Off Topic Thread 4.0

errlloyd

swiwi_ wrote: »

Don’t need to flatten the curve for the healthy population.

Edit: In fact, you want them infected (and hence immunised subsequently) as fast as possible. Just need to have enough ICU capacity for the small percentage of the low-risk population that turn bad.

I said vaguely this a few days ago.

errlloyd wrote: »

I am not confident in our strategy. I really struggle to understand it.

As far as I can make out, it is this.

EDIT - Tomtom has provided more accurate numbers on the amount of beds available. They significantly change the picture on my maths. Tomtom has also outlined another end goal - ie treatment drugs that would greatly reduce the burden on HSE resources that are not vaccines but will be coming soon

• We only have around 300 ICU beds / ventillators (I think we may have more of the latter, but they are being used interchangebly)
• 5% of people will need a ventillator - and will need it for between 1 week and 3 weeks.
• So if there are 300 ventillators being used 2 weeks at a time, on average there will be 20ish "made available" per day.
• That twenty is 5% of the maximum daily infection rate we can have (20 *0.05 = 400) so our daily rate has to be 400
• For us to naturally get "herd immunity" we have to wait till half the population - around 2.2 million of us get it.
• 2.2m / 400 = 5,500 days or 15 years of isolation.

So at the moment, our strategy seems to be - keep everyone at home until someone invents a vaccine? I am beginning to wonder (quietly) should a few of us be "chicken poxxing it". Getting it intentionally. You don't get lifetime immunity, but in almost all cases you seem to get strong short term immunity.

I sort of wonder is there a way we can begin infecting a cohort of healthy people. Turn that new resort in Longford into an infection zone. Anyone who thinks they are perfectly safe to get it heads in there and can't leave till they are clean. A few ventillators on standby for the few in that healthy cohort that do have underlying and unknown conditions.

I think I'd sign up.

Former Former

Sloane Nutritious Ham wrote: »

Do we even know if herd immunity is a thing that works in this case?

In theory, yes, but it would take so long to achieve it that the number of deaths that would happen along the way that it doesn't bear thinking about.

swiwi_

stephen_n wrote: »

That doesn’t reflect what’s happening. In Italy they are prioritizing the young over the old in ICU. It’s not as if the young aren’t seriously impacted by this, they are but they’re more likely to survive. Even at that there is residual permanent damage to the lungs in those who recover. Trying to manage the amount of people in ICU in any given time is a far more sensible policy, than feck it let’s build herd immunity.

But if there is no vaccination and no herd immunity, is your plan to simply close down the country for months on end and hope it all works out??

It doesn't seem to be a "winter" virus, so I'm not sure the virus is just going to disappear.

If the virus is not going to disappear, then the minute you relax the restrictions, the infections take off again.

Society might have to accept that some young people will tragically die. But you can't take a country like Ireland, tell people no work, no income for 12 months, and expect that to work either.

It's early days, and I'm in support of the current "shut everything down" plan, but there is only so long that plan is a runner.

swiwi_

Sloane Nutritious Ham wrote: »

Do we even know if herd immunity is a thing that works in this case?

There are very few human infections that do not create natural clearance and then immunity. HIV is an obvious example.

I don't think there is anything to suggest that this virus leaves people nonimmune and susceptible to multiply infections.

sydthebeat

errlloyd wrote: »

I said vaguely this a few days ago.




I sort of wonder is there a way we can begin infecting a cohort of healthy people. Turn that new resort in Longford into an infection zone. Anyone who thinks they are perfectly safe to get it heads in there and can't leave till they are clean. A few ventillators on standby for the few in that healthy cohort that do have underlying and unknown conditions.

I think I'd sign up.

this is the kind of 'out there' thinking that could work.. but can people be trusted to just "think they are perfectly safe"?

i made the point earlier that there are people out there who carry these 'at risk ' factors but dont know it yet. Do we test everyone who thinks they are safe before they go in? if we do we put more pressure on the system.

at this stage we know 80% will get mild to moderate symptom, but we also know that a cohort of that 80% will need supportive care, such as drip fed hydration, and will develop mild pneumonia which can have lasting significant effects. while hospitaliation may not be required, these case still could be a draw on scarce resources.

definitely worth a lot more investigation, if its proven that this cannot be recaught

Panda Killa

Sloane Nutritious Ham wrote: »

Do we even know if herd immunity is a thing that works in this case?

It doesn't...the English were trying this....It would have had catastrophic results

errlloyd

Former Former wrote: »

In theory, yes, but it would take so long to achieve it that the number of deaths that would happen along the way that it doesn't bear thinking about.

I think Boris Johnson has given Herd Immunity a bad name.

When we vaccinate people for the regular flu - we do so to artificially build herd immunity.
When we intentionally give children chicken pox - we do so to artifically build herd immunity.

Herd immunity doesn't necessarily mean allowing the virus to run rampant through the population. We choose segments of the population to give it to and choose how we give it to them.

swiwi_

Former Former wrote: »

In theory, yes, but it would take so long to achieve it that the number of deaths that would happen along the way that it doesn't bear thinking about.

Looking at the curves, I don't think so. The infection rate is massive. You would have the vast majority of the population infected rapidly. If you put "at risk" people off-limits, you would get immunity up quite quickly.

Tomtom364

errlloyd wrote: »

I said vaguely this a few days ago.




I sort of wonder is there a way we can begin infecting a cohort of healthy people. Turn that new resort in Longford into an infection zone. Anyone who thinks they are perfectly safe to get it heads in there and can't leave till they are clean. A few ventillators on standby for the few in that healthy cohort that do have underlying and unknown conditions.

I think I'd sign up.

The numbers in your original post are very off.
Current ventilators in the country 800 (500 existing + 300 delivered this week) and these numbers will increase by 100 every week.

+ 1000 other machines that can provide ventilator like treatment in less severe cases.

Your original calculation also takes no account of the current methods, it's isolate to slow down the spread to get a handle on it, and included specific isolation for those that will be most harshly infected. This in itsself will allow the virus to spread easier (but slower still) through younger people and should decrease the requirement for critical care as less younger people will require it compared to older groups.

Most importantly your calculations take absolutely no notice of the drug treatments being developed to fight the virus which are looking positive, which would again reduce the requirement for critical care.

And that's before ever talking about a possible vaccine in ~18 months


So to say the current plan will need 15 years of isolation to work is either downright sensationalism or a complete misunderstanding of the figures and how this all could play out.

Not sure I'd be following you into any infection resort plan.



Just to be absolutely clear: I in no way intend this to be a dig at you or anyone else, I just think in the current climate it's very important to highlight things like this. I am in no way qualified to work out the maths on this. I'd hazard a guess that noone on here really can.

Some people might see it and believe it as they don't understand what's going on, I felt compelled to call it out.

stephen_n

swiwi_ wrote: »

But if there is no vaccination and no herd immunity, is your plan to simply close down the country for months on end and hope it all works out??

It doesn't seem to be a "winter" virus, so I'm not sure the virus is just going to disappear.

If the virus is not going to disappear, then the minute you relax the restrictions, the infections take off again.

Society might have to accept that some young people will tragically die. But you can't take a country like Ireland, tell people no work, no income for 12 months, and expect that to work either.

It's early days, and I'm in support of the current "shut everything down" plan, but there is only so long that plan is a runner.

There are at least three separate vaccines in trial at the moment, along with some medicines that have been repurposed. It’s not seemingly a case of if but when.

Herd immunity is either a vaccine or 90% infection. With a current 3.7% mortality rate the death toll is unthinkable.

The policy of delaying although financially disastrous over a prolonged period of time is the only way to manage the resources of the health service. I would imagine given the death toll in the UK so far the NHS is going to be completely over run in the next two weeks. Their economy might recover quicker but it’s going to come at a massive human cost.

swiwi_

stephen_n wrote: »

There are at least three separate vaccines in trial at the moment, along with some medicines that have been repurposed. It’s not seemingly a case of if but when.

Herd immunity is either a vaccine or 90% infection. With a current 3.7% mortality rate the death toll is unthinkable.

The policy of delaying although financially disastrous over a prolonged period of time is the only way to manage the resources of the health service. I would imagine given the death toll in the UK so far the NHS is going to be completely over run in the next two weeks. Their economy might recover quicker but it’s going to come at a massive human cost.

Depends on the virus. Measles you definitely need 90 %, not sure for coronavirus. Also depends if your aim is to prevent infections or deaths. My country which is currently in the top 10 infected countries is running at 1 % deaths, probably less as testing is targeted, not systematic. Virtually all, if not all, deaths are in at risk patients for the moment.

NB: Still no vaccine for HIV. I think a vaccine will be found, and probably quicker than usual, but a vaccine in the next 30 to 90 days is probably overly hopeful.

stephen_n

stephen_n wrote: »

There are at least three separate vaccines in trial at the moment, along with some medicines that have been repurposed. It’s not seemingly a case of if but when.

Herd immunity is either a vaccine or 90% infection. With a current 3.7% mortality rate the death toll is unthinkable.

The policy of delaying although financially disastrous over a prolonged period of time is the only way to manage the resources of the health service. I would imagine given the death toll in the UK so far the NHS is going to be completely over run in the next two weeks. Their economy might recover quicker but it’s going to come at a massive human cost.

We don't know how any of this will play out, but I think the countries that aimed to save people rather than 'get this done' will be the ones with functional politics afterwards. America and the UK were in bad shape before this having been undermined by populists far more versed in public manipulation than they are in public service. They aren't equipped to deal with this kind of crises and going on their public utterances it's extremely clear that they have absolutely zero desire to do so. Marry that with extreme partisanship and huge distrust among large parts of the population and you have a recipe for social unrest.

The total lack of adherence to social distancing in those two countries is directly related to the lack of seriousness of their governments.

I'd take a year of economic hurt over more lives cut short and healthcare workers having to triage people away from life saving treatment.

molloyjh

Are we not essentially building the herd immunity slowly? Nobody is talking about anything other than ongoing increases in the number of cases. So does that not eventually lead to herd immunity?

Dave_The_Sheep

swiwi_ wrote: »

I think a vaccine will be found, and probably quicker than usual

My absolutely uneducated cynical guess is that this will be what happens. Given the size of the threat this poses to the world economy and the very real possibility of societal upheaval the longer this goes on, I suspect rules will be bent/broken to get this out in an abnormally fast timeframe.

But then again, I work in IT, what the **** do I know.

molloyjh

molloyjh wrote: »

Are we not essentially building the herd immunity slowly? Nobody is talking about anything other than ongoing increases in the number of cases. So does that not eventually lead to herd immunity?

Yeah. If we don't get a vaccine sooner then this will be managed in waves.

We'll get numbers down to zero now with social isolation over the next 6 weeks. Then they will rise again but we'll be highly vigilant and ultimately if numbers grow we'll again go back into isolation and distancing. Rince and repeat. Each wave brings greater volumes of immunity.

molloyjh

swiwi_ wrote: »

Looking at the curves, I don't think so. The infection rate is massive. You would have the vast majority of the population infected rapidly. If you put "at risk" people off-limits, you would get immunity up quite quickly.

But then problem is that this is almost impossible to truly control. You just cant control everything that everyone does or even necessarily know who is at-risk at times. Looking at projections we could potentially have the magic 60% number that's being quoted by late April or early May, but the stress that would put on the hospitals doesnt really beer thinking about, much less the mortality rate that goes with it.

All that said, I suppose we still dont truly know enough. Figures for those infected are 100% underestimated. Plenty have it and dont know or arent being tested. I cant imagine how difficult it must be to make political, public health and medical calls through all of this.

Former Former

errlloyd wrote: »

I think Boris Johnson has given Herd Immunity a bad name.

When we vaccinate people for the regular flu - we do so to artificially build herd immunity.
When we intentionally give children chicken pox - we do so to artifically build herd immunity.

Herd immunity doesn't necessarily mean allowing the virus to run rampant through the population. We choose segments of the population to give it to and choose how we give it to them.

We give children chicken pox intentionally?? No, we don't. And chicken pox is mild and self-limiting. There is a vaccine out there and we don't even bother administering it to children, because there's no point.

We do not vaccinate for the seasonal flu to build herd immunity, in fact we actively target at risk patients (old patients, pregnancy, healthcare workers) for vaccination which is the opposite of herd immunity. But so many of us have been exposed to some sort of flu over the years, that most of us have some sort of immunity already so we're grand.

No one has any immunity to Covid. You cannot build herd immunity in a couple of months. If 80% of people get it over e.g. 6 months, and 5% of those need hospitalisation, that's over 2 million people in the UK for instance. You're looking at a holocaust.

molloyjh

[Deleted User] wrote: »

Yeah. If we don't get a vaccine sooner then this will be managed in waves.

We'll get numbers down to zero now with social isolation over the next 6 weeks. Then they will rise again but we'll be highly vigilant and ultimately if numbers grow we'll again go back into isolation and distancing. Rince and repeat. Each wave brings greater volumes of immunity.

The waves idea is what I assumed. Doubt we'll get down to zero any time soon, but we'll get it low enough that maybe we can get a reprieve on the restrictions, even just temporarily. The approach really has to be limit it as much as possible to try and ensure the health service doesn't get overwhelmed. Minimise the damage and go again.

errlloyd

Tomtom364 wrote: »

Just to be absolutely clear: I in no way intend this to be a dig at you or anyone else, I just think in the current climate it's very important to highlight things like this. I am in no way qualified to work out the maths on this. I'd hazard a guess that noone on here really can.

Some people might see it and believe it as they don't understand what's going on, I felt compelled to call it out.

Great post Tomtom. Absolutely no offense taken - I don't consider it a dig at all. As I said in the original post I suspected I was wrong about the ventillators and I thank you for correcting it. I will put a note on the original post clarifying it below.

I'll prrobably remain a little defensive on the concept of the post - keeping in mind it was a few days ago. The concept of the post that this (or a greater) level of lockdown is going to have to remain in place for a long time if we want to prevent the HSE being overwhelmed. The only way this lockdown ends is if we achieve some form of herd immunity, or we get a vaccine. We could accelerate herd immunity by taking the group we know are relatively safe, and in controlled manner have cohorts of them infect, isolate and come out.

awec

Former Former wrote: »

We give children chicken pox intentionally?? No, we don't. And chicken pox is mild and self-limiting. There is a vaccine out there and we don't even bother administering it to children, because there's no point.

We do not vaccinate for the seasonal flu to build herd immunity, in fact we actively target at risk patients (old patients, pregnancy, healthcare workers) for vaccination which is the opposite of herd immunity. But so many of us have been exposed to some sort of flu over the years, that most of us have some sort of immunity already so we're grand.

No one has any immunity to Covid. You cannot build herd immunity in a couple of months. If 80% of people get it over e.g. 6 months, and 5% of those need hospitalisation, that's over 2 million people in the UK for instance. You're looking at a holocaust.

It's not a required vaccine but it's offered as standard during the 12 or 13 month vaccines (can't remember which). I have no data but I think the uptake would be relatively high.

errlloyd

Former Former wrote: »

We give children chicken pox intentionally?? No, we don't. And chicken pox is mild and self-limiting. There is a vaccine out there and we don't even bother administering it to children, because there's no point.

We do not vaccinate for the seasonal flu to build herd immunity, in fact we actively target at risk patients (old patients, pregnancy, healthcare workers) for vaccination which is the opposite of herd immunity. But so many of us have been exposed to some sort of flu over the years, that most of us have some sort of immunity already so we're grand.

On chicken pox - it is not mild in adults and would be fatal in a significant percentage of elderly people. It is mild for children, and in this country Pox Parties are still popular. We allow toddlers and young children to get it because it is mild in them, and once they get it once they can't get it again when they're older. Edit - I didn't actually read that Pox Parties wiki article, just posted it. Makes me look like an anti vaxxer. Strongly in favour of vaccinating kids instead of just exposing them!

Seasonal flu was a bad example, because we actually vaccinate different strains of it every year. But Measles is a better example.

awec

It seems to me there's two problems. Firstly, the potential for widespread infection which overwhelms the hospitals means that people who shouldn't be high risk become high risk as we don't have the capacity to give them the necessary care.

But, even if we contain the virus and the numbers become manageable, there is still the issue of vulnerable people and the relatively high death rate. To fix this, we surely need a cure?

Former Former

awec wrote: »

It's not a required vaccine but it's offered as standard during the 12 or 13 month vaccines (can't remember which). I have no data but I think the uptake would be relatively high.

Not in the republic. You can get it privately but state does not fund it.

Dave_The_Sheep

Johnson is speaking live now about the crisis over there. He's just waffling compared to Varadkar there the last day.

awec

Former Former wrote: »

Not in the republic. You can get it privately but state does not fund it.

Sorry that's what I meant, you can pay for it if you want it.

The public health clinics will all offer it, you don't need to go anywhere different to get it.

mfceiling

Buer wrote: »

Orals and practicals to be given full marks in the Leaving Cert. Is this not madness?

Imagine you're doing Irish, French and Home Economics for the exams. You've just scored 25% from a possible 25% in 3 exams. Then you've people just taking Irish, Chemistry and History who are all about the written paper and at a disadvantage in the points race. Am I missing something here?

Saw a great tweet earlier along the lines of "you little feckers wont be laughing in a few years when a doctor that should have failed his leaving cert is working on you".

stephen_n

Italy reports 5,322 new cases of #Coronavirus and 427 new deaths.

Total number of cases reach 41035 and Total death toll reaches 3405

Fatality rate= 8.2%

Italy has OFFICALLY passed China in MOST DEATHS in a country due to

swiwi_

Former Former wrote: »

We give children chicken pox intentionally?? No, we don't. And chicken pox is mild and self-limiting. There is a vaccine out there and we don't even bother administering it to children, because there's no point.

We do not vaccinate for the seasonal flu to build herd immunity, in fact we actively target at risk patients (old patients, pregnancy, healthcare workers) for vaccination which is the opposite of herd immunity. But so many of us have been exposed to some sort of flu over the years, that most of us have some sort of immunity already so we're grand.

No one has any immunity to Covid. You cannot build herd immunity in a couple of months. If 80% of people get it over e.g. 6 months, and 5% of those need hospitalisation, that's over 2 million people in the UK for instance. You're looking at a holocaust.

Um, no. There is a new flu vacc each year, because being immune to last year's version doesn't make you immune to this year's flu.

Those recovered from the current coronavirus virus are probably immune.

Where did you pull 6 months from?? Where did you get the figure that 5% of healthy people need hospitalisation?

swiwi_

molloyjh wrote: »

The waves idea is what I assumed. Doubt we'll get down to zero any time soon, but we'll get it low enough that maybe we can get a reprieve on the restrictions, even just temporarily. The approach really has to be limit it as much as possible to try and ensure the health service doesn't get overwhelmed. Minimise the damage and go again.

I get what you're saying molloy. But the waves idea assumes people are not remaining in isolation and sporadically getting infected. It's potentially a runner though, as I doubt (now) 100 % isolation is really possible.

@venjur - you must have financial means if you survive several months with no income. The Irish state is not going to gund it's population for months on end. There is no state capable of that, maybe the extremely oil rich states, but with flights grounded, oil prices are likely to dip sharply.

stephen_n

swiwi_ wrote: »

Um, no. There is a new flu vacc each year, because being immune to last year's version doesn't make you immune to this year's flu.

Those recovered from the current coronavirus virus are probably immune.

Where did you pull 6 months from?? Where did you get the figure that 5% of healthy people need hospitalisation?

5% of those infected become seriously ill, that’s the figure based on global infections so far.