Coronavirus Sars-CoV-2/Covid-19 Megathread

[Legbiter]

It could take years to get a vaccine? Is that even feasible?

We're about to find out the answer to that question. 

We'll open up fairly soon, but many of our export markets have been nuked from orbit. Unemployment is already hitting 2009 levels. If the Nordic countries kill it off fairly fast we might restart trade and travel links among ourselves as a sort of green zone that can be enlarged as the pandemic dies down elsewhere in Europe. 

[Josquius]

It could take years to get a vaccine? Is that even feasible?

They get a new vaccine for each year's flu season on schedule.
As I understand it corona is nothing too amazingly special. With the full weight of the world's research thrown at it, I think the odds are good we'll have one within a year.

[Sheilbh]

I've been thinking. What is the end game? What is the purpose of all actions due to Corona?

Originally the UK stated that the end game was herd immunity. It still seems to be the target for some countries including Sweden. This was assumed possible by keeping the sombrero down enough so that health care won't collapse. Seems cold and callous since a lot of people will die.

But for those countries not targeting herd immunity? Close down until a vaccine? Close down forever? Hold hand over ears and pretend Corona will disappear? Ease up in such a manner that the sombrero stays low enough to handle (and I guess in the end herd immunity and all the deaths on the way this implies)?

Take Norway and Finland for example, and to a lesser extent Denmark. They have been successful in stopping the spread and relatively few have died. But what now? As soon as they ease up Corona will strike again and then what? How do they get out of this?

Yeah. I've no idea, but I think the only chance to properly contain this was if we were able to basically contain it in China (which is really up to China) and then contain cases as and when they popped up in European countries. The failure of China to contain this internally and the more "surprise" outbreaks in Italy, South Korea and Iran have, I think, fucked that hope. This is out of China and circulating in the world now. So I think the second wave risk is very real.

I think several countries have basically said herd immunity is the only way out in the long-run - see Angela Merkel's comments about 60% of Germans getting the virus. Because of our political situation the UK's the only country where that was interpreted (by some - especially in the #FBPE community) as a general intention to mass murder the population - for some reason I don't fully understand the Tory government apparently decided to first express their murderous intent against their core constituency, the elderly.

We can get there by vaccine or transmission. From my understanding there are factors in Sweden which make it more able to follow this strategy - not least, I think the highest rate of single occupancy residences in Europe. There's also earlier stats from Wuhan that a huge proportion of their initial outbreak was intra-household infections (I think this might actually make lockdowns more risky in some countries - because lockdown increases contacts within the household). But the UK scientific papers were really worried about the injustice of a real herd immunity approach which is that we would basically be putting the elderly and people with certain health conditions under house arrest while the rest of society would be able to carry on their lives. I'm not sure that issue has been solved - it would be part of the Sweden plus approach I mentioned (as I say this seems to be the approach epidemiologists favour). But celed's right that is projected to have the biggest impact but it would still result in a lot of deaths.

I think at the minute UK politicians (and possibly this is true in Europe) are more liberal on using track and tracing apps to basically move to that "new normal" until a vaccine. This is one of those many areas where I think the general public are very authoritarian and have no issue with really intrusive data collection and use by the government. I don't know if the public would support the police turning up on your door to ask why you were outside when you shouldn't have been - as happens in some of the East Asian countries that have really gone for this.  A lot of work I do is basically data privacy law so I tend to be very anti-state doing things with people's information so I am biased, but I hope governments continue to take a more liberal, cautious approach on this than public opinion is pushing because I think there is a real risk around bio-surveillance. Also this app, track and trace approach seems to be favoured by other public health people.

My suspicion is that European countries generally won't be able to go for a purist Sweden or Taiwan approach. I think we'll basically go for a mix until a vaccine is available or we achieve herd immunity by accident. I think the European approach will end up being a combination of: masks, a liberal/voluntary/non-policed track and trace app, staged openings of most retail (and schools which are opening across Europe because that seems to be a relatively low-impact measure for coronavirus but high impact for the social/economic impact), no large gatherings over say 10/20 but continued social distancing within those parameters and social isolation for the vulnerable/symptomatic plus hugely expanded healthcare capacity. But who knows if that'll be enough to contain it until we get herd immunity either as a side effect or through a vaccine.

I suppose the other big unknown is widespread anti-body testing and asymptomatic cases. If that 75-80% asymptomatic figure from China, that Italian town and NYC hospital is true then I think that would probably change the possible approach countries could take.

[Tamas]

Isn't the 60-70% req. for herd immunity assumes a vaccine is already applied on the population?

I fail to see how 60% of people having gotten it (and hopefully immune) is going to prevent the 40% from infecting each other merrily.

[Josquius]

The way forward in the UK is to give more powers to the regions.
If we get rid of corona in the country and then open up again, but a new outbreak occurs in Manchester (for a random example) then there's no need to close down the entire country for that.

The biggest unknown is that there do seem to be several cases where people caught it twice. Herd immunity might be a nonsense.

[Threviel]

Isn't the 60-70% req. for herd immunity assumes a vaccine is already applied on the population?

I fail to see how 60% of people having gotten it (and hopefully immune) is going to prevent the 40% from infecting each other merrily.

It won't stop it, but it would become a slow burner instead of a pandemic.

[Tamas]

The way forward in the UK is to give more powers to the regions.
If we get rid of corona in the country and then open up again, but a new outbreak occurs in Manchester (for a random example) then there's no need to close down the entire country for that.

The biggest unknown is that there do seem to be several cases where people caught it twice. Herd immunity might be a nonsense.

Yes but that calls for less power to regions. If Manchester is free to decide whether they lock down for the good of the rest of the country or not then they may very likely decide they don't want to ruin their local economy for the benefit of other regions, thankyouverymuch. Such decisions must be made centrally.

[celedhring]

Regarding asymptomatic %, the Andalusian regional government has carried out 50,000 tests in nursing homes dragnet style and it's finding roughly 50% asymptomatics.

[viper37]

But for those countries not targeting herd immunity? Close down until a vaccine? Close down forever? Hold hand over ears and pretend Corona will disappear? Ease up in such a manner that the sombrero stays low enough to handle (and I guess in the end herd immunity and all the deaths on the way this implies)?

Take Norway and Finland for example, and to a lesser extent Denmark. They have been successful in stopping the spread and relatively few have died. But what now? As soon as they ease up Corona will strike again and then what? How do they get out of this?

everyone is targetting herd immunity, but we want to avoid our healthcare collapse, so we need to stop the rapid spread.  And we need to do more to protect our elederlys, obviously.  They're the ones most at risk.
What Quebec is doing is slowly relaxing the rules.  Adding businesses to "essential services".  First it was hospitals, pharmacies, restaurant take-out, pot&alcohol, groceries and their supply chains + everyone making personal protection equipments and various healthcare supplies.  Now we've added small construction sites, mechanics and tire change, gardening stores, and all the residential construction supply chain.

Next will be some schools.  Possibly at half capacity.

Then restaurants at 50% capacity.

Then sport events either with empty of half filled arenas.

Lastly will be cultural events.  No new shows for me until 2021 I guess   I was supposed to see Amorphis in september, it sucks.

[viper37]

It could take years to get a vaccine? Is that even feasible?

about 12 to 18 months.  It depends if the first vaccines testes are really succesfull in their trials.  Then, it's a matter of measuring side effects.

[Sheilbh]

Isn't the 60-70% req. for herd immunity assumes a vaccine is already applied on the population?

I fail to see how 60% of people having gotten it (and hopefully immune) is going to prevent the 40% from infecting each other merrily.

My understanding is that there's basically a point in the population at which a disease is no longer sort of spread through a population because enough people have immunity so they don't get it and don't pass it on. I think it's basically a function of how infectious the disease is, so measles is super-infectious so you need almost total 95% immunity or it'll start spreading through the population. From what I've read the highest estimates for covid-19 are 60-70% (other estimates are far lower) because it's very infectious, so more infectious than flu, but it's a lot less infectious than, say, polio, smallpox or measles.

So if you were running a vaccine campaign you'd need to reach about 60-70% to achieve herd immunity, it's the same if you accidentally achieve it. That's the point at which transmission would break down - it would still exist and there would still be cases but they'd be relatively isolated and wouldn't lead to an oubtreak.

The biggest unknown is that there do seem to be several cases where people caught it twice. Herd immunity might be a nonsense.

If that's the case it's really difficult to see how we get a vaccine, right?

[Sheilbh]

The way forward in the UK is to give more powers to the regions.
If we get rid of corona in the country and then open up again, but a new outbreak occurs in Manchester (for a random example) then there's no need to close down the entire country for that.

The biggest unknown is that there do seem to be several cases where people caught it twice. Herd immunity might be a nonsense.

Yes but that calls for less power to regions. If Manchester is free to decide whether they lock down for the good of the rest of the country or not then they may very likely decide they don't want to ruin their local economy for the benefit of other regions, thankyouverymuch. Such decisions must be made centrally.

I'm with Tyr on this. I think one of the benefits of Germany's system is that they're federal for healthcare and the German government just provides guidance and coordination. Though it does lead to some states shutting down less or later, I think this is less to do with economics than people don't see it as necessary for them because it's not a risk to them/their community yet. Also political pressure depends on what people think/see elsewhere rather than just economics, so Northern Ireland could very well have chosen not to lockdown as it has a relatively light infection but people were looking at the rest of the UK and the rest of Ireland so it would have been weird not to. But you're right it does rely on your federal system having sensible people in charge of the regions/states, not culture warriors as seems to be the case in some US states.

But I think we would be in a better overall position if we had Sadiq in charge of NHS London moving more quickly, maybe the same in the Midlands and if all those regions had their own public health capability rather than relying on a centralised body for 60 million people that might work in normal times but will be overwhelmed by a bad flu season far less an actual pandemic. But it requires a bigger conversation/constitutional shift because we're not set up that way (unlike Germany).

And I think the consequence of all this will be an end to the New Labour and Lansley reforms to "remove politics" from the NHS by making it independent with lots of competing chains of authority. I think we'll move back to the old post-war model of it being run by the Health Secretary far more directly and centrally.

[Tamas]

I think the key is to have an efficient system with skilled decision makers in charge.

Just look at the US, that's very decentralised right there, and what a mess it is. Just because Boris and his marry band of political conmen fumbled this one doesn't automatically mean we need to decouple regions from a central leadership.

Which reminds me, wasn't there some little news today or yesterday that some English organisation/company didn't supply enough masks to Scotland because their rules/regulation is to make sure England has enough before they share? Sorry, no link, but that's a shadowy part of decentralisation as well.

[Grey Fox]

I am in a pessimistic mood.

I don't think a vaccine is possible. IIRC there are no cold vaccine, usually caused by a corona virus.

We need widespread testing for anti-body to identify how far this has already spread. As this is a culling, reopen slowly & hope the healthcare system can cape for a year or so.
This is feels to me like it is impossible to not catch it eventually. If you are old or have preconditions, luck & technology will try to save you.

Canada is also decentralized & we're not a mess. Experiences can differ.

[Valmy]

I am in a pessimistic mood.

I don't think a vaccine is possible. IIRC there are no cold vaccine, usually caused by a corona virus.

Yet we have tons of flu vaccines

But what do I know?