COVID-19: Unwinding the Lockdown and Long Term Epidemic

[Jin+Guice]

Short some miracle, we are still far away from returning to BAU, but when it does happen what does it look like? What would be the best method and what's most likely to happen?

Is there likely to be another outbreak after restrictions are relaxed?

Are we likely to reverse course and let the disease run its murderous course?

How do countries/ regions that have successfully eradicated the disease keep from getting reinfected by those who haven't?

Will this become a yearly epidemic? Will it routinely over run hospitals? Will the old and infirm routinely die from this in massively greater numbers than they die from the flu?

How does the ERE crowd plan to handle the scenario that they think will happen?

I realize this is just wild speculation at this point, but it's interesting to start thinking about.

[ertyu]

At this point, with the US, we really need to ask ourselves "what is the best way to unwind this?" and realize that that might not be the way in which it is actually unwound - as the unconscionable incompetence of this administration has demonstrated.

The best way to unwind it would be in stages. In china, for instance, even though businesses gradually were reopened (starting with manufacturing and going from there, but also gvt officials, banks, etc), schools are still closed. Friends say they will likely open either the first or second week of April - so a whole month after the rest of the economy restarted. Now, in China this is possible because families live together so grandma, if still alive, will take over child care. But in the west, the fact that many workers don't have child care available is a real consideration. Also in China, if cases resurface, they have shown no hesitation in closing non-essential bullshit businesses centered around people congregating, e.g. movie theaters, as soon as there's suspicion that cases are ramping up again.

So the tl;dr: is, it should unwind in fits and starts and in stages, but the fact that this is what should happen doesn't mean that I trust the US gvt to actually do so.

Also consider exogenous shocks: the death toll might be too large and there might be social unrest, which means gvt would need to consider not only what's feasible with the billionaires, but also, what's feasible with the great unwashed. Or, god willing, Trump and Pence might catch it and die, and president Pelosi might actually do the right thing. Etc.

[George the original one]

Short some miracle, we are still far away from returning to BAU, but when it does happen what does it look like? What would be the best method and what's most likely to happen?

The best method for BAU is to get a vaccine that is proven to have no side effects. I'll be conservative in lining up for the first vaccine that comes along because there's bound to be something wrong with it.

Short of a vaccine, we need a quick accurate test before we can trust allowing anybody to come close. I can see higher class venues having immune bouncers who administer the test before they let you through the door. I can also see crappy employers faking the tests to convince minimum wage workers it is safe.


Is there likely to be another outbreak after restrictions are relaxed?

IMHO, yes, because 97% of the USA population will be vulnerable to a virus rebound and there are lots of countries that are several weeks behind us on the infection trajectory.


Are we likely to reverse course and let the disease run its murderous course?

I doubt it, even in the USA. For one thing, Trump is now presenting a realistic view and getting better at saying what are his dreams rather than implying an alternate reality. The administration currently figures 3% of USA population will be exposed to the virus by end of this wave and have allocated the wave the appropriate time to, generally-speaking, not overwhelm hospital facilities.

For another thing, the infection trajectory has different timing in the various states. This is finally being acknowledged by most governors. For instance, Kansas will be starting their lockdown tomorrow. I don't know about the more dogmatic governors in Missouri and Mississippi and Florida. Note how the Administration has rewarded Florida for backing the Trump ideology by apparently giving them 3x more federal supplies than Washington state even though Washington state still leads Florida in cases. Florida has also set the stage for the hate game, by implying that New Yorkers are flying down to Florida as an escape from COVID-19 and Trump played it up.


How do countries/ regions that have successfully eradicated the disease keep from getting reinfected by those who haven't?

Open question. South Korea will do what's working for them. I expect China will have no qualm about shutting things down again if necessary; current options are kind of slim beyond monitoring borders and contact tracing. No one else has yet achieved a semblance of stability, though it appears Italy has turned the trajectory.


How does the ERE crowd plan to handle the scenario that they think will happen?

Speaking for myself, pretty much the same way I've lived so far. Probably increase my food reserve, continue being socially cautious until there is a vaccine and/or COVID-19 is completely burned out.

[C40]

I'm no expert at all.. but my gut feeling is:

- It's not possible in the U.S. to rid ourselves of the virus now and then go back to BAU completely (we can't just do a 2 week national lockdown and then be ok). Even if that were possible, BAU would only last as long as we maintain 100% border/entry lockdown, which won't happen.
- It seems the reasonable route would be to balance hospital capacity and keeping the economy running. That is, ideally: create enough restrictions that hospitals aren't fully overwhelmed... but keep the restriction limited/loose enough that they do keep hospitals near capacity. When/where hospitals are well below capacity, allow more business/work/leisure.. Work hard to increase treatment capacity which would allow treatment of more people and less strict lockdown requirements. I think these decisions would need to made in a 2nd order fashion since there are likely always more cases existing than we know about, and current hospital loads were caused by transmission that happened 1-3 weeks ago.

[Ego]

The best method for BAU is to get a vaccine that is proven to have no side effects.

I disagree. A relatively effective antibody therapy will get us to the point where we let it rip.

[CS]

I disagree. A relatively effective antibody therapy will get us to the point where we let it rip.

Antibody therapy comes with all sorts of risks. I've been on the receiving end of that for a different thing and I can never give blood for the rest of my life because of it.

[CS]

@c40
There is also the cost of hospital staff attrition. People like me will leave the field because it is no longer worth the risk, others will get sick and die. The incredibly high wages offered to nurses in Washington state are only the beginning. Unless a cure/vaccine is found soon, medicine will no longer be the attractive field it is now in the US.

[classical_Liberal]

Antibody therapy comes with all sorts of risks. I've been on the receiving end of that for a different thing and I can never give blood for the rest of my life because of it.

Plus it ain't cheap. Vaccines are.

[Ego]

Plus it ain't cheap. Vaccines are.

Absolutely. First azithromycin and chloroquine. If that fails then plasma therapy. Then on to the experimental genetically engineered expensive stuff.

Lockdowns ain't cheap either.

[classical_Liberal]

@ego
No doubt. Which is why I think the key to winding down is massive scale serology testing. If the models about high percentage of asymptomatic infections are accurate (disclaimer, this has yet to be proven), then we'd have a huge percentage of the population with antibodies. It's most likely these people would be relatively immune (disclaimer, this has yet to be proven conclusively). They are the economic engine jump starters while we wait for a vaccine.

If either of the above assumptions prove to not be accurate, or if serology testing is not possible/implemented, my guess is that we're looking at long term rolling shelter in place/social distancing policies. They will likely roll in an out of action if positive cases begin to ramp up in a given geographic region.

Edit: Some of my blue/pink collar friends have begun mentioning the fact that the wealthier white collar world is sitting in their protective ivory towers of isolation, while they are considered essential workers and are being placed at risk. Do not underestimate the social implications of this in an already highly polarized country if this continues.

[nomadscientist]

My opinion is that absent some other fix we will eventually release the virus and let the old people die.

If we get back to the position of a month or two ago, it could be contained without broad lockdowns by mass testing and contact tracing backed by legal force for quarantining exposed persons. This may or may not be practicable in the US. It is probably going to happen in the UK. I don't know what the constitutional situation is in continental European countries.

A vaccine is too far away to end the lockdown. A vaccine is important if the virus becomes endemic.

HCQ efficacy would be lovely. Hope someone is doing a real trial with good statistics. Don't see why they wouldn't be. But this seems to be becoming a political football with HCQ being targeted as a pharmaceutical equivalent of a MAGA hat.

In terms of ERE, it does not make much difference to me. Either the economy comes back, or I get an extended period in which to buy more reasonably priced stocks.

I don't know if easy air travel is going to come back any time soon. There will always be some country in the world that does not have it controlled. Even with a vaccine, it would take considerable effort and foreign subsidies over many years for many countries to vaccinate all their population. Testing, quarantine, or an antibody test (which doesn't yet exist) may be required alongside a passport.

[classical_Liberal]

an antibody test (which doesn't yet exist) may be required alongside a passport.

https://techcrunch.com/2020/03/27/the-f ... e-caveats/

[nomadscientist]

https://techcrunch.com/2020/03/27/the-f ... e-caveats/

This seems to be saying that the FDA has stated it will not move against companies that produce antibody tests (which is a little less than saying they're approved, but functionally similar for now), not that any company has actually produced such a test. Am I wrong?

[classical_Liberal]

The tests exist in practice, not theory. Whether they have begun large scale manufacturing yet, I am not sure. Although I am sure now that the FDA has given clearance for their use, in at least some circumstances, it won't be long.

The FDA has not approved them as they have not undergone clinical trials, so the true efficacy has not been determined or proven.

[Ego]

[

Some of my blue/pink collar friends have begun mentioning the fact that the wealthier white collar world is sitting in their protective ivory towers of isolation, while they are considered essential workers and are being placed at risk. Do not underestimate the social implications of this in an already highly polarized country if this continues.

No underestimating here. I mentioned it more than five weeks ago in the Covid-19 thread.

What would it be like if we were experiencing a crisis similar to China's? I wonder how our systems would fare. Hospitals overwhelmed. Severe staff shortages. Severe equipment and supply shortages. Would hospital staff show up to work if they were not provided adequate PPE? A lot of the disposables are subject to just-in-time supply lines. A lot of it comes from China. Would staff show up if they were experiencing infection rates similar to their counterparts in China? Would we be able to scale up as quickly and as thoroughly as China? Would we be able to quarantine the population as well as they have?

How long until we have an adequate supply of PPE? As far as I know, here in California we have adequate stocks of everything including vents. There is grumbling in New York but staff is still showing up.

[classical_Liberal]

@ego
I really don't know. I think it depends on the scale of the spread in a local area.

My anecdote. At this point I haven't been asked to go into a room with confirmed COVID without Airborne and Contact PPE. We have a special unit in our hospital system which is handling most of the cases so far, but it's capacity is obviously limited. I have not worked there and only worked in units with "rule outs" (ie possible but not yet confirmed cases), and so far I've always gotten the airborne PPE requested. What I'm willing to do will probably vary with the situation. If it got to the point I was asked to go into confirmed COVID rooms without airborne PPE, without any serological testing available (to show personal immunity), I'm not sure what I'd do. I've had asthma my whole life, so am at higher risk than a normal 40-something person.

Some part of me just wants to get it, roll the dice and get it over with, move on with life. Other times I'm pretty anxious about dying. Humans are silly this way, I guess.

Edit: and @ego wrt the social issues. I remember you writing about it. That part of my post was not directed at you specifically, I know I was unclear about that. Rather it was for everyone here trying to guess what a wind down would look like.

Edit #2 @CS My comment wasn't meant to mean I'm trying to get it. Just that if it's inevitable, I'd rather get it done and move on with life and immunity so I can be more useful and personally free. I appreciate the concern nonetheless

[CS]

@CL
That 38 year old nurse in NY that died a few days ago had asthma. His older sister was interviewed for it (sorry, didn't keep that link).

If you have asthma, please don't try to get it. I think in Minnesota, along with a number of other states, that would disqualify you for a vent--at least when push comes to shove. Funny how I found that out on a foreign website. Not exactly something people want spread wide and far because of outrage, I'm sure. https://www.avvenire.it/mondo/pagine/ni ... hi-salvare

edit: and yes, antibody therapy was hella expensive. Paid for that out of pocket. It was five figures.

[The Old Man]

I don't know if easy air travel is going to come back any time soon. There will always be some country in the world that does not have it controlled. Even with a vaccine, it would take considerable effort and foreign subsidies over many years for many countries to vaccinate all their population. Testing, quarantine, or an antibody test (which doesn't yet exist) may be required alongside a passport.

Once a vaccine becomes available, then proof of vaccination would be required - similar to how Yellow Fever is handled today. Today, 14 day quarantine is required for all travelers when travel is even allowed. That requirement is likely to continue for the foreseeable future until a vaccine becomes available.

Finally, I believe non-essential travel will be prohibited until a vaccine becomes available. Tourism will be decimated.

As far as business travel (with a business visa), then it is hard to say what will be the requirements going forward. Quarantine may be too restrictive, since it defeats the purpose of the travel.

[J_]

OP: good to question! ERE, the blogs and this forum works for me like an early warning system. Not only after Covid started, but long before.
My answers:
The graph Jacob posted about the expectations for US( see Covid post) are useful here in Europe too, only I have to play with the different starts, the difference of measures per country and to look after what happened in Italy, Spain and the border between France and Germany. I look to Austria and the Netherlands.

So for Austria, who has reacted early, with slack in the hospitals, with disciplined civilians, the curve will be flat, hardly any overload of hospitals and the situation will be really (not trumpish) "in hand" about 20 of May I think. In the Netherlands with much less stringent measures, a higher density of people per square kilometer and late in precautions, also in hospitals, the situation will likely follow the US curves, about 15/20 of April the situations in hospitals will be hectic/frantic/disaster-like with shorts of everything inclusive nursing people. I expect that the situation at hospitals will be more or less in hand in the beginning of June.

And yes there will be a lot more deaths among the people with a poor health during the peak times so between beginning of April until half May. There will be a significant percentage (40%?) more persons dieing than in normal months.

The grade of infection is already about 20% of the population I guess, and will rise to about 80% or more. In the end (end of the year ?) we all will be/have been infected, but many of us will have no severe implications. There will be a better awareness of contamination in the coming 1 or 2 years.

I do not reckon there will be a vaccine before next year. This together will the decline of new infected people (herd effect) the extra load of patients and extra deaths will diminish from June to the end of this year.

Prices of food, especially fresh food (not meat) will rise, inflation will rise.

Besides caution, maintaining my most optimal health and fitness will be the best safety net. But in this net there are always holes.. so be prepared for that case too.

I plan to travel to the Netherlands after the peak prognosis (so beginning of May)

Please comment.

[bostonimproper]

A realistic plan outline from Scott Gottlieb at AEI (former FDA commissioner), who by the way is one of the better expert sources on Twitter in case you're interested in keeping up to date with US response and promising drug treatments.