Covid-- exit strategies

[adc82140]

As a break from the doom and gloom, let's look at possible ways out of this. There are more than you think.

1. A vaccine. The big problem with this is that it may or may not happen. It looks promising, but not guaranteed. It may end up being partially successful like the flu jab, but enough to get us back to normal. There's also the thought that a certain element of society will be placated if they are simply told it works!

2. An effective treatment. This is where I think we should be heading. We have Dexamethasone. We have Rendesivir. These are known to reduce hospital stays and the death rate. More treatments are being investigated all the time.

3. Herd immunity. Let's see how Sweden pans out.

4. It just fizzles out or becomes less dangerous. Possible. A virus exists to replicate. It won't exist for long if it kills its host, so will tend to mutate to make you less ill.

5. Mass testing. Spit in a pot before you go in to a venue, and wait a few minutes for the results. Spit in a pot before you leave the house in the morning to go to school/work/Tescos. The ability to do this is just round the corner.

Whatever happens, in 12 months time, or even 6 months, we are unlikely to be facing restrictions on our day to day lives. The government can't afford it. Society is tolerant up to a point.

Your thoughts?

 

[Richard Scott]

Currently options 3 and 4. We have no idea how long or how effective a vaccine is. We need a definite policy now as other issues are on the rise such as mental health problems (as some on this forum are saying they are suffering) and possibly other medical issues that have been neglected recently such as cancer treatments, not to mention the economic impact.

 

[duncanp]

Of your five options, I think effective treatments and mass testing are the most likely to be available soon.

There needs to be some triage in the testing system, so that schools do not send a whole year group home, and require them to have a test, just because one pupil has a slight sniffle.

Similarly for the general population - we need to screen out the "worried well" from the testing system, so they cannot book a test just because they have a slight cough.

We also need to look at the age distribution of the new cases, as we know that the rate of hospitalisation, the chance of needing to be ventilated, and the risk of death, varies greatly with age. It should be possible to use the data to predict the numbers requiring hospitalisation in a few weeks time, so that capacity can be managed.

I do hope that the saliva test is proven to be effective. Then a wide range of people can be trained to administer it, and testing kits could be sent out to schools, workplaces, GP surgeries and pharmacies. So if one school pupil feels unwell, he or she can be isolated for the 20 minutes or so it takes to administer the test and wait for the result. Depending on the result, the most appropriate action can be taken.

 

[Bantamzen]

As a break from the doom and gloom, let's look at possible ways out of this. There are more than you think.

1. A vaccine. The big problem with this is that it may or may not happen. It looks promising, but not guaranteed. It may end up being partially successful like the flu jab, but enough to get us back to normal. There's also the thought that a certain element of society will be placated if they are simply told it works!

The problem with depending on a vaccine strategy is that is there is guarantee that one will be successful, or will have any long term effectiveness. And even if one is proved to be successful, it will be months maybe even years before it can be fully distributed. We simply can't wait that long.

2. An effective treatment. This is where I think we should be heading. We have Dexamethasone. We have Rendesivir. These are known to reduce hospital stays and the death rate. More treatments are being investigated all the time.

This is certainly one of the best ways, having effective treatment & measures to get that to people that need it swiftly.

3. Herd immunity. Let's see how Sweden pans out.

Ultimately this is going to have to be the way forward, along with #2.

4. It just fizzles out or becomes less dangerous. Possible. A virus exists to replicate. It won't exist for long if it kills its host, so will tend to mutate to make you less ill.

Its not going to fizzle out, although it may mutate in time. However we will over time develop stronger immunity to it so long as it remains in circulation.

5. Mass testing. Spit in a pot before you go in to a venue, and wait a few minutes for the results. Spit in a pot before you leave the house in the morning to go to school/work/Tescos. The ability to do this is just round the corner.

Mass testing would be way too expensive, and isn't really an exit strategy, just another restriction. What happens if one day half the population wakes up with it? The entire country grinds to a halt?

Whatever happens, in 12 months time, or even 6 months, we are unlikely to be facing restrictions on our day to day lives. The government can't afford it. Society is tolerant up to a point.

Your thoughts?

I'd love to share your confidence, but so far governments and local councils seem to be enjoying making up new ones.

 

[brad465]

2 and 3 combined I think. 2 primarily as this is what takes out the severity of severe cases and reduces loads on hospitals. If this is readily applied and almost everything else continues as normal then 3 will naturally occur in time.

 

[yorkie]

It's not going to go away; it cannot be eliminated.

It seems unlikely that sufficient people can be tested so that every case is detected in a timely manner; most people do not realise they had it. Anitgen tests can come back positive even if you are not infectious:

Coronavirus: Tests 'could be picking up dead virus'

Scientists say a positive coronavirus result does not guarantee that someone is infectious.

www.bbc.co.uk

The main test used to diagnose coronavirus is so sensitive it could be picking up fragments of dead virus from old infections, scientists say.

Most people are infectious only for about a week, but could test positive weeks afterwards.

There is also no affordable/effective way to test for immunity, or detect who has had an asymptomatic or mild infection either.

The only achievable way out is to build up sufficient immunity in the population to slow down the spread and also to reduce the number of severe infections by shielding vulnerable elderly people.

There are two ways to build up immunity: either to recover from the virus (or to have pre-existing immunity), or to be vaccinated. I believe immunity will be achieved by a combination of these. So far the news is good on this front:

Persistent immune memory of COVID-19 found in recovered patient T cells | University of Oxford

Oxford University researchers have found that infection with COVID-19 produces a robust T cell response, including inducing T cell ‘memory’ to potentially fight future infections.

www.ox.ac.uk

The researchers also found that the spike protein of SARS-CoV-2 was often recognised by T-cells from recovered patients, which adds support for the approaches used by many of the current vaccines in development, including the Oxford vaccine. The research team additionally found that other parts of the virus, including its membrane and its nucleoprotein, also provoked a strong T cell immune response, potentially providing other vaccine targets too.

People who argue for elimination of the virus tend to lack knowledge of how the immune system actually works; they often ignore the role of T cells in fighting infections such as Sars-Cov-2; they often ignore the social and economic impacts; they tend to ignore the obvious need to value the life of (say) a 20 year old over the life of (say) a 90 year old.

I don't know of anyone with any gravitas who claims this virus can be eliminated, or indefinitely suppressed, who can actually come up with a convincing argument. It's a fallacy peddled by people who have failed to carry out even a modicum of research.

 

[Camden]

I disagree that in 12 month's time we can't still be facing restrictions. Don't forget that wars go on for years. WWII inflicted continual and devastating damage on this country for years on end and people had to, and did, live with that.

In all but 3 and 4, the virus needs to be in low circulation as a precursor, so we need to get there first and that seems to be the main focus of restrictions - making it manageable.

Elsewhere, in response to someone who suggested that at risk people should remain indoors for the foreseeable to let them go about their mask-free business (paraphrasing), I sarcastically suggested that could be flipped so the at risk and responsible people can go about theirs. But who knows what actual restrictions they will come up with, as they grapple with options to keep things open while reducing the spread. As long as the majority support it, even begrudgingly, the restrictions will continue for as long as they are needed.

If it was a flu it would eventually go away (ie 4), but this isn't like that, so it's looks like a vaccine plus better treatments combined with keeping a lid on it is the only real option available. There probably is no actual "exit strategy" available as such.

 

[Bletchleyite]

Mass testing would be way too expensive, and isn't really an exit strategy, just another restriction. What happens if one day half the population wakes up with it?

That's a silly "what if" because it is impossible - if one day it's in only a few people, the next day it can at most be in every person that person spoke to that day, which isn't going to be more than maybe 100-200 people even in people who have a lot of close contact e.g. bar staff.

 

[Bantamzen]

That's a silly "what if" because it is impossible - if one day it's in only a few people, the next day it can at most be in every person that person spoke to that day, which isn't going to be more than maybe 100-200 people even in people who have a lot of close contact e.g. bar staff.

OK maybe a little over the top, but I noticed you avoided the cost issue. On average how many people do you imagine would need a daily test?

 

[Bletchleyite]

OK maybe a little over the top, but I noticed you avoided the cost issue. On average how many people do you imagine would need a daily test?

Depends how effective you want it to be and how cheap you can get it! If you tested everyone once daily and isolated positives for 14 days you could probably wipe it out entirely. You would gain various levels of control depending on how much you stepped down from that.

 

[Yew]

I disagree that in 12 month's time we can't still be facing restrictions. Don't forget that wars go on for years. WWII inflicted continual and devastating damage on this country for years on end and people had to, and did, live with that.

This virus isn't Kaiser Wilhelm or Adolf Hitler, which we must defeat to protect our way of life. Our efforts to defeat* this are the threat to our way of life.


* attempting something that has never been shown to work, and before this our scientists would have considered impossible.

 

[Bantamzen]

Depends how effective you want it to be and how cheap you can get it! If you tested everyone once daily and isolated positives for 14 days you could probably wipe it out entirely. You would gain various levels of control depending on how much you stepped down from that.

No, you really couldn't. I thought we'd already all but established that eliminating a virus completely is virtually impossible.

As for cost, well a quick search reveals anywhere between $20-$850 per test. So lets go with the lowest rounded down to say £10 per test. Now let's say 10 million per a day on average leave their homes, that would mean a cost of £100 million per day, £3 billion a month or £36 billion a year, which is around a quarter of the current NHS budget. All just to be able to interact with other people. Nah sorry, that is way too much of a cost.

 

[HSTEd]

As for cost, well a quick search reveals anywhere between $20-$850 per test. So lets go with the lowest rounded down to say £10 per test. Now let's say 10 million per a day on average leave their homes, that would mean a cost of £100 million per day, £3 billion a month or £36 billion a year, which is around a quarter of the current NHS budget. All just to be able to interact with other people. Nah sorry, that is way too much of a cost.

Compared to the insane costs of the other options that the ruling class is willing to countenance, this is positively reasonable.

Ofcourse I am worried about the panopticon but that fight is already well lost.

 

[Bantamzen]

Compared to the insane costs of the other options that the ruling class is willing to countenance, this is positively reasonable.

Ofcourse I am worried about the panopticon but that fight is already well lost.

Remember though I'm talking about about around 15% of the population out on one day. If the average were higher costs would also be much higher. And it wouldn't just be the cost of the tests either, there is the logistics of having enough testing sites open 24/7 to service 10 million people or more.

 

[Mag_seven]

Elsewhere, in response to someone who suggested that at risk people should remain indoors for the foreseeable to let them go about their mask-free business (paraphrasing), I sarcastically suggested that could be flipped so the at risk and responsible people can go about theirs.

Actually the latest NHS advice for even the most at risk people is not much different to the rest of us - there is no requirement for them to "remain indoors for the foreseeable":

How to avoid catching and spreading COVID-19 infection.

Read NHS advice about how to reduce your risk of catching and spreading COVID-19 infection, and ease your symptoms at home.

www.nhs.uk

You should follow the same social distancing advice as everyone else.

Do

• try to stay at least 2 metres (3 steps) away from anyone you do not live with (or anyone not in your support bubble)
• wash your hands with soap and water often – do this for at least 20 seconds
• use hand sanitiser gel if soap and water are not available
• wash your hands as soon as you get home
• wear something that covers your nose and mouth in places where it's hard to stay away from other people, such as on public transport, in shops and in hospitals

 

[Camden]

This virus isn't Kaiser Wilhelm or Adolf Hitler, which we must defeat to protect our way of life. Our efforts to defeat* this are the threat to our way of life.

* attempting something that has never been shown to work, and before this our scientists would have considered impossible.

Your opinion, presented here as fact, is a minority one. Saying "to hell with the consequences" and accepting the avoidable deaths of hundreds of thousands does not represent my way of life.

Anyone would think you're having to live on rations and being kept in pens, rather than being asked to join in with some very minor collective efforts to reduce spread and limit the need for restrictions. The whining is pathetic.

 

[Yew]

Your opinion, presented here as fact, is a minority one. Saying "to hell with the consequences" and accepting the avoidable deaths of hundreds of thousands does not represent my way of life.

Anyone would think you're having to live on rations and being kept in pens, rather than being asked to join in with some very minor collective efforts to reduce spread and limit the need for restrictions. The whining is pathetic.

I'm struggling to understand what questionable opinions that I'm presenting as fact here ? That this has changed our quality of life for the worst is self-evident, perhaps you have a post-lockdown stockholm syndrome, but don't presume the rest of us pine for the days of the Thursday NHS clap. I feel that saying that this isn't a human enemy is fairly uncontroversial, and since we've never managed to suppress a respiratory illness disease in widespread intercontinental circulation before, the null hypothesis says we must assume it won't work.

You cant say that I'm presenting evidence as fact, and then magic up hundreds of thousands of avoidable deaths without any evidence. If you're referring to the predictions from Niel Fergursons questionable models, based on sketchy assumptions, that haven't been peer reviewed, then you're going to have to do a hell of a lot better than that.

 

[scarby]

A Danish professor whose specialisations include epidemics has now suggested that Sweden’s epidemic “may be over”.

On the positive side they may be finished with the epidemic

he said.

See: https://www.thelocal.se/20200919/swedens-pandemic-may-be-finished-danish-researcher

 

[BJames]

Anyone would think you're having to live on rations and being kept in pens, rather than being asked to join in with some very minor collective efforts to reduce spread and limit the need for restrictions. The whining is pathetic.

I don't think that some of what we are being asked to do is minor.

Rule of six
Not meet anyone outside our household (dependent on where you live)
Wear a mask at all times indoors

Only meeting with six people at all times is not a minor inconvenience for me, or for others. If it is for you that's fine but please don't assume that it is for others or detract from the very real efforts we are making here.

In terms of exit strategies I agree that relying on a vaccine is not a good idea. While it seems 2 or 3 would make the most sense, the government's "Moonshot" plan appears to indicate that they're hoping for number 5 while 1 or 2 are unavailable.

But as said upthread as well, effective treatments have already progressed significantly and the death toll is considerably lower day-on-day than what it was at the start.

 

[Richard Scott]

Your opinion, presented here as fact, is a minority one. Saying "to hell with the consequences" and accepting the avoidable deaths of hundreds of thousands does not represent my way of life.

Anyone would think you're having to live on rations and being kept in pens, rather than being asked to join in with some very minor collective efforts to reduce spread and limit the need for restrictions. The whining is pathetic.

Ok, so you're happy with it all, some of us aren't and also we haven't fallen for the it's killing thousands. Lots of people are dying of other illnesses that possibly could have been treatable but haven't sought treatment as felt they might be a burden on NHS or couldn't as nothing was available. You're ok with that fact (and it is a fact as many cancer units were closed and A and E departments due to fuss over the virus) I hope? A bit of a reality and fact check needed before saying that the whining is pathetic.

 

[Philip Elliott]

Are people still pushing this fallacy that elimination is impossible when more than 10 countries have already done so? It is quite clear that many people don’t understand the difference between elimination and eradication.

From the WHO:

a definition of control as a reduction in the incidence, prevalence, morbidity or mortality of an infectious disease to a locally acceptable level; elimination as reduction to zero of the incidence of disease or infection in a defined geographical area; and eradication as permanent reduction to zero of the worldwide incidence of infection.

The same people who people who say elimination is impossible say they want herd immunity - which is an elimination strategy (but can only be achieved by vaccination).

 

[bramling]

Your opinion, presented here as fact, is a minority one. Saying "to hell with the consequences" and accepting the avoidable deaths of hundreds of thousands does not represent my way of life.

Anyone would think you're having to live on rations and being kept in pens, rather than being asked to join in with some very minor collective efforts to reduce spread and limit the need for restrictions. The whining is pathetic.

The last lockdown certainly wasn’t a minor inconvenience. People have lost their jobs because of it, and many more will do so over coming months.

For those sort of consequences there needs to be a pretty strong justification. Saving lives may be a very noble aim, but is it a realistic one if all it does is kicks the can down the road? We can’t keep on gambling on the appearance of an effective vaccine, and not can we keep locking down every few weeks.

 

[yorkie]

Are people still pushing this fallacy that elimination is impossible when more than 10 countries have already done so?

Which countries have done this, how did they achieve it, and what would we have to go to achieve it, and maintain that status?

It is quite clear that many people don’t understand the difference between elimination and eradication.

It's also quite clear that some people have completely mistaken ideas about how easily this virus spreads and how difficult it is to detect who has it, given that most people are asymptomatic.

The same people who people who say elimination is impossible say they want herd immunity - which is an elimination strategy (but can only be achieved by vaccination).

You can word it however you like; the only way out of this ulimately is to develop immunity. There are two ways to develop immunity: one is through infections, and the other is through vaccinations. I believe that ultimately we will achieve high enough levels of immunity to end the pandemic, through a combination of these factors.

 

[Yew]

Are people still pushing this fallacy that elimination is impossible when more than 10 countries have already done so? It is quite clear that many people don’t understand the difference between elimination and eradication.

From the WHO:

The same people who people who say elimination is impossible say they want herd immunity - which is an elimination strategy (but can only be achieved by vaccination).

Elimination via herd immunity may be, however it can easily supress to a level that is acceptable, and that's before we consider disease-modifying immunity that will lessen the symptoms.

 

[DB]

Herd immunity is where a sufficient proportion of the population has immunity, meaning that spread is relatively limited - as we have with lots of diseases. It doesn't mean that it's completely gone away. As pointed out many times, the only formerly widespread human virus which was eradicated is Smallpox, and that took close to 200 years from the first vaccine for it.

 

[Yew]

Are people still pushing this fallacy that elimination is impossible when more than 10 countries have already done so?

Typically when one makes incredible assertions, one provides evidence.

 

[takno]

Are people still pushing this fallacy that elimination is impossible when more than 10 countries have already done so? It is quite clear that many people don’t understand the difference between elimination and eradication.

From the WHO:

The same people who people who say elimination is impossible say they want herd immunity - which is an elimination strategy (but can only be achieved by vaccination).

You may still respect the WHO, and previously I have done, but they have been shown up as utterly incompetent, useless and wildly out of touch with reality throughout this. I respect the work they have done over 40 years, but i think at some stage they have been captured by self-regarding fantasists and we are all paying the price.

People who try to differentiate between eradication and elimination are pointlessly splitting hairs. Elimination apparently isn't actually achievable even with a 3 month lockdown. And even if you get to elimination, elimination without eradication isn't an endgame, and in the modern world it isn't maintainable for most countries for any significant time. Basically it just seems to be a way to pretend you've got a plan when all you're actually doing is hammer and dance

 

[Yew]

You may still respect the WHO, and previously I have done, but they have been shown up as utterly incompetent, useless and wildly out of touch with reality throughout this. I respect the work they have done over 40 years, but i think at some stage they have been captured by self-regarding fantasists and we are all paying the price.

Indeed, it's an organisation for helping enhance healthcare in the developing world, not one to lead in a time of emergency.

 

[Bantamzen]

Your opinion, presented here as fact, is a minority one. Saying "to hell with the consequences" and accepting the avoidable deaths of hundreds of thousands does not represent my way of life.

Anyone would think you're having to live on rations and being kept in pens, rather than being asked to join in with some very minor collective efforts to reduce spread and limit the need for restrictions. The whining is pathetic.

Not being able to see other family members is not whining, suggesting that it is fine is downright despicable in my humble opinion.

 

[Philip Elliott]

Typically when one makes incredible assertions, one provides evidence.

Brunei, St. Vincent Grenadines, Macao, New Caledonia, Grenada, Saint Kitts and Nevis, Greenland, Falklands, Anguilla & The Holy See. You can easily check it yourself on worldometers. Yes they are all small, however China appears to be only importing casesso is elimanated from the community. It has pretty much gone from Vietnam, Mongolia, Thailand, Cambodia, Laos, Malaysia.