vaccine was even needed, so it was just dumb luck yet again that it wasn't worse. Also a false equivalence. 

 

Sweden does not have a "maximizing death" policy no more than anyone else who is going by the generally accepted science that after a certain infection point, the virus is going to run its course no matter what you do, even when you "Flatten the Curve" you are just spreading it out over time.

[cmarshall]

45 minutes ago, thaibeachlovers said:

and only till they have to open up to save their economy. Delayed, but not eliminated.

 

Why do people think that because the infection rate falls during lockdown that the threat is eliminated?

Reading skills not quite up to snuff?  Taiwan never had a full lockdown.  New Zealand and Australia, who also managed the infection extremely well and have effectively eliminated the virus, are considering retaining the ban on incoming flights and allowing travel only between their two countries.  That's how you keep the infection out until it has run its course among the badly governed nations.

[Mama Noodle]

2 minutes ago, cmarshall said:

Reading skills not quite up to snuff?  Taiwan never had a full lockdown.  New Zealand and Australia, who also managed the infection extremely well and have effectively eliminated the virus, are considering retaining the ban on incoming flights and allowing travel only between their two countries.  That's how you keep the infection out until it has run its course among the badly governed nations.

 

The only way any of the above points work is if every country is exactly the same in terms of climate, landmass, population, natural borders, and societal norms - which they are not. 

 

Its a false equivalence to compare New Zealand to, say, The USA or Italy. Or Oz to, say, New York. And its an insult to intelligence to say that harder hit countries are hit harder because they are badly governed and lesser hit countries are better governed. 

 

And again you are faced with the dilemma that you've contained the virus for now, but a vaccine (if its even possible) could be more than 18 months away. 

 

Now if by luck the virus appears to be able to be contained, then pushing forward with containment and lockdowns is possible, but should be sold to the population in its real terms - Eliminate the Virus and stay completely isolated for 18 months (if its even possible) before a vaccine is available, and the consequences being serious economic hardship in the long term. 

[Laza 45]

If you look at the countries that have been most successful at containing the virus...Taiwan, South Korea, Australia, New Zealand and China and Thailand too....all these countries enforced stay at home, social distancing, wearing of masks, hygiene with sanitisers etc.. they have all reached a point now where they can now quickly identify new infections.. act quickly and prevent the spread.. They are all in a position to carefully open their economies again.. they are the winners in the race to 'open up'.. they will be the first to open their tourism industries.. the first to open trade between each other..  and they are now in a position to react quickly to any threat of a second wave..  ...the alternative?  ..look at the US total chaos.. and no end in sight..