hoakley July 18, 2020 General, Life, Technology

The road ahead with Covid-19 isn’t as swift or simple

We all want instant solutions to the pandemic. For those US states which have recently suffered resurgence in fresh case numbers, there are many quick fixes being proposed which will somehow allow normal life to resume quickly, and schools to return this fall/autumn. This article looks at probable timescales, and what’s needed.

There’s now ample experience from Europe and New York City of the timecourse of measures to stop such runaway growth in fresh cases.

nycfresh

The pattern in fresh cases for New York City shows a peak in case numbers between 30 March and 5 April, from one to two weeks after the city went into lockdown. It then took eight weeks from the peak before the daily number of fresh cases fell below 500 per day, and a further two weeks before they finally dropped off.

englandfresh

In England, daily fresh case numbers rose exponentially from around 1 March until they exceeded 1,000 after 18 March. They then rose linearly until levelling off to a peak at around 1-10 April, two weeks after lockdown measures took effect. Since then they have been declining more slowly than the original rate of growth, reaching 500 fresh cases per day seven weeks after the peak, and taking a further two weeks to fall below 250.

Currently, states such as California, Texas and Florida are in a worse situation than either New York City or the whole of England were at their peak, often reporting as many as 10,000 fresh cases per day. Had they gone into full lockdown again last week, daily fresh cases would still be expected to rise for a further one to two weeks before reaching peaks of 12,000 to 15,000 fresh cases per day, perhaps even more in Florida. If the measures to prevent spread were effective enough to bring fresh cases down from those levels – roughly twice the peaks attained in New York City or the whole of England – then it’s unlikely that the daily rate would fall as low as 500 per day for at least another 12 weeks, and more probably towards 16.

Thus, if any of those states had applied a lockdown as complete as those in Italy, France, Spain or the UK last week, they would need to maintain that for at least 14 or probably 18 weeks before daily fresh case numbers would be likely to fall to around 500 per day. That’s at least three months, or the middle of October at the earliest, long after the intended date for re-opening schools.

The economic cost of such a full lockdown is very considerable, and there are several alternatives which are being proposed. I have been unable to find any evidence of a country or region comparable to those three states which has brought such high rates of Covid-19 infections under control without enforcing a sustained and complete lockdown.

In particular, some are advocating using the combination of distancing and universal wear of (mainly cloth) facemasks, or facemasks alone, without isolation of family units in their homes. Sadly, no other comparable country or region has attempted to bring high infection rates down using those measures alone, neither is there any evidence that they would be sufficient on their own to bring Rt values below 1, which is essential if the rate of new infections is to fall at all.

With Covid-19, there are no instant solutions. Vaccinations aren’t a few weeks away, but unlikely before next year, and may only confer transient immunity. Turning colossal infection rates into those small enough to re-open most businesses and schools is a long, hard and agonising process of isolation. Anyone who tells you that all you need is a facemask is making a false promise – exactly as happened in the pandemic influenza of 1918.

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1

M.A. on July 18, 2020 at 9:37 pm

In Sweden we have brought down the infection rate mainly through social distancing. I would argue that this model could work anywhere where there exists trust, effective communication between authorities/experts and the population as well as at least a temporary financial safety net for those who get sick.

While there have been international news articles published lately comparing our death toll to our neighbouring countries or claiming that we’ve reversed our strategy based on misunderstood quotes, they tend to be written from an outside perspective without a deeper understanding of what the strategy was, what parts of it worked and what parts of it failed. For a rebuttal to a recent article, see https://emanuelkarlsten.se/multiple-errors-in-the-new-york-times-article-about-swedens-corona-strategy/

3/4 of the deaths have been in care homes, where the residents are only expected to live a few more years either way. The message from our health agency since the beginning was always to protect our most vulnerable, the elderly. Yet this is the part that failed. Unlike the rest of society, the care homes did lock down for visitors early but the virus appears to have made its way in through employees who did not follow proper procedure initially.

Besides the care homes failing to protect their residents – something which most likely can be improved for the future – we were successful in flattening the curve by urging people to work from home if they were able to and to practice social distancing if not. And most importantly, to stay home if we’re experiencing any symptoms at all. (Asympomatic spreaders are not believed to be a major source of infection)

Regular masks have not been recommended since they’re not believed to be very effective, and can in fact be problematic by providing a false sense of security and have to be handled correctly. Few have used them. School for the younger grades have also stayed open since children are not known to be affected like adults, nor to infect others to a large degree. Our strategy was explicitly chosen in order to be sustainable over a long period of time rather than the limited one a lockdown must have.

That our infection rates have declined at nearly the same pace as other European countries suggests that staying home when experiencing any symptoms and otherwise practicing social distancing can be enough to significantly slow the spread. I hope this lesson won’t be lost or disregarded once all of this is over.

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  hoakley on July 18, 2020 at 10:34 pm
  
  Thank you. I’m very grateful for your insights – the international press hasn’t done the Swedish approach justice.
  First, I try to avoid death figures. Although in terms of overall impact on individuals and society there are of course the most important, they’re also the most complex and least understood. The UK, Italy and Spain all had high numbers of cases, and relatively very high numbers of deaths, particularly compared with Germany, or even Brazil. Given that we still don’t have any specific treatment, and the UK even at its peak had a great many empty ICU beds, there’s simply no explanation for our figures.
  Yes, we had a lot of cases in care homes (locally, deaths among those in care homes accounted for over 40% of total deaths), but care homes have proved a problem in many countries, including Canada, without such high death rates.
  From the current situation in states like Florida, Texas and California, moderate approaches such as those which proved successful in Sweden are unlikely to be sufficient. There are just so many people infected, and so many more being infected every day, that enforcing physical separation until the rate of fresh cases has fallen to less than 500-1000 per day is the only measure likely to prove effective. As with contact tracing, those measures which work well in more controlled epidemics would simply be overwhelmed.
  Contact tracing is a good example: in a state with 10,000 fresh cases per day, you’d need something like three contact tracers for each case, that’s 30,000 trained up and ready, and total collaboration from people. For each of those 10,000 fresh cases, upwards of three contacts would have to be traced and told to quarantine themselves. Quarantining that many people each day for 2 weeks would simply not be feasible.
  The only proven methods for reducing such high rates of fresh cases is complete lockdown for a period of many weeks. Earlier in the course, with fewer fresh cases, there were more options, and distancing, test and contact tracing, and face masks could have played a valuable part – only part – of such a strategy. It’s too late now though, and the only alternative is to let the local epidemic burn itself out, at a terrible cost to lives, much as the 1918 influenza pandemic did.
  Howard.
  
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3

G.J. Parker on July 19, 2020 at 9:00 pm

There is no quick solution.

Given the political polarization, i won’t expect significant action from state governments. CA is shutting down again. Though ~1/3 of the new cases are coming from L.A. County alone.

Didn’t Churchill say “Americans can always be trusted to do the right thing, once all other possibilities have been exhausted.”? Yeah, i think that’s the situation. I just hope we don’t have to wait until January to do it.

You should talk about masks- there is so much bad information floating around.

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  hoakley on July 19, 2020 at 10:39 pm
  
  Thank you. Yes, I heard that California is shutting down, partially at least. I really hope that it brings the control over spread that is so badly needed.
  I wrote as cogent an account of masks as I can a few days ago here. It’s a very difficult and polarised subject. There’s next to no good research available, no standard for home-made masks, and many users don’t use them properly either. In many cases, a face shield is probably a better choice: they are easier to use properly, protect the eyes as well, are more compatible with spectacles, and usually cheaper. But if you can afford a clinical/surgical mask, or N95, and use it properly then you will get a worthwhile level of protection both for yourself and those around you. But please never allow that to replace distancing – the best use for the public is to augment the protection provided by careful distancing.
  Stay safe,
  Howard.
  
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