What happens next after a successful lockdown?

I remember all of the statistical problems centered around virality that we would have to do in college. The problems always seemed so make-believe and dystopian.

Now my company is close to going out of business and I have just been laid off. Partly due to high-ranking officials not believing in the virality of nCov-19.

I can't get W.B. Yeats "The Second Coming" from 1919 out of my head:

"Turning and turning in the widening gyre The falcon cannot hear the falconer; Things fall apart; the centre cannot hold; Mere anarchy is loosed upon the world, The blood-dimmed tide is loosed, and everywhere The ceremony of innocence is drowned; The best lack all conviction, while the worst Are full of passionate intensity.

Surely some revelation is at hand; Surely the Second Coming is at hand. The Second Coming! Hardly are those words out When a vast image out of Spiritus Mundi Troubles my sight: a waste of desert sand; A shape with lion body and the head of a man, A gaze blank and pitiless as the sun, Is moving its slow thighs, while all about it Wind shadows of the indignant desert birds.

The darkness drops again but now I know That twenty centuries of stony sleep Were vexed to nightmare by a rocking cradle, And what rough beast, its hour come round at last, Slouches towards Bethlehem to be born?"

I thought this interview was illuminating for post-lockdown life in China https://twitter.com/MikeIsaac/status/1238604080571772928?s=2...

It shows just how far behind we are.

TLDW: Temperature checks everywhere. Fever clinics optimized for quarantining the potentially infected.

China is trying to actually contain the virus. The only way out for us unless we significantly ramp up testing and lockdown is to admit defeat and simply optimize for slowing down the onslaught.

It's your typical pandemic response:

- denial

- placating measures

- minor lockdowns

- major lockdowns and panic (running to the store to stockpile toilet paper, for some reason)

- total quarantine

- life slowly returns to normal

China is now on the final stage (restaurants and stores reopening, etc), with the rest of the world between 2 and 3 months behind.

Most people are unable to comprehend exponential growth, so this is the pattern that gets followed.

I’m surprised that no one here is mentioning the example of South Korea. [1]

They are not in total lockdown, but they are doing extensive testing and contact tracing, and substantial isolation of anyone who might be contagious.

Once we get testing infrastructure ramped up, this is not an unreasonable plan in the United States.

[1]: https://www.bbc.com/news/world-asia-51836898

If social distancing can bring the number of cases down to a manageable level, you can switch to a traditional public health approach: Test anyone showing symptoms, and aggressively trace and test any contacts of known cases.

The South Korean model:

1. Build up testing and contact tracing capabilities.

2. Massive mask making, everyone required to wear a mask in public.

3. Hospitals reconfigured to deal with covid patients.

People can then go outside and mingle again.

There's vids all over YouTube from WuHan what to expect. First the jubilant singing and party slogans, then screaming for help all night https://m.youtube.com/watch?v=Zp3jH6iYrnw

Then each block is allowed movement after 2 months with community punishment if they hide cases and monetary incentive to follow rules, such as keeping contaminated clothing outside. Workers in critical industry will live at work and not allowed home to prevent contamination https://m.youtube.com/watch?v=yyucJekT87E

Is anybody else wondering about authoritarian power grabs?

It's all so surreal, I can just imagine it. (In the US, I think some primary elections are under discussion for delays.)

I'm not worried, just wondering how to best disarm it from a distance.

I would hope the lockdown gives us enough time to do thorough testing & tracing of the virus. Also a lockdown + messaging should convince people to take this thing seriously and follow the precautions.

If we know who has it well enough then we can focus care on them, wait until they can fight off the virus and go back to normal after. That is assuming people don't transmit the virus after recovering from it.

The primary goal right now is to flatten the curve so the growth doesn't stay exponential for any longer than it has to.

Once that flattens out and the growth rate slows or decreases a concerns is that folks will head back out, assuming the coast is clear.

That could cause a second wave of infections that restarts this whole thing.

Folks not taking this seriously is a problem, imagine what happens when folks who don't take this seriously think that it's finally over, when it really isn't.

Resume work after countries have the capacity to test everyone who has a fever. Maintain strong hygiene and social distance if possible. Firefight clusters of outbreaks where they occur. Wait for treatment and vaccine.

If tensions ease too quickly and we release everyone into the wild, it could cause another outbreak. I don't personally know the parameters of that risk, I just know it is a risk.

But on the bold assumption that we somehow contain the virus, we have a global economic collapse to tend to.

It's a good question. I've been thinking of it this way;

If we have an "unlimited" (by which I mean we manufacture them faster than we consume them) number of test kits with a turnaround time of < 24 hrs, then everyone on lock down for 14 days. Medical/Drive through facilities set up to process everyone for a test. Get a test, and then within 24 hours get a text on what their status is (infected, uninfected, immune (post infection)).

People who test positive go into quarantine to be re-tested weekly until they are immune.

People who test immune are allowed to resume work movement while keeping good practice (washing hands, coughing into elbow, Etc.)

People who test as non-infected are required to come back for re-testing every week, can move around with social distancing.

I don't know if it would work (I'm not a public health professional) but from a systems perspective surveillance of the infection seems to be the best strategy for staying on top of outbreaks.

Once a vaccine is available it becomes one of the things you get every year like a flu shot.

I anticipate that sooner or later the economic costs of staying on lockdown will overwhelm the benefits. We will probably begin to loosen restrictions and we will probably see periodic outbreaks in various places.

I don't know if that simply continues until a vaccine is viable or some other factor intervenes.

But this new reality won't be short-lived.

I don't know if anyone is still following this post but does anyone know if there are studies around the cost in lives of the shutdown itself? I recall reading somewhere that every 1% of unemployment equaled some number of additional deaths per year. Does anyone know of a study of the human cost of a shutdown vs. the virus itself ?

The commonly stated goal of lockdowns is to slow the spread, flatten the (new cases vs time) curve, and thereby try to manage the rate of new cases so hospital resources (ICU beds, respirators, nursing staff) arn't overwhelmed.

Once (whenever that may be) the curve is shown to be flattening and hostpitals are in control, it'd be logical to see some gradual loosening of the restrictions that are currently being ramped up.

I personally doubt that loosening of restrictions, once above conditions are met, will be contingent on a proven and widely available vaccine having been developed (not least because there's no guarantee that one ever will be).

At this point it's anyone's guess how long it'll be in any given country until things appear to be more under control... Even in South Korea, who seem to have done best job in containing this, I've yet to see any estimates of how long it'll take at current rates on infection for the majority of the population to get it and/or get to "herd immunity" point.

In the US all bets are off.. it seems we were (and still are) extraordinarily slow to recognize the severity of this and take appropriate actions (severe lockdowns, widespread testing and resulting case tracking), so a reasonable expectation is that we may be following the case trajectories of the harder hit countries, with similar measures as they have in place coming to the US.

The endgame is to figure out the least cost sustainable measures of getting R0<1 until we have a vaccine or treatment safe enough for people in high risk groups to take.

The purpose of the lockdown is solely to prevent emergency services from being completely overwhelmed. Not make it go away.

A country like Colombia could implement a lockdown and stop transmission entirely. The virus would naturally die out there in a few weeks. All foreign travel would have to be quarantined but life could go on after that internally without disruption. Eventually vaccination could bring herd immunity.

I've heard an epidemiologist say that if a vaccine becomes available in 18 months it'll be a record.

Experimental treatments are being researched, but with only very small numbers of patients. It'll take quite some time for those treatments to become widely available.

It's unlikely that we're going to even begin to see things return to normal in a month or even three of isolation, especially if that isolation isn't as effectively and universally enforced as in China.

Afterwards there has to be extremely aggressive testing, tracking, and monitoring, or the outbreak has a very good chance of starting all over again.

In addition, the health care system itself has to have time to recover and replenish its equipment, ICU capacity, and healthy and able medical personnel.

I think you just gradually make lockdown less strict to throttle number of cases so that it's on the level your healthcare can handle and do that till most of your population already had the virus. And hope for new treatments, vaccines and that immunity from already having the virus lasts at least a year or two.

A rational move would be to lock everyone down until a vaccine is proven safe and efficacious can be delivered to enough people. Since no one other than indigenous people living near bats have any immunity to beta-coronaviruses, it doesn't make sense to expose billions of people to unnecessary risks when we can pause nearly all social- economic activity until immune defense is possible or supplies run low.

The vaccine, once developed, should be free for everyone to encourage high uptake herd immunity.

How long did the HIV vaccine take?

Use that as a yard stuck.

A lockdown isn't 'successful' it does little, except drag society into the dirt while a little time is bought to work things out.

Time China bought us but we squandered.

If you're lucky it's a winter desease so it'll become summer and it'll die off. But that's coin flipping a little.

Treatments might be found but it's hard to know how fast, especially while everyone is on lockdown.

One word...

Summer..

once the summer starts and we see 30c or above , i think the spread will be limited and the quarantine might end.

But, worrying part is what comes next, without a Vaccine, coming Winter might be lethal, and we may end up with same cycle..

https://www.scmp.com/news/china/science/article/3074131/coro...

The virus isn’t serious enough to warrant or motivate total quarantine so a ton of people are going to get it. Then we’ll have collective immunity and things will go back to normal. 3 to 6 months from now.

The economic loss of a lockdown is just extraordinary. Just think about how many people and resources are idle... Literally trillions of dollars in lost economic potential (let alone the harder to quantify human+health consequences).

So it's crazy to me how little, relative to the hard economic costs of the virus, is being spent on mitigation.

I'm a totally uninformed lay-person, but the below seems reasonable:

Huge testing effort, something like 5% of the country's population gets tested every day (once every 20 days per person). Manage electronically. If positive, quarantine that person and known contacts.

Huge contact tracing and small lockdown strategy (found 10 cases in Omaha, Omaha lockdown for 2 weeks).

Seems that would be doable, cost billions and billions, but enable economic activity and minimize health+human consequences. Would be a great RoI.