Is UK government insane or genius?

Their reasoning is that if the only things you can do are China-style lockdown or nothing, then the disease will just resume exponentially growing the second lockdown ends, so it's pointless to do it at all.

While that may be technically right (under some optimistic, unverified assumptions, e.g. no reinfection), it's a false dichotomy. Singapore, Hong Kong, and South Korea aren't under lockdown, they're stopping the spread by just having good testing and case tracking capacity, and good hygiene. And the longer things go on, the better they're getting at doing that. If things are getting out of hand, a temporary lockdown is effective (as it was in China), to get the numbers down while building up this kind of capacity. But lockdown doesn't have to last forever; China has already lifted restrictions in most cities.

The UK seems to be ignoring this, and I don't understand why. I suspect the real logic, as some government officials have outright said, is that a completely failed response would free up money for the NHS by killing off "bed blockers".

The social signalling around it is "prudent caution", in the sense that they are talking slowly and confidently while using big words. This gives some people the gut feeling that this must be the "rational" thing to do, but it's just window dressing. The plan is neither prudent nor cautious; it's recklessly endangering millions of lives. Experts in the UK are horrified; there's an hours-old petition against this with hundreds of academics already signed on [0]. The WHO has condemned it, and half the people I know studying abroad in the UK have fled the country over it.

0: http://maths.qmul.ac.uk/~vnicosia/UK_scientists_statement_on...

I’m going to try and lay out the case in as neutral terms as I can, although to be clear I think they are probably right. They’re going to take an awful lot of stick for it though, and indeed already are.

They believe that there are basically two mitigation strategies. One is to have a very drastic early lockdown that shuts down the virus before it spreads widely. The problem with that is, once you lift the lockdown it will simply start all over again. The problem with this is lockdowns are most effective the first time you do them, and then mostly in the first few weeks of the lockdown. Do it too early, and yes it will be very effective in the short term, but later on when cases become much more prevalent the lockdowns will be less effective.

The option they are going for is to start the lockdown a little later in the cycle. The hope is this will make the lockdown more effective at a higher point in the spread. Effectively instead of a series of booms and busts, you get one longer slower initial burn and then you’re mostly done. They believe that in the long term this will make it easier to protect those most vulnerable to the virus, because you only have to do it once, at the cost of increased prevalence among people least vulnerable to it. So they see it as a better longer term strategy.

You can read some of the rationale behind the plan here:

https://assets.publishing.service.gov.uk/government/uploads/...

I'll be honest, I watched the announcement on Friday in open mouthed horror. I can't claim I have a concrete refutation for either the broad logic or the specific evidence underlying it, but even the best case scenario is a disaster of historic proportions. I wish us luck. I wish the rest of the world luck if it turns out we're right and they're wrong.

There is no proof immunity will happen, the UK Gov is thinking in economic terms and worried about GDP.

https://www.theguardian.com/education/2020/mar/13/coronaviru...

The NHS makes a huge difference. As a single entity it can pivot in a way that I wonder if other countries can come close to.

My daughters dentist commented yesterday that all her surgeries (and her team usually do 50 a week) had been cancelled. The reason? All the anaesthesiologist had been requisitioned as they will be required to do ventilation. All elective surgeries had been cancelled, and her paeds specialists sent on refresher courses for adult patients.

We're in uncertain territory here, the NHS's response may not be 100% perfect and a lot of people will argue that some minutiae could be done better, but I believe it has the huge advantage.

I wonder if other countries, and particularly the US, can manage such a coordinated healthcare response?

Thinking about it from where I am right now, I don't think it is crazy.

Let's think about it again: China, Japan, South Korea, Hong Kong and Taiwan. They are countries which are very connected to each other; and yet, somehow, they managed to contain it. It's 'herd responsibility'. The people are applying social distancing and hygiene rules, that's why it's working.

It's possible, as a knowledgeable politician, that you recognize that it's impossible to implement such measures in your country. The reasons are beside the technical abilities of your government: Your citizen are not committed enough to the hygiene. And that's not because Asians are cleaner or superior, they have been exposed to these viruses before and thus they are already trained to deal with them.

It's not the same deal for many countries of the west. We didn't have much trouble in the last few decades and thus people have forgotten why we do most of the hygiene measures in the first place.

Also, here is my first reaction, as a citizen, if the government has declared 'herd immunity' as their strategy: STAY AT HOME. I'd also probably warn the closer one and avoid contact with them too.

So the UK might win twice here: Have enough social distancing by fear (and fear is a hell of a thing as you experienced in the last few days); and also have its population adopt strict hygiene and distancing rules making it safer in the future and readier for the next disease.

https://twitter.com/AdamJKucharski/status/123882151552689766... appears to give a better explanation from the modellers.

The aim is to flatten the curve, any herd immunity is a by-product but not the aim.

Here is a rule of thumb that will be familiar to many who manage risk in a professional capacity:

The time to get creative is when you face a capped downside on the one hand, and an uncapped upside on the other. The time to get conservative is when you face the opposite condition.

The reason for this rule is that creative policies almost never work; but when they work, they have a much higher chance of working extraordinarily well than conservative policies do.

The UK is facing a capped upside and a huge potential downside. The UK is choosing to handle this situation with a creative experiment. This experiment will, in all likelihood, not succeed. And unfortunately most values of "not succeed", in this context, map to catastrophic outcomes.

Time, as always, will tell.

I like tomp's comment from a few days ago, feels like the UK playing a game theory https://news.ycombinator.com/item?id=22555643

1) no pandemic, no action -> government was "right", avoided wasting money -> reelected

2) no pandemic, action -> government was "wrong", wasted a lot of money, damaged the economy, inconvenienced the lives of the population -> voted out

3) pandemic, no action -> government was "wrong", caused loss of lives and damaged the economy -> voted out

4) pandemic, action - this is the trickiest scenario, so let's consider two options:

4a) pandemic, action, it works -> government was "right", saved lives, spared the economy -> reelected

4b) pandemic, action, doesn't work -> government was "wrong", their actions failed, they're incompetent -> voted out

Here is a discussion on Channel 4 on the approach taken by the UK government.

https://youtu.be/C98FmoZVbjs?t=590

Debating are:

- John Edmunds: a professor in the Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine

- Tomas Pueyo: his modelling of the pandemic has gone viral on the web: https://medium.com/@tomaspueyo/coronavirus-act-today-or-peop...

During the debate, Pueyo throws up his hands in horror at what the professor says. Listening to them both, I honestly don't know who is right. You may think a level-headed response is the right approach rather than an emotional one. But there is something cold, clinical and unemotional about the UK's strategy to tackle this pandemic.

And can you "nudge" people to adopt certain behaviours in one country when the rest of the world is doing the opposite to what you advocate?

I think we (UK) are trying to be too cute about managing the curve, like we can ramp it up to the capacity line then slam on the brakes with the big measures at exactly the right time and keep it ticking along there nicely through the spring and summer and have this thing wrapped up by the end of the year. It could all go very badly wrong.

I get the impression we're being overly influenced by a few gurus of behavioral science, a field which must surely make even experimental psychology look replicationally robust, and in particular by 'nudge theory', for which our politicians have a particular penchant. I also gather we war-gamed this exact scenario two years ago, which may have led to a degree of overconfidence amongst some key players.

My intuition on this is that any strategy that relies on rather precise targets to hit in terms of infection rates is doomed to fail. There is simply far too much uncertainty about the exact properties of the virus, the behaviour of the community and the effectiveness of the various measures that are employed to try to contain or mitigate the pandemic.

The incubation period is something like 5-6 days on average, it'll probably take at least another day, likely more to get test results. So you're always at least a week behind when you're trying to examine the results of your actions, and the pandemic spreads at an exponential rate if no containment or mitigation measures are preventing it. If you get this kind of strategy wrong, at the point where you're noticing it you will have doomed your healthcare system and your population.

It is the nature of exponential spread that you will have to act before it is obvious, and that if you don't do that it'll be far too late once you notice that.

It looks like to me just a comfort pill for the public. They basically acknowledged that they can't handle the crisis already. So what they gonna do? They want it to appear to be an advice from expert, to persuade the public, rationalize a forced decision.

The uncomfortable truth is, the British government have weighted cost and benefit, and they have decided, the death of thousands or more is not worth the cost of near-absolute lockdown of a country, It might lead to total breakdown of the economy, full-recession, and that may cost more lives anyway. These elder people are old enough anyway, and the death rate for young is just 0.2%. (which rise to 1.3% for people elder than 50, and 6% for elder than 60 according to data from China)

What does those number mean? If you and your partner's parents are elder than 60 years old, there is 25% chance, at least one of them will die. That is, very likely, you're going to hear it from your best friends that one of their parents died from COVID-19. Are you okay with that? (Under the assumption everyone will get infected anyway). And beware, these statistics are not final, and mostly from patients who received some level of medical care, although we do not yet know how many of those heavily-ill patients received intense care. Without medical care, the number could easily double, after all, it takes time to die, that's just how lung disease works.

Modelling disease spread seems like the kind of scientific endeavour that one can dedicate one's whole life to becoming an expert in, and many people presumably do. Considering that, why should anyone give much credence to a random medium article on the topic by a 'silicon valley tech executive'? (lol)

There are 10's of thousands of scientific research papers [1], by scientists, on COVID-19 already, and this guy is just some tech exec who knows how to play with a jupyter notebook. I see no reason to pay much attention to him.

[1] https://twitter.com/freereadorg/status/1236104420217286658

I don't understand how Europe+US governments (and epidemiologists!) say things like "It's basically inevitable that 40-70% of our population gets infected overtime". It feels like the Western countries gave up without even trying.

But yet, there's at least temporary evidence among several Asian countries (South Korea, China, Singapore, Taiwan, Hong Kong) that it's possible to get the R0 < 1, the infection rates to shrink, and seemingly be well contained well before any herd immunity effects happen.

In the US we spent only $7B to fight the virus but yet hundreds of billions to manage the economic impact. And yet, our companies/people will still suffer economically and humanitarily.

In an ideal situation, in ~8 weeks, Italy/US/Europe will only have dozens of new cases per day and will try extremely hard to contain these limited new cases and their spread. The only difference between Early Feb and Early May in these places will be that we had 3 months of potentially avoidable economic and humanitarian destruction- just to teach us the problem was serious and give us time to prepare systems to contain.

If the successful Asian countries (specifically Taiwan, Singapore, Hong Kong, but also South Korea) show that this was possible to keep small, the voters in the Western countries should demand accountability from their scientists and government leaders.

Insane. Here's the key line, from one of the people in charge of that clown car:

"There’s going to be a point, assuming the epidemic flows and grows, as we think it probably will do, where you’ll want to cocoon, you’ll want to protect those at-risk groups so that they basically don’t catch the disease and by the time they come out of their cocooning, herd immunity’s been achieved in the rest of the population."[1]

Here's the thing about this: it's plainly moronic. Because this strategy only works if they can identify the point in question. And there's no universe in which a government can identify that point under incomplete information and exponential growth. It's the sort of thing that only a psychologist who has spent too much time hanging out with Cass Sunstein and other believers in the omnipotence of the administrative state could possibly come up with.

[1] Quoting a psychologist in charge of something called the "behavioral insights team" in https://www.theguardian.com/world/2020/mar/13/herd-immunity-...

I'm pretty confident they'll start copying everyone else in 10-14 days.

They are ignoring any sensible model of this and they won't be able to deal with the uproar once the numbers reach a psychological threshold. Happened last Sunday in Spain BTW.

The other countries are going for herd immunity too. The goal of all lock-downs and red zones is just to prevent the health system from collapsing.

Okay so here is my dispassionate take on it.

1) everyone (>= 60% of population) will get it

2) the modelling that’s been done by the British government is probably very good and almost certainly includes more variables than the shut it all down countries

3) we don’t know enough about how the virus operates but we might know enough by the time peak cases occurs in the UK

4) It’s very likely to come back in China et al, they think in the Far East it’s under control but it only takes one person arriving in Beijing to reignite the problem and you’re back to square one

5) they are trying to limit peak deaths including a lot of factors I have to assume that is their strategy

6) do you go with the models that give you a way to return to some normality sooner?

7) what is the best case outcome according to the best scientific models we can get? It’s very easy to just do what everyone else is doing without thinking through the best path.

8) I actually trust the people thinking about this issue, I know it’s hard to believe but I do think the UK government is going with a view that there are more factors than are immediately apparent in this equation.

9) will the UK turn out to be right that stopping this permanently will involve herd immunity. Unfortunately the American/Italian/Western society situation means stopping this virus will be impossible so you then start calculating if you want international travel to continue how can we keep our societies interconnected?

My guess is based on a lack of information and a load of assumptions about this, but I think it’ll prove to be the right decision medium term. We are going to be in this thing for some time, some countries much longer than others.

I strongly disagree with the approach in the UK. We should be following the WHO guidelines and the rest of Europe

It feels like we're the big version of one of those corona-virus cruise ships

The government isn't going with a herd immunity strategy. It's waiting for the most impactful time to lockdown.

Here is a link to the Coronavirus Action Plan on GOV.UK: https://www.gov.uk/government/publications/coronavirus-actio...

I would suggest anyone read this and other official publications before any Twitter thread to understand the UK government's approach to the virus. Large, complex decisions are hopefully not made off of a few hundred word summary of the situation.

One region of Italy is close to their ICU beds limit, despite a full lockdown. And they have more beds per person than the UK. Without a full lockdown, won't they run out of beds very quickly, thus increasing the death rate a lot?

This strategy is not insane only if there is also a concerted effort to protect those who are vulnerable while the virus spreads. The problem is there isn't one. At all. None. Zip. Zero. Some care homes are, off their own back, banning visitors but apart from that the old and the vulnerable are not being asked to self isolate or engage in social distancing, only those who have symptoms themselves are being told to self isolate, and not members of their households. Social clubs, churches, pubs, cafes, day centres, restaurants etc. where a lot of older people congregate are all still open. None essential home visits have not been curtailed and people are not being advised to socially distance themselves from the vulnerable.

I do wonder if this decision doesn't have a Brexit component, the transition period will be over the end of this year, so I guess that is when the real bad stuff from Brexit will start becoming clear, if you mess up your economy the year before by lockdowns then what happens when things go really downhill?

If you don't lockdown, and other countries do, can you somehow benefit? I would say no that doesn't make sense but I somehow have the feeling that the people who currently lead the UK do not share my understanding of what is reasonable in any way whatsoever so maybe they would have a Baldrick level cunning plan in mind?

I think it would be rational if we knew more about the virus, but we really don't know much, given how new it is. There could be long-term health effects from contracting it, but we just don't know. The UK seems to be making a lot of assumptions, which may not bear out. +1 insane.

It's totally insane and I am amazed more people in politics and the media aren't calling it out. Other countries have already demonstrated it can be contained with rapid testing, tracing and limited lockdowns so why are we doing this?

Lets assume 60% of the population are to catch it, they have said they want the worst of it over by the winter. That's 40 million people. If 5% need an ICU bed and the average ICU stay is 2 weeks (both conservative numbers) and infections are spread out perfectly over the next 8 months we will need 125,000 ICU beds, the NHS has something like 5,000 and most are already used for non-coronavirus patients.

You run our of ICU beds the fatality rate is going to rocket, more like 3-6% then 1-2% and we are looking at deaths of 1.2million - 2.4million, let alone all the deaths that come from a completely over-run NHS.

How can you describe a plan that will allow the collapse of the NHS and the death of millions anything other than insane?

The UK approach is highly interesting. It's assuming that a government telling people to social distance themselves is highly effective. You then direct the elderly to social distance themselves; they are mostly protected from the virus; it runs rampant through the general population; and after a two months of relatively mild, mass cases among the young, you've effectively built a herd immunity firewall around the elderly.

Three possible issues:

1) Telling people to social distance themselves has a weak effect, not a strong one. In that case, the fire burns through the young population and burns through the old population, and you end up with a pile of flaming corpses.

2) I don't know if herd immunity of the young population is enough, epidemiologically, to give herd immunity to an older population. Old people can pass it to each other, and their day to day interactions are disproportionally among the elderly. So you risk an older subgraph all catching it at once still. I don't think this is a big risk compared to 1).

3) Individuals don't develop an immunity. This would be disastrous for this strategy. Then again, it's disastrous for all strategies.

The first issue seems like the biggest issue to me, and I think it's pretty damning. If that's the case, the elderly never have the protection of herd immunity, and you're not flattening the curve but sharpening it.

Another possibility: the government knows it won't work to seriously change the number of deaths, but it also believes all measures possible in Western countries are likely to fail. In that case, you immolate the elderly population as fast as possible and then get used to a new norm instead of spending months in a futile battle. Essentially, it's possible that even with heroic efforts that the curve can only be flattened a bit, so it's just a matter of timing the deaths and how long you want to be enduring terrible economic damage. And if every other country suffers pretty much as much as you do, political impact is limited.

I remember when I was a kid, I didn't really understand refrigerators. Like I knew that the cold would eventually leak out, so how was it cold inside if the cold would eventually leak out? How does insulation even work?

So, I eventually figured it out. The insulation slows down the heat transfer. The fridge still has to do work to keep cold, but the insulation means that it can keep up with the losses and spend less energy on that.

The countermeasures to COVID19 are like that. The virus is going to spread, but we still need to slow it down, so that the healthcare system can deal with individual cases, and not a flood.

Some people are going to get it, but that doesn't mean we have to be fatalistic about it. We should take it seriously, but also rationally.

Isn't there a higher likelihood for the virus to mutate if a large population gets it?

Is there even conclusive proof that people can be immune from the virus after being infected?

We have no long term effect data on Covid-19 so it’s absolutely insane to do anything but minimize infection rates.

According to other famous virologists, this is a risky strategy to play. This is an RNA virus, this means that you cannot safely assume that the population will be immune after the first infection.

I suggested this a few days ago and it was not a popular idea, but if you can enforce a sufficiently strong quarantine for the elderly, I believe this could decrease the total number of deaths (although the total number of infections will be higher than with universal social distancing, the faster it spreads, according to most simulations).

There are already some reports of re-infection. It may be that immunity isn't so easy to build for this virus. Not enough is known about it yet. This is a huge gamble.

The idea of not testing except the most serious cases, wait for herd immunity is starting to attract criticism from many scientists

https://www.bbc.co.uk/news/science-environment-51892402

I think they’re taking more or less the right approach. I do think they could have gone further and banned big events and told anyone with cold or flu to stay at home for 7 days (instead of with specific symptoms).

It’s already too late to ban travelers, and will do more damage than benefit. Well it’s possible to score political points by closing borders, the damage it will do the economy is not necessary.

Countries like New Zealand and Israel are so isolated from their neighbors they may benefit from closed borders, but tbh it feels like more short term planning when what we need is long term thinking. What happens in 2 weeks when the crisis is still unfolding?

I wouldn’t be surprised if more cases pop up in China in new locations because of the nature of this virus (delayed feedback system)

I’ll go out on a limb here and say that this sounds “Dr Strangelove” level bad. Like, phenomenally cavalier.

They need to release the data and assumptions they’re basing their simulations on, because this will affect the entire world, not just the UK.

The current numbers have COVID-19 at something like 20x more deadly [than the flu] for people under 50. It’s not nothing. At scale, that’s a lot of people dying. Those numbers are also a reflection of the treatment being done in all the other areas of the world right now. Does their model adjust for an increased mortality rate that would surely occur in an overwhelmed medical system? Are they assuming a nearly perfectly executed quarantine of the elderly?

They need to share their data and assumptions.

One question here: Do we have any scientific way to verify which strategy works? I been waiting for related research that can either proof or disproof the usefulness of the "Lock-down strategy" which China been using in the past couple of months and still not fully lifted.

We had little less than 30 total cases in our city with just over 1 million population, and the city was in lock down mode for few weeks. I can feel the slow rise of living costs during that period of time.

It's quite funny to see how people reacts to this, panic-buying all the face masks for example. Makes me think whether or not it's worth it to go full-out panic, because panic usually creates way more chaos/problems than the problem itself.

There is a huge flaw in this thinking which is that the disease takes about 5 days before symptoms and another 5 before hospitalization.

And many places put the virus doubling time in several days. So the hospital situation will get 5x to 20x worse after they initiate lockdown.

I feel like this is what Sweden is doing without saying it. They have stopped testing anyone except the elderly, severely ill, or healthcare professionals. It kind of seems like they'll just expect most of us to get it with only mild symptoms since it's out there now anyway, and confirming a mild case isn't really going to change treatment. At the same time they are stopping gatherings of over 500 people and telling people to stay home when sick. Many people are now working from home, but schools are still open. But without testing people and proper statistics how do we know when it's safe to resume gathering, or go back to the office?

You can't do this without adequate testing. If you can do tens of thousands of tests per day, and you're testing everyone, then you can potentially control the rate of infection by opening and closing public places and schools, etc. But without testing you won't know and the goal of not putting strain on the NHS will fail.

Places like the US are completely in the dark because of incompetence, but once we have the visibility as to who is sick, and having widespread testing, then I think this might make sense. Heck, if I knew I would have access to a critical care bed if things got bad, I would probably volunteer to get infected now.

lol it sounds more on the insane side to me. you have to have a thought out plan to protect the vulnerable and do exposure in "phases", but has that ever been done ever?

and even if you are young and healthy why would you knowingly expose yourself to something that, while wouldn't kill you could put you in a life threatening situation, regardless. i know there are probably way more statistical higher ways to die, but there's a reason i don't go rubbing my face in a sick co-workers hand. even the flu symptoms are no joke.

i've heard that there's a chance of re-infection, but not sure how accurate that is.

unless the world plans to stay isolated until there is a cure this may be the alternative that doesnt also bankrupt a lot of businesses and put people out of work.

There is evidence from China and Korea, that you do not build immunity from the disease.

https://archive.is/Gv1iu

This makes the UK response almost as bad as doing nothing at all. Maybe some people will show to have a natural immunity, but many people will die. The UK is in arrears politically and socially. There honestly is no response that would be appropriate, that they could hope to deploy.

> the virus seems to be relatively inoffensive for young people

Not enough is known about the long term effects of this virus. There are reports that those who recover are experiencing reduced lung function [1].

[1] https://www.sciencealert.com/even-those-who-recover-from-cor...

Lockdowns are just to decrease the rate of spreading (and avoid high concentration of virus particles) not to eliminate the virus, so everyone should prepare oneself to face it and get through. Just this.

Some small percentage of population in isolated regions have chances never meet the virus, but hiding is not the stable strategy.

Getting through and become immune is. This is what UK government is saying. Let's face it.

I watched a presentation/session by Norwegian directorate of health that included some comments from Italy [1]. I think they shed some light on the mortality rate - in effect 50% of those intubated died. And they were some percentage of those needing icu care. Assuming the icus are overrun, and all ventilators taken - all of those patients would be dead.

So (given the size of population, and relative lack of ventilators) - in an actual uncontrolled spread, I think we will/would see much higher mortality rates than we've seen so far.

I hope the UK won't be the first to prove that (I suspect the US might be the first to do so). Or indeed, maybe Iran already has.

I heard there was mentioned that in areas hard hit in China, where low(ish) mortality rates were reported, they were also desperately seeking more people for

[1] in English, starts at 4h mark: https://youtu.be/LtWti5prxzg?t=4h

FWIW, I submitted this earlier today:

When an epidemic outbreak such H1N1, Zika or SARS viruses occurs, containment measures may seem to be the most reasonable solution. However, an EPFL study casts doubt on that idea, showing that such measures make a society less resilient and less able to return to pre-epidemic economic and social conditions. The study, published in Nature Scientific Reports, coincides with another publication on the same subject but based on other mathematical models, published in Nature Physics in December. That study also compared the advantages of containment measures with those of non-intervention, and reached the same conclusion: Preventing travel and social interactions is not always the best way to deal with an epidemic outbreak.

https://phys.org/news/2018-01-epidemics.html

and causing the deaths of >80 year olds, thus reducing the costs of dependency on the health system? #consipracy :)

It's hard to say, especially when you consider that the NHS has had its funding cut for years, and that even with a full lockdown it is likely to struggle even with a modest rise in patients over time.

This might sound dark, but as others have said, it feels like the government would rather see the country overwhelmed over a short amount of time, compared to a prolonged battle where their failures in healthcare will be highlighted.

I won't pretend to be a virologist, but one thing I will say is that it is wishful thinking to assume that the elderly are going to go into lockdown as the rest of the population builds an immunity. There is a level of arrogence and entitlement, mixed with regular doses of misinformation, that will ensure that the UK public will "keep calm and carry on" throughout this entire mess if there is no enforced lockdown.

I think this is really a battle against ignorance. Until people see results in front of them they aren't going to respect these rules without authoritarian measures.

Best is to shut everything down for a month THEN let 40s and under back to work. By then, hospitals will have been overrun but hopefully on the upswing and people will be a lot more sober and willing to listen.

I imagine once the shutdowns happen and reality sets in, people will not want to go out and expose themselves willingly and politicians will rather keep everyone locked up as long as possible, but that is a mistake too. Everything hits with a 2 week lag so it is import to trust the trends and the analysis rather than the current situation - I expect us to be too conservative on the way out just as we have been too cavalier on the way in.

The UK government is criminally insane to the point that they should be locked up and shot.

For every person who would die in the normal course of the disease, around 3 more needed hospitalization. The Wuhan experience showed that when hospitals are overwhelmed and cannot put them on ventilators, the fatality rate roughly doubles.

The UK course of action is guaranteed to overwhelm local hospitals. At which point even if half the vulnerable population does not get sick, you have as many fatalities in that group as you would have if the rate of spread was reduced.

Worse yet, it is currently unnecessary. Both China and South Korea have demonstrate that aggressive containment and quarantine efforts can result in exponential declines in the disease. As a result we should not yet be giving up hope that the disease can be contained, avoiding mass casualties. And even if we did want to take the UK approach, you could always switch to it after you had demonstrated that you can't contain the disease.

This idea that the primary aim of the UK Government is herd immunity is plain wrong. The primary aim is to flatten the curve with specially timed interventions and any herd immunity is a by product of that. The aim is to flatten the curve so that the systems are able to cope better.

Herd immunity will be a by product in almost every western countries actions today. Ask them and if they are honest they will say the same that it's a long term effect but not the primary driver or the main aim.

The difficult non sound bite criticism is about the flattening of the curve based on their models which basically means they need to get both the timings and the interventions spot on for it to work correctly. Dont let fear win

The Italian strategy is simply to try to prevent running out of ICU beds or at least minimize the number of people that can't get IC in the short-term due to the current uncontrolled spread.

As far as I can tell, what to do long-term is still up to debate, and continuing the lockdown only for higher-risk/older people is certainly an option.

Note however that jumping straight to such a differentiated lockdown seems much less likely to work, because behavior changes are easier in a total lockdown with full media and discourse focusing on it, as well as much easier enforcement since you don't have to distinguish the high-risk people.

A sudden surge of infections will overwhelm the health services, number of available hospital beds, ICU units, and ventilators. This means that many more people will die that would have otherwise survived if the spread of the virus was slower and treatment was available.

Unfortunately there are many who view the countless avoidable deaths of those who are older, have underlying conditions or otherwise could have benefited from proper treatment as an acceptable price to pay for a faster "economic recovery".

If you read the longer version of the UK's strategy that is not what they are doing... They are waiting until their numbers are high enough to justify lockdown and then lockdown as they know the economic shock is huge. So they wait until it is time, lockdown for 30 days, see if they can flatten the curve, then boot things back up.

The media picked up part of the story, but not the entire story. And, Boris played up one part to the detriment of the actual entire white paper.

This is insane. It depends on a bunch of things we don't know turning out to be true: can we develop herd immunity to COVID-19? Can we adequately isolate young/healthy people from old/sick?

IF this turns out to be the UK strategy it will also become imperative for countries trying containment to ban travel from the UK.

I think it's an idiotic brainwave from a bunch of people who have spent way too much time pretending that they are the "smartest people in the room".

Herd immunity and keeping the total infected at any one time to a manageable level is the end game everywhere. I think the difference you are seeing is a difference of opinion over how extreme the measures need to be to keep the total infected from overwhelming the hospitals. It's possible that moderate measures early might be enough clearly if you wait too long more extreme measures definitely seem to be necessary.

There are three things to consider:

1) Even if they contained it inside the UK, it will be imported every day by people returning from the continent/USA. Unlike the quick flu tests, its 2+days for a result in testing

2) Vaccination at scale is a year+ out (as in at least may 2021)

3) flu season is only 7 months away, which means doing this all again, but with a newer version of the virus. This virus might be more mellow, or not.

Look at the infection rates in spain, france, Nederlands and germany. They are in lock step. Containment has failed.

update THe last, possibly most important point is this: the voting base most at risk of this virus is Boris's. Its really not in his interest to let them all die. I find the man abhorrent and selfish, but I doubt he's stupid enough to let his vote base disappear.

Letting people past a certain age just die only works if people at that age co-operate. No matter how much the authorities try to spin it, there are more than a few "runners" who don't want to die (yet). https://www.imdb.com/title/tt0074812/?ref_=fn_al_tt_1

Okay about the mortality rate. What about the hospitalization rate? Is it low enough to do not break the health system ? And about the smokers? diabetics ? Cancer patients ? And about the old one already hospitalized ? The kids ? And about the 0.3% that will dye ? How many young people will die in a old population ? And about the doctors and nurses extra exposed to the virus from different people?

Scientifically, yes. Politically, suicide.

Herd immunity is what you hope for once the infection has gone through the population. To the extent that they try to build it by telling people they must be infected with it (questionable, and arguably a misinterpretation of public statements) it will be perceived as an attempt to cull the lower classes for the benefit of the ruling ones.

Herd immunity is particularly insane idea if it's confirmed that you don't, in fact, get immunity:

https://thehill.com/changing-america/well-being/prevention-c...

No it's insane. Because you know viruses do one thing: they mutate.

Also heard immunity takes to long at which point all old people will get potentially infected too.

Also cases to death ratio (and infection to death ratio) are still on a magnitude larger then with the flu. Especially given that somewhat between 10-20% of infected need intensive medical care, all roughly at the same time if you don't slow the spread which likely can't be provided if that should happen increasing death ratio.

With such a strategy we at looking a mostly likely at >350000 deaths. Not unlikely even over 1800000...[]

Through well there is always very, very small chance that it will work. Less because it's a good strategy but because even if you do nothing there is a very very very small change for a virus to "self destruct" (not correct way to describe they effect but it basically similar to a self destruction to a outside observer knowing nothing about virology).

But gambling hundred of thousand lives one it would be insane.

Well except if you have no morals and want to destabilize the country. Through I don't think that's the case, incompetence is more likely.

EDIT: spelling

EDIT: Numbers based on not unlikely infection rate of 60% of population and IDR of 1% (health system not overloaded) and 5% (health system overloaded to some degree).

EDIT: argument based on heard immunity idea not explicitly the UK strategy

It looks like they've either backtracked on the idea or it was misconstrued from the start:

https://www.dailymail.co.uk/news/article-8113011/Downing-Str...

Does anyone have a link to an actual policy document explicitly stating the UK's herd immunity policy? The link is a tweet from a random guy.

Herd immunity is the default, and it's also being pursued by the US, despite statements to the contrary. So I'm not sure there would actually be a document, but maybe it does exist.

We are about 2 weeks behind Italy in death rate, which is the only measure that can be reliably compared between countries, due to differences in test rates and criteria to be tested.

Is 2 weeks "grace period" before implementing a lockdown and starting the heavy measures worth it in the long run? I don't think so.

I'm not really qualified to comment on this strategy, but isn't this going to lead to stronger exposure to virus specimens per individual, i.e. more severe infections and thus higher CFR?

The actual goal of the UK might be to sacrifice a few people to boost the economy while the rest of the world wrecks its economy.

https://philip.greenspun.com/blog/2020/03/14/if-the-british-...

I don't think there's any working strategy for infecting the young and keeping them separate from the old. Many young people have contact with older people (live together, work together, being taught by them etc.), and anybody who claims it might work is IMHO divorced from reality.

I think the main mystery about the UK govts approach can be solved when your realise it is not very clever; just very incompetent. The whole word has been stunned by the herd immunity experiment policy; only to have it denied a week later. We are fools led by clowns.

The UK government is neither genius nor insane. What the UK government is, is pragmatic.

Turns out they were insane: https://www.buzzfeed.com/alexwickham/coronavirus-uk-strategy...

No. It’s dumb asf.

It’ll last like 2 days.

Here’s the EIC of The Lancet:

https://twitter.com/richardhorton1/status/123814984490619290...

I'm not sure I understand how this herd immunity strategy can work in the current world. Albeit the UK is segregated from the rest with water, there are still a lot of people entering your frontiers and that are not immune.

Herd immunity is basically doing nothing right? How is that any different from what happened in the Spanish Flu? I'm sure herd immunity came into play eventually but at the cost of all those lives.

I see lots of praise for Singapore and Taiwan's handling of the crisis.

What about the weather? Is part of the solution for cold dry places to have warm humid weather, which apparently kills the virus?

Insane, but we already knew it thanks to their past decisions. This is just the last confirmation. In the best case we’ll have close to 1M deaths if they succeed with their strategy.

Herd immunity by mass exposure is an interesting, very likely catastrophic, approach. It's interesting that he (of the twitter cite) claims that it is "more refined", as if simply doing nothing and rationalizing your hubris is 4D chess.

Every country realizes it can't be stopped now. Every country realizes that the majority of the population will get it. But as has been cited a thousand times, having hundreds of thousands of vulnerable people, along with a substantial enough number of otherwise healthy people, needing heroic medical care would be disastrous. See: Italy. Their approach wasn't "more refined".

I doubt the outcome is going to be good.

Meanwhile, people returning from the UK to the EU are being tested positive for Covid-19...

So, maybe the strategy (if it is one) works, but the UK is imposing it on everyone else without a care.

It is correct in theory, but Wuhan coronavirus spreads very quickly and easily. I doubt UK has enough hospitals and people to provide proper medical treatments.

All the kids get it, infect their parents, and off it goes.

I expected immunity once you'd had it, but have heard of re-infection occurring (not from official sources).

This sounds like the "bargaining" stage, in the 5 stages:

denial, anger, bargaining, depression and acceptance.

(Acceptance being a China style lockdown of course...)

MMh. is the netherlands then doing the same thing ?

The bit I don’t understand is how you carefully infect the bulk of young people and simultaneously keep the older folks uninflected.

Sounds incredibly risky to me. I suppose if all countries end up crippled anyway then it would be good to be the first to recover.

I think this is the path the USA will be taking as well if not "officially" so the old folks won't freak out.

The title reads like judging a startup founder. I'm not sure if all the startup rules apply to governments.

I feel really torn about this.

The intuitive way of managing this is to try all possible containment methods as long as possible. The benefits of this is that it will give maximum chance for containment, and failing that, maximum time for therapies/vaccines to emerge. What are the chances of this? Containment thus far has already failed. The asymptomatic period make this hard to contain, and even in China with drastic measures new infections are occurring. Even if this worked, it would only take one area not doing this effectively to allow reinfection of these other areas once measures are lifted. The other issue is that an effective vaccine is not going to appear for at least a year. Other repurpose therapies are being trialed, and initial results will be released this month. I’m not aware of any other completely new therapies which may change outcomes. So, it appears the benefit is limited. The main risk of this approach is that containment is initially successful, but then fails in Autumn (fall), leading to a peak in the winter when the health system is already under a large amount of stress. This would be a disaster, and may well be what happens to other countries who try this. So, the UK approach of making occur in summer may make sense for the UK. How appropriate this course of will obviously depend on level of seasonal variability in health care needs. Therefore countries like Indonesia or Singapore will do well to stick to containment initially, as they dont risk a peak occurring in winter.

Doesn’t herd immunity work if reinfection isn’t possible, which is unconfirmed at best at the moment?

As long as the virus does not mutate and start killing young people, which is a definite possibility,

Doesn't herd immunity require like 90% immunity?

Even with 5% of cases requiring hospitalization this is insane.

An interesting experiment is about to be carried out with the British as the control group.

The only thing we know for certain about C19 is we don't know anything for certain. The EU recognise that fact and are playing for time. The UK, on the other hand, is pretending to have a sciencey fix based on some adolescent game theory nerdgasm. Herd immunity can be conferred by both vaccine and disease. But there's a difference between vaccine and disease that seems too subtle for Whitehall to grasp.

The UK is planning for 60% of its population - forty million people - to contract C19. The gamble is that this won't overwhelm the health system. How? Because the government has told the virus not to infect people who might get ill.

In China, healthcare workers were at greater risk than the general population because of elevated exposure. The UK has told the virus not to infect doctors.

The big risk with RNA viruses is mutation: we could develop a vaccine this year that's useless next. Obviously, the larger the infected population, the higher the viral mutation rate. China and the EU are responding by locking down. The UK has told the virus not to mutate.

When declaring a pandemic, the WHO director-general said, “The idea that countries should shift from containment to mitigation is wrong and dangerous.”

Most comments here raise excellent points.

One more in the mix: Many companies in many countries are working on vaccines and cures. So far some are reporting moderate successes; as I understand it, those with the experience to tell seem to think odds are pretty decent there'll be some sort of vaccine available within a span of a year, maybe sooner.

Whether corona infections 'outpace' the time when a vaccine will be generally available depends a lot on how long it'll take to get a vaccine out the door, but presumably a ton of resources (and a lot of leeway on relaxing regulations) are spent on this, as well as exactly how fast corona spreads.

If it spreads very fast, all of this 'planned herd immunity' stuff is nonsense, all the taps you can close should be closed and stay closed and it'll still spread. The UK would be mismanaging this and should be closing more facilities.

If it doesn't, then the UK is probably mismanaging this, in that it'd be better to try to slow the spread because the end game is the vaccine.

Effectively then, they appear to be betting on a creative and untested solution that they more or less have to keep secret because it doesn't work well if it is generally known, which requires accurate forecasts from lethality rates amongst various parts of the public to spread rates in circumstances that are probably unique to the UK then, if they are the only country to go with this plan, __whilst__ betting that the vaccine solution is not going to be fruitful for a long long time.

I'm going with 'insane' on this one.

I do now know what is right, but I am glad humanity has a diverse set of strategies

They've backed away from the herd immunity approach now. Embarrassing

Herd theory works once you have an immunized herd(from recovery from infaction while we have no vaccine) so that infection passes only from an infected person to a vulnerable one. As we sit, the current policy will lead to an exposure to all people - more or less, and then the recovery and formation of the immune herd commences. Thus the IK government has decided to allow unfettered spread = all the casualties that involves to form the herd. This is a million or more people. An isolate into tiny herds-at-home, test symptomatics - treating positive by supportive care = formation of many immunized small herds. This second procedure will kill 50,000 or so. Laters it does not matter if the mini herds mingle as they are all immune. There will be little subsequent spread. UK is deciding to kill a large number of it's citizenry = some sort of class war???

Do you get immunity to cold caused by coronavirus after having it?

So, it sounds like the UK is having a big chicken pox party?

Definitely insane, here's why:

In order to get to herd immunity, you need something around 60% of the population to get infected and thus immunized [0] (there's a big assumption here already, that immunity lasts forever, might well be wrong). The UK's population is 66 million people, so that's about 40 million who need to get sick.

Let's assume 2% of cases require intensive care (it's closer to 10% in Italy right now [1], but we can assume for the sake of this calculation that the UK has the superpower to isolate people over 65 or so perfectly). That's 800000 people who will require intensive care!

There are about 4000 ICU beds in the UK [2]. Let's assume, again highly optimistally, that only 50% are occupied, so 2000 are available for Covid19-patients. Covid19 patients may need to spend 7 days in the ICU [1], which means there can be up to 286 new Covid19 patients starting intensive care each day.

You can see where this is going. At that rate, it would take 2797 days to reach herd immunity. It's utterly nonsensical. We will hopefully have a vaccine way, way before that. What this "herd immunity" strategy is actually going to do is lead to a total break-down of the hospital system in the UK, if the government doesn't change course real soon now.

[0] This is 1-(1/R_0), see https://en.wikipedia.org/wiki/Herd_immunity and unmitigated R_0 is around 3 for SARS-CoV-2, https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndr...

[1] https://www.statnews.com/2020/03/10/simple-math-alarming-ans...

[2] https://www.theguardian.com/commentisfree/2020/mar/03/icu-do...

It’s worth noting that many diseases don’t converge to herd immunity except through very high vaccination rates. Examples include polio, small pox, chicken pox, etc.

So their assumption about outcome seems flawed.

This is utter, utter madness. Assuming UK has 66M people and 2/3 need to be infected, that's 44M people. Coronavirus has, depending on the quality, affordability and accessibility of the healthcare system, a fatality ratio somewhere along 0.7% in best case and 15% (at least!) in old and pre-conditioned people... which means that there is anything possible between 300k and 6.6M (!!) deaths.

tl;dr: absolutely fucking nuts to risk more people than the UK lost in WW2. If BoJo really tries to execute that plan, he has to be stopped.

Important to remember that this person doesn't know what the policy is. They're just tweeting their opinion.

What could possibly go wrong.

They are neither; they are making difficult decisions on the basis of limited information across multiple disciplines. The main aim is to prevent the NHS from being overwhelmed, which would be a humanitarian disaster. A secondary aim is to prevent bringing economic life to an end in the UK, which would also be a humanitarian disaster.

We are at most about five months into this pandemic; to suggest we know what strategies succeeded and failed is very premature. We are just at the beginning.

In another world, we could all spend 2020 in individual seclusion, without any economic, social, familial, cultural, mental, or behavioral concerns. In the world that actually exists, "No man is an island, entire of itself" and so rather annoyingly we must continue to live our lives without being completely governed by epidemiological concerns. SARS-CoV-2 can be transmitted asymptomatically and is basically everywhere at this point, so if your entire strategy is just "don't let anyone get infected, ever", it is surely doomed?

One country did get a legitimate chance to end COVID-19 for all humanity by preventing onward transmission, and they blew it. The next off ramp is global herd immunity (either natural or artificial), which lies years or decades in the future.

It's worth pointing out that the UK already pursues a strategy of herd immunity regarding chicken pox (along with other countries), despite the availability of a vaccine: http://www.ox.ac.uk/research/everything-you-need-know-about-... I disagree with that strategy but I am not qualified to make that decision on behalf of a country, and I'm glad it's not my responsibility to do so.

It is a theoretical solution. That also could backfire fiercely. The more it spreads, the more likely it is to mutate. And not all mutations will be equals. Plus it might make producing a vaccine more complex.

Could also work. Unexplored territory, the truth is we don't know.

"In practice, people won't be disciplined about isolating vulnerable ones in the first phase, thus leading to disaster."

That is the point. One can catch the virus, become asymptomatic then continue to live normally and become even more dangerous to anyone in vicinity ("hug me, I'm safe!"). Eventually most of us will be infected anyway, and some will recover becoming immune (hopefully; this is far from guaranteed), so the correct line of action IMO would be to isolate everyone from everyone to gain time and resources. Nothing would stop them later from making people immune through controlled infection (aka vaccination) when the crisis is over.

To me they don't have a clue and just chose the only option that might paint them as still in control.

More insane than genius.

The government expert on TV was basically saying most people are going to get it eventually so why bother making huge efforts to delay but that kind of ignores that if we delay we may get better treatments or a vaccine. Just fine tuning some of the existing treatments could make a big difference.

The economy wasn't important for Brexit but it somehow is for COVID-19, and we're going to sacrifice half a million people (best case).

I say bring back the guillotine

To be honest, I don’t think this kind of conversation is worthwhile on HN. There are very few facts here, just opinions.

I’m all for posting authoritative information, and interesting side-effects.

But just shooting around opinions is best left for Twitter, Facebook, Reddit.

This might work. But how many people will die in the process? There are many cases of young people, with seemingly no prior health issues, dying after getting severe issues as a result of the virus.

On top of that, you can't guarantee that young people will only get it. With no travel restrictions, it can easily spread to the elderly.

This is the same thing China is doing, except China is also lying about it and saying they have "contained" it with extreme quarantine, in part to trick other nations into doing the same thing to tank their economies while China is going back to work and letting the virus spread.

Good for UK to step up amidst hysteria. Hopefully other democratic nations will follow suit.

I wonder how much of it is just playing the odds. Shutting everything down will very likely have a large, but fixed consequence on the economy, which has huge cost, including in lives and health. Whereas biding your time increases the relatively small risk of catastrophic consequences from coronavirus, but avoids the economic consequences. So it comes down to a choice between accepting a known downside, or taking a gamble on a path with the possibility of very little downside, but also much larger worst-case downside. Leaving the expected values of the choices aside, maybe Boris just likes to roll the dice?

There are other considerations, like how well the president/prime minister’s incentives are aligned with the countries. Donald Trump, through very little fault of his own[1], faces the possibility of a failed presidency due to the economic consequences of shutdown. If possible, a president might think it worth swinging for the fences, if he is down a couple of runs in the ninth? If he strikes out, he is no worse than before, although the country is. And Boris has kinda made himself out to be a guy who tries for home runs, at least in his public persona.

There is also the game theoretic considerations on the country level. If all the other countries are doing everything to stop the spread and paying the economic cost, than U.K. can take the benefit of that sacrifice, and not crash it’s own economy.

[1] of course he is doing his best to compound the external factors.

I really can't believe how stupid this is, I was starting to feel positive about the whole thing, China got it under control, they are sending resources to Italy to help get it under control, cures and vaccines are being developed while people stay indoors and the number of cases drops. WE COULD ERRADICATE THE VIRUS JUST BY STAYING HOME FOR 1 FUCKING MONTH. Literally that's all it would take, a person isn't contagious after a month, if everyone cooperated for the greater good we could have this under control, it's not too late, it's the one and only chance to not make this virus "the norm" of our society, every day it's gonna get much harder... But then you hear a country with 60 million people just isn't gonna do anything about it, throwing in the towel before the fight even started and dooming the whole world with them. It's beyond insane.

I'm sorry but this is just too much, I was hoping we would have the common sense to do our best to contain the spread but seems we just have to travel, go to the gym, go for beers every night and hang out, even though it will kill a lot of people around you. Your fathers, mothers, grandparents, your friend's parents, your neighbour's family, they might as well all die because you can't stay home for a month. Really I expected too much from people and forgot how stupid the average person is. I expect global warming will also go great, kudos humanity.

https://www.scmp.com/news/china/society/article/3074945/coro...

You better hope this isn't true and the virus doesn't have any lasting effects on reproductive health.

So let's assume that building immunity is even a possibility even though there is no evidence to support this while there exists substantial evidence to the contrary (people getting reinfected)?

Not happy to be living in the UK if that's really the plan.

This "strategy" is rebranded "do nothing". The journalist running the country (with his "everyone's had enough of experts" and "fuck business" attitudes) is simply displaying his usual contempt for all the non-privately educated, and is miles out of his depth. This is in a similar vein to how they're also rebranding a no-deal Brexit as an "Australia-style" deal. I don't believe they have a strategy at all - and "herd immunity" means hope for the best (a la "sunlit uplands").

From a PR point of view this is not a clever move. The very phrase 'herd immunity' says a lot about what they think of people. It is also a highly memorable phrase, much like 'shock and awe' and sometimes you just don't need a 'marketing slogan' for something divisive.

The kill rate from economic loss far exceeds the virus atm.

You mightn't see it yet as people stick together but a lot of small business owners will be killing themselves in a year's time. (But most of economic deaths are more subtle)

The UK is also reducing this.

They are also coming into Summer, it's crazy to not maximize during this time.

The right thing to do would be to purposely infect people with a spray and isolate.

Society won't allow this. So we have to do other methods. They have a lot of lag and are random and exponential so probably out of real control.

With the UKs plan they can't keep it to young people. That certainly won't work.

But they will save many invisible economic lives.