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Thread: COVID-19: A bloody battle or a long war?

  1. #1
    Garbarsardar's Avatar Et Slot i et slot
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    Default COVID-19: A bloody battle or a long war?

    First, I hope you are all well and you take good care of yourself and yours.

    I am aware there is a thread in the mudpit about COVID-19, but I would like, here, to discuss response options as informed by current science and steer away from political recriminations and bickering.

    The incentive for posting this is this excellent paper.

    It's rather short and a good read but I will briefly summarize it here.

    There is a number of NPIs (non-pharmaceutical interventions) which are presently available:



    The first three (CI, HQ, SDO) aim at mitigation, or the "long war" of the thread's title. With the addition of the last two (SD, PC) we have suppression, that is the "bloody battle".

    For example China used suppression while Taiwan uses something akin to mitigation (akin, in the sense that SDO is not mandatory).

    The argument is that most countries do not have the necessary means (an all encompassing regime with near totalitarian powers) to implement suppression especially for an extended period of time. Therefore suppression efforts are eventually bound to fail, after they have placed a horrendous strain on our existing resources.

    On the other hand, mitigation will tax society less, at the cost of a considerable death toll now and in the near future, but will stave off the collapse of our health systems.

    You can see below the chart with the availability of hospital beds in each scenario



    Your thoughts.

  2. #2
    Gigantus's Avatar I am thinking more about running away now then I did as a kid, but by the time I put my teeth in, my glasses on and find my car keys I forget why I am going.
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    Default Re: COVID-19: A bloody battle or a long war?

    Well, the success of mitigation will revolve around testing actually being available. And if that wasn't enough of a stumbling block it will work only if any cost for testing and treatment is borne by the state. The first should not be much of a problem, the second however is unlikely and will lead to critical delays. While I believe that self preservation will lead to a person getting him\herself tested it will most likely be critically delayed in view of possible hospitalization - given news like 'US35K for covid19 treatment'.
    Given that even the most optimistic estimate shows a drastic shortfall of available hospital beds that criteria however will become obsolete and testing as a means of mitigation determination might then have a chance to 'flatten the curve'.

    Suppression isn't going to work as it will be impossible to enforce it totally and over longer periods.
    Last edited by Gigantus; March 21, 2020 at 12:36 AM.




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    Default Re: COVID-19: A bloody battle or a long war?

    Quote Originally Posted by Gigantus View Post
    Suppression isn't going to work as it will be impossible to enforce it totally and over longer periods.
    Suppression is currently working in South Korea, but they have a few advantages. Their population is largely cooperative and they can control their borders since they have only one land border and it is already militarized. They have already brought the R0 below 1.0. They will return to mostly normal life long before other countries, because once they have eradicated the disease within their borders, there will no longer be a need for strict controls within the country.

    This strategy can work for other countries. It will likely work in Israel (where I live), again because the borders are already tightly controlled. The population is certainly less compliant than in South Korea, but they are nonetheless use to disruption in daily life due to frequent military conflicts and general security concerns. Whether or not it can work in countries where current border controls and population dispositions are less amenable to such a strategy is really a matter of priorities, as in how their governments and populations assess the costs vs benefits of its implementation.
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    Default Re: COVID-19: A bloody battle or a long war?

    Looks like a long war to me. How many deaths occur seem to depend largely on how atomised a nation is, and what a state is willing or able to do.

    Has anyone read WWZ? Well, in that book North Korea’s population disappears underground and in the movie they reputedly pulled everyone’s teeth out.

    The highest of fantasy I know, but I’m just saying that you can possibly go too far.

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    Copperknickers II's Avatar quaeri, si sapis
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    Default Re: COVID-19: A bloody battle or a long war?

    Quote Originally Posted by Garbarsardar View Post
    First, I hope you are all well and you take good care of yourself and yours.
    Likewise.

    Therefore suppression efforts are eventually bound to fail, after they have placed a horrendous strain on our existing resources.
    With respect, that's not what I took from the report you posted. In fact, they seemed to suggest that we need to pursue suppression as much as possible since it will still help even if it puts strain on resources:

    "Optimal mitigation policies might reduce peak healthcare demand by 2/3 and deaths by half. However, the resulting mitigated epidemic would still likely result in hundreds of thousands of deaths and health systems (most notably intensive care units) being overwhelmed many times over. For countries able to achieve it, this leaves suppression as the preferred policy option."

    "Cities in which [major] interventions were implemented early in the [Spanish flu] epidemic were successful at reducing case numbers while the interventions remained in place and experienced lower mortality overall."

    "It it will be necessary to layer multiple interventions, regardless of whether suppression or mitigation is the overarching policy goal."

    "there is no easy policy decision to be made. Suppression, while successful to date in China and South Korea, carries with it enormous social and economic costs which may themselves have significant impact on health and well-being in the short and longer-term. Mitigation will never be able to completely protect those at risk from severe disease or death and the resulting mortality may therefore still be high. Instead we focus on feasibility"

    There is a number of NPIs (non-pharmaceutical interventions) which are presently available:



    The first three (CI, HQ, SDO) aim at mitigation, or the "long war" of the thread's title. With the addition of the last two (SD, PC) we have suppression, that is the "bloody battle".

    For example China used suppression while Taiwan uses something akin to mitigation (akin, in the sense that SDO is not mandatory).

    The argument is that most countries do not have the necessary means (an all encompassing regime with near totalitarian powers) to implement suppression especially for an extended period of time.
    Many European countries have some quite substantial powers once they declare a state of emergency. Hungary in particular faces the prospect of becoming a dictatorship until Orban decides otherwise. In some other Former Communist countries borders have been closed and transport ceased for weeks, you can't venture outside without a mask, and some people are being forcibly imprisoned in quarantine camps against their will. Even in the UK, it seems the government has no problems shutting down universities and schools - the timing is quite fortunate considering high schools and universities generally stop having classes from April-September anyway due to exams and Summer break. So while it's not something that can be kept up for another year, if we can last the next 6 months it will buy a lot of time to fix the healthcare system up. Of course, keeping people from informal gatherings is a different matter, especially once Summer hits. That being said, I think a lot of introverts, rural people, older people and members of the digital generation will have no problem adjusting to the new reality since it's not so different from their old reality.

    I haven't seen the scientific take on this, but I wonder if Italy has suffered so badly because of profound cultural differences from somewhere like South Korea, where life has for some time increasingly been lived alone, indoors and online. But that's a cultural shift which is very recent, so I wonder if it actually gives us some hope that people are more flexible than you might imagine. If you'd told me I could do my job via the internet 1 month ago I wouldn't have believed you, but in the space of one week I've moved literally everything online and I see no reason why I couldn't do it for the next 18 months or more. I think the distinction between 'Asian culture' and 'Western culture' is a bit of a myth to be honest. Certainly here in the Former Warsaw Pact, the difference is not so extreme. Israel's similarities with South Korea have already been mentioned. And the reality is that China may have cultural advantages, but it's also incredibly more densely populated with much fewer health resources and poorer education and online infrastructure, which are big disadvantages for public health. Not to mention the extent to which they are probably covering up the reality. So it's swings and roundabouts - once the Western world gets its act together we may find that Asian efficiency and societal cohesion are more myth than reality and in fact, our aging population is the only real disadvantage we have.

    In general, I'm skeptical about the idea of economic damage from suppression being worse than the amount of deaths which will result from only mitigation. With hospitals overloaded we'll experience many, many extra deaths which are not directly related to coronavirus simply due to lack of care provision. We were already due a major global recession before the virus hit, so we need to factor that in to the economic impact which is currently occurring - it's not just because of the virus and there will be a bounceback effect. The quicker the virus is dealt with the quicker we get to the bounceback, thus the less long term damage will be done. 18 months sounds like a long time for massive lifestyle changes and government action, but in reality it's really not as bad as it sounds. WW2 lasted 5 years after all and that was before the digital revolution. Most travel, meetings and assemblages are entirely unnecessary in the digital age.

    And as for 'bloody battle or long war', I think it's pretty clear this is going to go on for at least another year or two and of course strict suppression can't be maintained for that long. But there is the possibility of rolling periods of extreme action and relaxation. I think this will be the preferred option in the UK. But extreme suppression HAS to come first, to ensure we buy ourselves time to deal with the later upswing when it is relaxed, which I think you'll agree is better than the alternative (which at any rate it is already too late for - basically all European countries have already ordered the closing of borders, institutions and businesses excepting those essential to avoid societal breakdown).
    Last edited by Copperknickers II; March 21, 2020 at 09:07 AM.
    A new mobile phone tower went up in a town in the USA, and the local newspaper asked a number of people what they thought of it. Some said they noticed their cellphone reception was better. Some said they noticed the tower was affecting their health.

    A local administrator was asked to comment. He nodded sagely, and said simply: "Wow. And think about how much more pronounced these effects will be once the tower is actually operational."

  6. #6

    Default Re: COVID-19: A bloody battle or a long war?

    This piece Coronavirus: The Hammer and the Dance I think makes a very strong case for maximum suppression (bloody battle) at the moment. Not so much because it would necessarily limit the number of people who may eventually get the virus, but because it would give governments the time needed to scale up the provision of hospital care and equipment. That would narrow the gap between the demand for Intensive Care beds etc and the supply, hence reducing the overall number of avoidable deaths for both people with the virus and those requiring emergency care for other reasons.

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    Ludicus's Avatar Vicarius Provinciae
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    Default Re: COVID-19: A bloody battle or a long war?

    -Postpone no urgent/elective surgeries to flatten the curve.
    -Total lockdown.
    -Massive numbers of fast tests.
    -Wait for a vaccine or effective therapy.
    -Forget the "merits" of the genocidal violence of "herd immunity". China is rapidly controlling the spread of the virus without requiring herd immunity. Only 0,00056% of the Chinese population has been infected.
    ---
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    A stern warning isn't enough. Step away from the complacency. It doesn't work.
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    Last edited by Ludicus; March 21, 2020 at 05:50 PM.
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    Default Re: COVID-19: A bloody battle or a long war?

    If the governments acted swiftly and shut off everything for three weeks as it was getting worse we could blow it off much quicker. However, most governments phased out their measures which is lengthening the process. We're looking at a lost month or two now. If the info coming out of China is to be trusted they managed to keep it under control by taking drastic measures like locking an entire region up.

    Prolonging the crisis also helps the current strains to survive. Make no mistake. The current corona virus is evolving. It can get better but it can also get worse. Check this website out: NextStrain. You can see how the virus is mutating:

    Last edited by PointOfViewGun; March 21, 2020 at 06:13 PM.
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    Ludicus's Avatar Vicarius Provinciae
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    Default Re: COVID-19: A bloody battle or a long war?

    An historical curiosity. 100 years later, nothing changed.

    "Conselhos ao povo": educação contra a influenza de 1918 Advice to the people": education against the 1918 influenza pandemic
    Summarized, printed and reprinted by the press, usually under the title "Advice to the People", such information underwent variations even though one thing remained the same: the recommendations to practice personal hygiene and avoid large social gatherings to prevent contamination and the spread of the disease.

    And..."oral quinine, 25 /50 centigrams/day
    ".

    Il y a quelque chose de pire que d'avoir une âme perverse. C’est d'avoir une âme habituée
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    Every human society must justify its inequalities: reasons must be found because, without them, the whole political and social edifice is in danger of collapsing”.
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    Default Re: COVID-19: A bloody battle or a long war?

    It also helps if people don't do as in Australia ^_^


    Bojo (UK) only now closing down pubs was another terrible decision. Those should have closed weeks ago.
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    Ludicus's Avatar Vicarius Provinciae
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    Default Re: COVID-19: A bloody battle or a long war?

    A different perspective from a top epidemiologist that deserves to be read. Very well written.

    In the coronavirus pandemic, we're making decisions without reliable data
    "...One can only hope that, much like in 1918, life will continue. Conversely, with lockdowns of months, if not years, life largely stops, short-term and long-term consequences are entirely unknown, and billions, not just millions, of lives may be eventually at stake.
    If we decide to jump off the cliff, we need some data to inform us about the rationale of such an action and the chances of landing somewhere safe"


    I dare say, I don't agree with this statement, "if not years, life largely stops". It seems likely to be a gross exaggeration. I stand by what I said earlier...
    Il y a quelque chose de pire que d'avoir une âme perverse. C’est d'avoir une âme habituée
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    Every human society must justify its inequalities: reasons must be found because, without them, the whole political and social edifice is in danger of collapsing”.
    Thomas Piketty

  12. #12

    Default Re: COVID-19: A bloody battle or a long war?

    Probably a long war full of bloody battles.
    I mean now that opportunity to nip the rose at the bud and close borders has been missed by pretty much the majority of Western leaders, all we can do is shut our countries down.
    Only question is how long before our economy would seize to function at such pace. Sooner then later the supply chains will start to buckle, while the gravy train of budget will run out. Then what?

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    Stario's Avatar Campidoctor
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    Default Re: COVID-19: A bloody battle or a long war?

    @Kyriakos
    Ironically Australia's CFR is about 0.5% -however the CFR might be considerably less than 0.5%- if we assume that “the number of asymptomatic/minimally symptomatic cases is several times higher than number of reported cases.” - such a low CFR could potentially be in the range of seasonal influenza outbreaks.


    My 2 cents,

    As already mentioned "prolonging it" will probably allow Covid-19 to mutate AGAIN! (potentially making it even deadlier). ( ′̥̥̥︹′̥̥̥ )
    I think best approach is to lock-down the old + weak. Educate the population about good hygiene, risks etc. but ultimately letting life go as per usual for the rest of the population- in time majority of the population will acquire natural immunity.
    Last edited by Stario; March 22, 2020 at 11:02 AM.

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    Akar's Avatar I am not a clever man
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    Default Re: COVID-19: A bloody battle or a long war?

    "Lock down the old and the weak"

    lmao

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    Stario's Avatar Campidoctor
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    Default Re: COVID-19: A bloody battle or a long war?

    Quote Originally Posted by Akar View Post
    "Lock down the old and the weak"

    lmao
    Hey man, whatya laffing at!!!
    This would be easily achieved- just confiscate their wheeled walkers (๑˃́ꇴ˂̀)

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    Default Re: COVID-19: A bloody battle or a long war?

    Quote Originally Posted by Ludicus View Post
    An historical curiosity. 100 years later, nothing changed.

    "Conselhos ao povo": educação contra a influenza de 1918 Advice to the people": education against the 1918 influenza pandemic


    And..."oral quinine, 25 /50 centigrams/day
    ".
    The world is rickrolling us. The plague hit in 1718(largely Marseille, and lets just say they were able to handle it much better than the 1300s, and much better than we are now), Cholera in 1818, Spanish Flu in 1918, and now Covid-19. I mean, for the 1700s, and 1800s you'll see the places over an expanded period of time do to slower travel. But they're there literally every hundred years.
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    Default Re: COVID-19: A bloody battle or a long war?

    Quote Originally Posted by Kyriakos View Post
    It also helps if people don't do as in Australia ^_^


    Bojo (UK) only now closing down pubs was another terrible decision. Those should have closed weeks ago.
    Big shame job, the yoof are more interested in posing than their granny's life.

    There's been a break in ranks between the Feds and state governments, the NSW govt let in a cruise ship full of untested cases that has returned 20+ positives after the fact so far out of 2000 (whether from a bribe or sheer incompetence remains to be seen), and my home state has closed the schools on a technicality ("extended holidays") to placate the Teacher's Union: its unlikely they will reopen for six months at least.

    Now the nurses will be taking carers leave instead of working because, you know, they're 80-90% of nurses and they are the primary caregivers for their children. This will also affect police and other essential services to a lesser degree.

    So our ability to create a disciplined is compromised by our free society (in most contexts an excellent and desirable thing) and our lack of political discipline. We are getting up there with the testing regime (not at South Korea levels yet but an order of magnitude better than the US) and nudging toward highly disciplined social controls (the National Cabinet has supported the PM every step until Sunday) but this stumble means its less likely he can pull the switch on harsher controls. Look for us to jump up in infection cases.
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    Kyriakos's Avatar Praeses
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    Default Re: COVID-19: A bloody battle or a long war?

    Here there is now some policy of seeking permission to go out via mobile phone text etc. I think it will dissuade the older people. Haven't tried it yet, given today has horrible weather anyway and I don't need to go to the supermarket.
    Λέων μεν ὄνυξι κρατεῖ, κέρασι δε βούς, ἄνθρωπος δε νῷι
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  19. #19
    Stario's Avatar Campidoctor
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    Default Re: COVID-19: A bloody battle or a long war?

    Big shame job, the yoof are more interested in posing than their granny's life.
    OH! the price of freedom -maybe they also know granny has roughly the same odds of dying of influenza (which has a CFR of roughly 0.1-0.5%), or as a result of death from injuries sustained due to motor vehicles -about 1.0% ( I posted some other odds in the other covid-19 thread).
    Yet despite these every day risks life goes on as normal- we don't lock-down the country every year etc. These odds are also very small -its really not worth worrying too much about & ruining the economy -other than taking simple precautions i.e. good hand hygiene vs looking where you're going when crossing the road etc.

    But yeah today the PM announced a lock down of all restaurants, pubs, cinemas, gyms, beaches are also closed etc. (I don't agree with it, but hey the commoners it seems are quite happy too loose their jobs or forfeiting such pleasures as enjoying a nice dine-in experience in a restaurant or spending time at the beach etc).
    I went out today & most restaurants just closed outright, some are still open but only having skeleton staff & not allowing dining-in, takeaway only (or 'to go' as those of you in the US like to say). Lots of people loosing their jobs as a result of all these closures- its gonna be tough ride for the next 6-8 months. In NSW most public schools are still opened though- which kind of defeats the purpose of these draconian 'lock-down' laws as it's from school that the squirts mostly spread all the influenza, chicken-pox, other diseases ect.
    I personally think the gov should have banned all flights/cruise ships 2 months ago- not two weeks ago; & the recent cruise-ship bungle doesn't help. This would have saved us a great deal of pain.

    Here there is now some policy of seeking permission to go out...
    That's crazy you need to seek permission to go out?! North Korea anyone? (Albeit it does kinda remind me of communist Czechoslovakia were we did need to seek permission for a lot of things we now take for granted in our democracies etc.)
    Though it is interesting to note how willing the commoners are to allow government unlimited power to detain people etc. on the pretense that the government is doing good by the people.
    This is a good example for those posters in the history forums when they debate/talk about how stupid the German people were to allow the rise of the Nazi's in Germany etc. etc.

    Its a pity that most of us are not as courageous as this guy.
    Last edited by Stario; March 23, 2020 at 07:32 AM.

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    Kyriakos's Avatar Praeses
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    Default Re: COVID-19: A bloody battle or a long war?

    Quote Originally Posted by Stario View Post

    That's crazy you need to seek permission to go out?! North Korea anyone? (Albeit it does kinda remind me of communist Czechoslovakia were we did need to seek permission for a lot of things we now take for granted in our democracies etc.)
    Though it is interesting to note how willing the commoners are to allow government unlimited power to detain people etc. on the pretense that the government is doing good by the people.
    This is a good example for those posters in the history forums when they debate/talk about how stupid the German people were to allow the rise of the Nazi's in Germany etc. etc.

    Its a pity that most of us are not as courageous as this guy.
    It's Greece. I tried the system and - surprise - didn't get any reply at all. So 15 min later I just went out to take some money from an atm. Still haven't gotten a reply. I suppose the system failed from day 1

    Re if the measures (like closing shops, schools etc) are warranted or not - I don't know. Having hundreds of deaths (or thousands) in places like Italy obviously helps drive popular opinion. Obviously a lock down of this type, spanning months, isn't sustainable anyway, so if it is the Black Death (like) then things will collapse.
    Last edited by Kyriakos; March 23, 2020 at 08:15 AM.
    Λέων μεν ὄνυξι κρατεῖ, κέρασι δε βούς, ἄνθρωπος δε νῷι
    "While the lion prevails with its claws, and the ox through its horns, man does by his thinking"
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