Ask HN: What happens next after a successful lockdown? • Hacker News Board

Re: Ask HN: What happens next after a successful lockdown?

#181

Post by kidsil » Tue, Mar 17, 2020, 11:00 AM UTC

adaisadais wrote: post #75

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 w…

Do not go gentle into that good night.

Rage, rage against the dying of the light.

Re: Ask HN: What happens next after a successful lockdown?

#182

Post by notyourday » Tue, Mar 17, 2020, 11:46 AM UTC

lultimouomo wrote: post #175

notyourday wrote: post #143

Earlier quoted context omitted.

Ebola fatality rate ranges between 25-100%. The only thing that we have as the data is that with these two drugs the fatality rate might be less than 100% . Because Ebola is extremely aggressive and is largely contained to isolated areas its carriers tend to die and everything those people were in contact with is destroyed. Same goes for patients that contract Ebola and recover. That was the protocol for EVD outbreak…

mAb114 and REGN-EB3 have shown success with lowering the mortality rate from ~70% to about 34%; they are cures. Sure, we don't have a cure for COVID, but this has nothing to do we the fact that we have cures for totally unrelated virus-caused diseases.

> mAb114 and REGN-EB3 have shown success with lowering the mortality rate from ~70% to about 34%;

That's a claim in NYT. The papers are far more cautious because there is not enough data.

ZMapp, for example, showed around 40-50% decrease, was well tolerated during the West Africa outbreak but was still canceled because after more data was crunched it was not possible to attribute that decrease in mortality to ZMapp in a statistically significant way.

> they are cures.

Not as of now. They are promising regiments that might be developed into cures but as of now there are no cures for Ebola.

> Sure, we don't have a cure for COVID, but this has nothing to do we the fact that we have cures for totally unrelated virus-caused diseases.

That has been a long promised but it is not the case as of now. I believe the last cure was supposed to come out of DRACO but it even though the studies were initially promising (2011 press was ga-ga over the coming cure for nearly all viral diseases based on DRACO derived therapy) it failed to demonstrate enough viability to secure funding for further studies).

It is why the vaccinations are super-important. It is vaccinations and prevention that controls nasty viral diseases, not treatment. Ebola will be controlled and eradicated via vaccine, not cured.

We have been extremely lucky the most of diseases caused by the common viruses are relatively banal ( even if unpleasant ) i.e. the likes of common flu, herpes and HPV or extremely nasty i.e. polio and Ebola because at the present time we do not have a way to significantly affect the outcomes.

Re: Ask HN: What happens next after a successful lockdown?

#183

Post by j7ake » Tue, Mar 17, 2020, 12:51 PM UTC

DanBC wrote: post #174

superpermutat0r wrote: post #173

Earlier quoted context omitted.

What kind of masks are effective? The one I have seems weird, I just feel the water vapour touching my eyes when I exhale. I guess the mask would block the sneeze/cough projectiles and small spits while talking but if I were sitting in the public transit the water vapour would float around.

Masks are not effective unless you combine them with all the other PPE and have training in how to use them. Without those masks increase your risk. Don't wear masks. Listen to literally all the medical advice telling you not to wear masks, unless you've been advised by people treating you to wear a mask. (eg one person in a family is infected and the family is self isolating).

That is not a good argument to not wear masks.

You could also say "don't wash hands" because it's not effective unless you combine them with social distancing and other quarantine measures.

A preventive measure does not need 100% effectiveness to be recommended. For example, washing your hands.

Re: Ask HN: What happens next after a successful lockdown?

#184

Post by treis » Tue, Mar 17, 2020, 1:06 PM UTC

netsharc wrote: post #153

smoyer wrote: post #18

Earlier quoted context omitted.

I saw a statistical analysis of the flatten the curve idea but assuming we couldn't ramp up the number of intensive care beds, it took 3600 days to fit everyone in under the "available health care" line. It's still a good strategy for right now because it gives us some extra time to ramp testing and healthcare up.

Yeah, I noticed the flatten the curve graphs have a horizontal line about "available beds". It probably also represents available healthcare workers, equipment, etc. Surely this line can be made to move. E.g. when China sent a plane with doctors and equipment to Italy. Or simpler, find suitable buildings and make hospitals out of them (easier said than done, obviously).

I seem to post this everywhere, but the flatten the curve math doesn't work. There's very little excess capacity in the system and in a scenario where half the country is infect about 1% of people would get care. Even if we perfectly flattened it over the rest of the year.

Re: Ask HN: What happens next after a successful lockdown?

#185

Post by projektfu » Tue, Mar 17, 2020, 1:18 PM UTC

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.

Re: Ask HN: What happens next after a successful lockdown?

#186

Post by inscionent » Tue, Mar 17, 2020, 1:22 PM UTC

dang wrote: post #171

inscionent wrote: post #20

Earlier quoted context omitted.

Take your xenophobic yammering elsewhere please.

Please don't sink to this regardless of how bad another comment is. https://news.ycombinator.com/newsguidelines.html

Not clear what I sank to. Was yammering too far? What guideline are you directing me to? I feel that calling out this repugnant behavior is more that acceptable.

Re: Ask HN: What happens next after a successful lockdown?

#187

Post by inscionent » Tue, Mar 17, 2020, 1:27 PM UTC

mardifoufs wrote: post #118

inscionent wrote: post #20

Earlier quoted context omitted.

Take your xenophobic yammering elsewhere please.

His tone was out of place but I don't see any xenophobia in his comment? Is it not ok to criticize China? China really did made huge mistakes early on. And there has been a lot of criticism towards the EU and the US too.

If the OP comment was the second half yours there wouldn't be an issue, but it wasn't, it was a simple racist screed scrawled upon a forum that I go to for useful information and substantive opinions.

Re: Ask HN: What happens next after a successful lockdown?

#188

Post by projektfu » Tue, Mar 17, 2020, 1:39 PM UTC

timhigins wrote: post #149

hluska wrote: post #59

Earlier quoted context omitted.

I’m not OP, just a concerned parent who is trying to figure things out. I have not been able to locate a single scientific study about this. Rather, the evidence all seems to be news reports of people testing positive, then negative and then positive again. Since it isn’t scientific, all the usual caveats apply - we don’t know much about how effective those tests were and again, these are news reports. If you’re inte…

The truth is that these current tests (rt RT-PCR) are not completely accurate and may only have a true positive rate of 60-70%. See Discussion section of: https://pubs.rsna.org/doi/10.1148/radiol.2020200642 Additionally, people who are asymptomatic can test negative on all of their tests and only be diagnosed via other means. See Figure 1 here: https://link.springer.com/content/pdf/10.1007/s11427-020-166...

You have that a little backwards. The positive predictive value in the discussion is for CT. rtPCR is being used as the definitive test but it lacks sensitivity so it has false negatives. The 59% rate for rtPCR positive suggests that they are missing cases that CT might catch. However, the CT findings are not “pathognomonic” meaning that other conditions can cause the appearance of viral pneumonia (such as influenza).

Re: Ask HN: What happens next after a successful lockdown?

#189

Post by rtkwe » Tue, Mar 17, 2020, 2:19 PM UTC

jodrellblank wrote: post #180

rtkwe wrote: post #158

Earlier quoted context omitted.

The issue is the people who need to be hospitalized in the worst cases go on to require ventilation to force air into their lungs and those machines have a limited supply. On top of that people on ventilation require pretty close observation so you need about 3:1 patient to nurse ratio. Those are the numbers that are hardest to increase rapidly, nurses and ventilator equipment.

I heard a radio program about the life of a UK (I think) surgeon who worked in war zones and crisis regions like Syria, and one thing he found in a hospital was an intensive care unit staffed mostly by Skype cameras to a hospital in Washington, so the very few nurses on site could be directed to the patients most in need, and the remote nurses could watch the vital signs of many patients without having to spend time…

That would allow you to move capacity around. Not sure if intubated patients could be monitored remotely though I'm just not sure if they only need vitals monitoring or if they require a present person doing something there.

That is a neat thing though I didn't know about. Wonder if hospital networks could handle the feeds properly, getting the equipment setup would take a bit but it should all be doable with consumer grade stuff.

Re: Ask HN: What happens next after a successful lockdown?

#190

Post by scottlocklin » Tue, Mar 17, 2020, 2:39 PM UTC

etrabroline wrote: post #167

scottlocklin wrote: post #151

Earlier quoted context omitted.

> I've heard an epidemiologist say that if a vaccine becomes available in 18 months it'll be a record. Your epidemiologist should talk to a chemist or look at a wikipedia entry. In 1957, the H2N2 pandemic vaccine was available in 3 months. Still managed to kill a few million people. https://www.globalsecurity.org/security/ops/hsc-scen-3_pande... https://www.city-journal.org/1957-asian-flu-pandemic

I think you are nitpicking this doctor's words instead of listening to what he's saying. 18 years and no SARS vaccine. 18 months for SARS 2 would be miraculous.

He's an epidemiologist, and I think people aren't listening to what history is saying about the possibility of things. People accept 18 years or 18 months because they're trained to live in a sclerotic bureaucratic hellscape not because those are actual limitations involving long periods of time.

There was a thread last night about people worrying that improvised ventilators aren't FDA tested or whatever. That's a great thing to worry about in soft times. If I (or a member of my family) am facing death while waiting for a ventilator to save my life, I'll take my chances on the doodad cobbled together from a CPAP machine without FDA approval. Same story with vaccinations.