Coronavirus/Covid-19 Discussion Thread (2 Viewers)

[enoilgam]

NSW Premier says coronavirus social distancing to stay 'until vaccine is found'

NSW Health confirms 49 new coronavirus infections and two deaths, as Premier Gladys Berejiklian warns social distancing will stay in the state "until a vaccine is found".

mobile.abc.net.au

Hmn

The government really needs to be transparent on the next steps, because "flattening the curve" isnt a solution. Also keeping this status quo until a vaccine is found (or should I say if it is found) is pretty ridiculous.

 

[Trebla]

NSW Premier says coronavirus social distancing to stay 'until vaccine is found'

NSW Health confirms 49 new coronavirus infections and two deaths, as Premier Gladys Berejiklian warns social distancing will stay in the state "until a vaccine is found".

mobile.abc.net.au

Hmm. Realistically might not be feasible to do so.

The government really needs to be transparent on the next steps, because "flattening the curve" isnt a solution. Also keeping this status quo until a vaccine is found (or should I say if it is found) is pretty ridiculous.

Agreed. SARS was brought under control without a vaccine. This is obviously a bigger scale pandemic but longer term there needs to be an optimal middle ground with restrictions vs infection risk.

 

[Isomorph]

Unless you're going for herd immunity there isn't actually too much of a middle ground. Release too many restrictions and cases will explode.

An option is summer slows transmission to the point where you can temporarily ease restrictions.

Problem with coronavirus is milder symptoms and more contagious than SARS, therefore hard to track and more difficult to effectively quarantine sick people.

 

[Trebla]

Unless you're going for herd immunity there isn't actually too much of a middle ground. Release too many restrictions and cases will explode.

An option is summer slows transmission to the point where you can temporarily ease restrictions.

Problem with coronavirus is milder symptoms and more contagious than SARS, therefore hard to track and more difficult to effectively quarantine sick people.

The restrictions as they currently stand are very blunt. The benefit of having a blunt tool is that it is the quickest means to control the immediate problem of an exponential growth of infections. The restrictions could be more targeted to those that have an actual impact on reducing infections (e.g. preventing someone from having lunch on a park bench by themselves does crap all in actually reducing infections).

If we get to a point where the growth rate of infections reduces to basically zero for about 4-5 weeks straight under the current restrictions then in theory there is basically little to no transmission from any existing infected people to someone else. In that 4-5 week time frame of zero known infections, any potential incubation periods of undetected mild/asymptomatic cases would have run their course.

It would then be feasible to make the restrictions sharper and more targeted as well as accept an incrementally small risk. For example, some small businesses, schools and universities can reopen but still ban mass gatherings and retain physical distancing rules. This would be a reasonable middle ground, with the flexibility to revert back to tougher restrictions if needed. For this to work, there should currently be capabilities being setup to be able aggressively isolate and trace any future cases. This should be supported by widespread testing capabilities as well.

The point is you can't sustain tough restrictions like that for too long, especially if the downward trend in infections are looking good, because you risk unnecessary economic pain or even worse, social unrest. There needs to be restrictions that are more sustainable than what is currently being done if our strategy is to manage a low number of infections for a long period of time.

Thankfully, we will not be moving first to ease restrictions. Countries like Austria, Denmark and obviously China are about to ease their restrictions after 1-2 months of locking down and will be a useful litmus test to see what could work for Australia.

 

[Isomorph]

I believe the approach you are suggesting is the "on and off" where restrictions are put in place and the released in cycles as infections climb, thereby creating a sense of normality for at least periods of times?

If instead you are looking at a long term release in restrictions, indeed as you note the most restrictive aspects (i.e Stage 3 restrictions) can be eased without too much of an effect. However when you start opening bars and resturants, schools and universities, the potential for gatherings accompanied by the high infectivity of coronavirus makes it very likely to cause a second wave. I find it hard to imagine bars and resturants opening but guests following social distancing principles when the entire objective is to socialize.

Talking about reducing the cases to zero, that will likely take several months before we get there, but is an option to consider. If you look at countries like Singapore or South Korea (well known for their good response), even they have daily increases around 50-100. Maybe we can get there - but a short term "lockdown" at zero cases is unlikely enough to eradicate the virus, as there are always people who don't follow the rules and transmission within a household can occur over months. For example, a linear transmission chain down 4 people in a large household could take almost 2 months to complete. We will learn more about this approach when NZ comes out of their lockdown, and can further evaluate its effectivness. Essentially, Australia's effective approach so far has bought us time to wait-and-see what happens within other countries.

 

[enoilgam]

The point is you can't sustain tough restrictions like that for too long, especially if the downward trend in infections are looking good, because you risk unnecessary economic pain or even worse, social unrest. There needs to be restrictions that are more sustainable than what is currently being done if our strategy is to manage a low number of infections for a long period of time.

Expanding on this, a lot of people who scream for lockdowns and "putting lives ahead of the economy" dont fully understand the ramifications of the lockdown. First of all, public health and economic health go hand in hand. Hospitals are a major cost to any society and at the moment, the already meager revenue base of hospitals (elective surgeries) have been suspended. Moreover, those "non-essential" businesses that are being shut down pay the taxes that fund the healthcare system, as do their employees. Keeping the economy shut down for an extended period will eventually impact the health system as funding decreases. If you are really that obtuse, just remember, a societies health and wealth are positively correlated. It doesnt run on fairy dust and good will, just look at Africa or other third world regions to see how their health systems operate.

The other thing people arent really seeing is the suspension of a lot of basic medical care in this country. Those "Elective procedures" that have been cancelled arent just botox and boob jobs. They include things like joint replacements and proactive surgeries to address potentially dangerous health conditions (i.e. benign tumors that could become cancerous). Furthermore, many regular specialist checkups have been suspended, which is often essential to catching dangerous medical conditions early. Take my grandparents for example, they have several specialist appointments a month which have been cancelled or postponed as being "non-essential" as they are checkups. Not to mention my grandfather cant get his skin cancers removed as that isnt considered essential. These issues will eventually restrict quality of life and life expectancy - in other words, this will eventually start killing people.

The sad truth is that COVID-19 is going to kill people, either directly or indirectly. It's just a matter of how we want to do it. I think we need to get aggressive like Trebla has said or move towards something like herd immunity. Either way, this shutdown cannot drag on, our society cannot function like this indefinitely. As much as I despise him, Donald Trump was speaking the truth when he said our society isnt made to be shutdown. We just have to harden up and rip the band aid off quickly.

 

[Trebla]

I believe the approach you are suggesting is the "on and off" where restrictions are put in place and the released in cycles as infections climb, thereby creating a sense of normality for at least periods of times?

If instead you are looking at a long term release in restrictions, indeed as you note the most restrictive aspects (i.e Stage 3 restrictions) can be eased without too much of an effect. However when you start opening bars and resturants, schools and universities, the potential for gatherings accompanied by the high infectivity of coronavirus makes it very likely to cause a second wave. I find it hard to imagine bars and resturants opening but guests following social distancing principles when the entire objective is to socialize.

Talking about reducing the cases to zero, that will likely take several months before we get there, but is an option to consider. If you look at countries like Singapore or South Korea (well known for their good response), even they have daily increases around 50-100. Maybe we can get there - but a short term "lockdown" at zero cases is unlikely enough to eradicate the virus, as there are always people who don't follow the rules and transmission within a household can occur over months. For example, a linear transmission chain down 4 people in a large household could take almost 2 months to complete. We will learn more about this approach when NZ comes out of their lockdown, and can further evaluate its effectivness. Essentially, Australia's effective approach so far has bought us time to wait-and-see what happens within other countries.

I think the current restrictions should remain in place until we have truly flattened the curve for a sustained period of time (something like 0.0-0.5% sustained growth rate over the rest of April perhaps - we're currently at 1-3% growth rate in the past week) and reduce the proportion of confirmed cases from unknown sources to some acceptable level.

Once we reach that point, the new status quo should be a more sustainable one than the current restrictions. In restaurants for example, it could be something like two people maximum can dine at a table, with the tables being say 2 metres apart (rather than pure take away) - and restrict it to small bars and restaurants only. For schools and universities, it could be that students only show up for exams which can be appropriately managed with distancing rules (e.g. staggered starting times, distanced tables and use of multiple rooms). Monitor the situation for a few weeks and adjust accordingly. We would likely look at what other countries are doing to decide what this should look like here.

Sure, it may potentially increase the number of infections but the government's long term strategy was never about eradication but tolerance of a certain number of infections (a very different objective to NZ's strategy of eradication) so that it doesn't overwhelm hospitals but at the same time doesn't screw society and the economy too drastically. The lever is still there to escalate restrictions again if the number of new infections grows beyond a certain tolerance point (perhaps something like 20-30 daily cases nationwide could be deemed acceptable). The other piece is that a more aggressive isolation and contact tracing strategy than before on new confirmed cases (which is manageable for low numbers) would be necessary to reduce the infection rate lower than what it was before.

Regarding the example of the household transmission of four people, a chain of that nature would seem very unlikely (it's basically like the far tail of the bell curve). For this to occur, you need person A to infect person B pretty much exactly at the tail end of their infection. Person B then needs to be infect person C exactly at the tail end of their infection and so on. Not only that, you need the first three infected people to be all asymptomatic, otherwise there would likely be reactionary intervention to test and break the chain as soon as one person shows symptoms. It is far more common to have overlaps in infection progression amongst members of the same household and at least one of them to show symptoms. From a probability standpoint, any asymptomatic household transmission would likely run its course within one month for most households, rather than two months.

Basically, no strategy is 100% foolproof and it's all a numbers and risk tolerance game.

 

[BLIT2014]

Australia now has 6,289 confirmed cases of Covid-19.


Confirmed cases
1,773,358
Deaths
108,702

Source:https://www.theguardian.com/austral...demic-politics-scott-morrison-nrl-latest-news

 

[brent012]

Australia now has 6,289 confirmed cases of Covid-19.


Confirmed cases
1,773,358
Deaths
108,702

Source:https://www.theguardian.com/austral...demic-politics-scott-morrison-nrl-latest-news

Had by far the lowest increase from 6am yesterday to 6am today - 51. It's been around 80-100 for almost a week (reported 6am-6am and 3pm-3pm).

While we seem to be flattening the curve, unfortunately over the last week a lot of countries (of note India, Russia, Sweden and Japan) have overtaken Australia in number of cases and are quickly growing.

 

[Trebla]

Had by far the lowest increase from 6am yesterday to 6am today - 51. It's been around 80-100 for almost a week (reported 6am-6am and 3pm-3pm).

Would treat that lower figure with caution because testing activity is usually lower on weekends (and it’s the Easter weekend as well). There is also a rescue plane full of like 70 positive cases that landed from Uruguay so not sure how that will get incorporated into the count.

Also, call me pessimistic but I reckon we’ll see a bump in cases in the next week or so from the Easter weekend...

 

[brent012]

Would treat that lower figure with caution because testing activity is usually lower on weekends (and it’s the Easter weekend as well).

I've seen this mentioned, but the effect doesn't seem too pronounced for positive cases in Australia at least. ~80-90 -> 51 was a pretty big drop though

But, even excluding Easter, if the Uruguay cases are included in the count it will completely obfuscate the data for a day or two. At least there seems to be better processes now than with the Ruby Princess.

 

[Potato Sticks]

I feel like the most telling figure they should release is number of close contacts not tested. Would give a sense of the magnitude of unknown cases out there

 

[cosmo 2]

in all fairness there prob isnt a single person in aus who cant afford the internet

the only ppl who dont have internet in aus are oldfags and ppl who deliberately live "off the grid" lol at there being ~anyone~ who isnt homeless, unemployed and is completely is ineligible for any govt payment (lots of homeless ppl are on the DSP), and thats an implausibly tiny number of ppl, who cant afford the internet

and those fags wouldnt have kids in schools anyway

 

[#RoadTo31Atar]

in all fairness there prob isnt a single person in aus who cant afford the internet

the only ppl who dont have internet in aus are oldfags and ppl who deliberately live "off the grid" lol at there being ~anyone~ who isnt homeless, unemployed and is completely is ineligible for any govt payment (lots of homeless ppl are on the DSP), and thats an implausibly tiny number of ppl, who cant afford the internet

and those fags wouldnt have kids in schools anyway

Not having internet at home is comparable to not having water or electricity nowadays, it's impossible to live a normal life without internet.

 

[Time&moretime]

'New data from the Korean Centre for Disease Control and Prevention (KCDC) has thrown up a new theory about how we build immunity to coronavirus. The KCDC stated last week that there have been 91 documented cases of patients in Daegu, South Korea who had recovered from the coronavirus, left quarantine, and then tested positive again.' as reported from Al Jazeera.

 

[studiesofboard]

NSW schools could reopen by August

Scott Morrison has revealed he would send his two daughters Abigail and Lily back to school in a “heartbeat” if they were going to be taught by teachers complaining the current distance learning model is “child minding”, not education.

www.news.com.au

 

[Potato Sticks]

Regarding the issue of schools, probably either they reopen around August, or not until at least midway next year (or they reopen August and then reclose).

Now it’s looking increasingly like the government pretty much has one shot of getting us out (i.e eradication) and if they screw up (or it turns out to be out of their control) and the reopening of society causes resurgence, this is going to be here until a vaccine comes.

Suppression and control is not an option that is compatible with significantly easing restrictions (significantly meaning e.g reopen restaurants, not just repealing stage 3 restrictions) or reopening school, no matter how careful. While many thought this was before, the situation has changed substantially in the past two weeks and Japan and Singapore are having a second wave, Singapore still in its exponential phase, in spite of their restrictions being similar to what would be considered under a “eased” regime (now their restrictions are stricter of course). Singapore also has the phone tracking system that is widely acclaimed. China are locking down different provinces, but the extent of the second wave,if existing, is unknown. The unfortunate truth is that people become complacent when there are less cases (as is recently). This will result in a second wave unless we enforce closures of “principle places of social gathering”. Allowing cinemas to open is asking for social interaction (even if you implement, say, 1.5 m social distance, that is very difficult to enforce). Personally, I cannot imagine a group of teenagers visiting the cinemas and maintaining 1.5 m from each other. And if someone sees “oh there’s only 50 cases today, it won’t matter”, then the problem will balloon out of control again. The problem is the same with other places - the only way to enforce social distancing is to stop the gathering.

Now, about eradication, which is a legitimate path that has opened up now. In my opinion, eradication is our only and best chance out before our vaccines. If we shut down everything (except health care, of course) for 2 months, ban on exercise, enforced food deliveries and banning on site supermarket visits unless emergency, etc. It is also worth noting that New Zealand has 20 or so odd cases recently each day, with their lockdown strategy but if this is lifted in a week’s time as scheduled, there is little chance that eradication is successful. But they also haven’t done everything, such as stay at home orders, which would reduce residual contact.

Something interesting that I notice is that the daily cases tend to be exponential when there are not enough restrictions and social distancing, and approximately linear when there are, as the linear portion represents the people that continually flout the rules. This is crux of our problem, as 1) it means the virus is survives through periods of restriction, and 2) the “acceptable” linear growth quickly turns into exponential growth as the general population increases contact (above r of 1). Considering the new estimation of r being 5-6, this is quite difficult without the current restrictions. (Note: the current restrictions easily reduce the number of people you contact 6 fold). This is why if we implement eradication approach, and we are required to stay at home (except health care), then the rule flouters stand out even more (currently they can pull one of a number of excuses convincingly, such as they are exercising when they are really going to a party (no way to check), or they are driving to a supermarket when they are really going to their friends house (if they remember which supermarkets they pass on their drive)), and can be fined or jailed as necessary. And then the curve might drop to zero.

 

[Potato Sticks]

New evidence has recently come to light from multiple studies about the role that asymptomatic transmission, links can be found in the article below.

“In one Washington State nursing home, 56 per cent of those who tested positive for COVID-19 had no symptoms. Aboard the Diamond Princess cruise ship, 50 per cent showed no signs at the time of testing while 18 per cent never did.
One study published in the journal Science indicates that people with no or mild symptoms contributed to 79 per cent of all transmissions within China, as they felt they were healthy enough to travel.
A study based in Italy similarly identified between 50 and 75 per cent of carriers were asymptomatic.”

Dangerous number of ‘invisible’ spreaders

They’re what makes this pandemic so difficult to stop: “silent spreaders”, infected men, women and children who have no idea they are ill – but are infectious.

www.news.com.au

The role of children also seems to have been underplayed in the past weeks. Evidence appears to be building that they are infected more often and transmit more often than previously thought.

“Most New York children “probably” already have coronavirus and are serving as vectors to spread the disease, a New York paediatrician says.
Dr. Dyan Hes at New York City’s Gramercy paediatrics advised parents to assume their children have the virus if they contract even mild symptoms consistent with the disease.
“I think that probably 80 per cent of the children have coronavirus.”

Now, onto the decisions:

1) They are aiming for a 4-6 week reopen of the economy, implying repeal of all stages of restriction. Nothing wrong with aiming, just not particularly realistic.
2) They are aiming for a week 3 reopen of schools in NSW. Again, given the increasing evidence of children as asymptomatic spreaders, this isn’t likely to last long. Reopen is highly dependent on how well they control a second wave (which is not, to be honest, compatible with reopening schools - just think about the public transport, interaction with members of the public, family members, teachers, and int case anything other than eradication or indefinite stage 2 restrictions)

I believe, unfortunately, what is happening is they are starting to yield to public pressure too much, which is always “lockdown! Lockdown!” in the exponential phase (what NZ tried to do, and is unfortunately not working), and “repeal the restrictions”in the linear phase .

 

[Trebla]

I think care needs to be taken to distinguish between people who don’t have symptoms at an observed point in time (but then develop them later on) and people who never show symptoms at all. Asymptomatic transmission captures both the above types but the vast majority of them fall into that “presymptomatic” category which is contact traceable.

 

[cosmo 2]

i have the virus