Re: [silk] silklist archives

[Udhay Shankar N]

On Wed, Apr 22, 2020 at 8:58 PM Dave Long  wrote:

(sorry if I'm behind; I'm on digest. do we have archives anywhere now?)
>

Try https://www.mail-archive.com/silklist@lists.hserus.net/ (appears to
have an expired certificate, hope they fix it soon)

Udhay

-- 

((Udhay Shankar N)) ((udhay @ pobox.com)) ((www.digeratus.com))

Re: [silk] 'herd immunity strategy'

[Tim Bray]

It might have been a cruel-but-rational strategy if you were prepared to
accept the increased mortality among vulnerable demographics. (I wouldn't
be.) (But I'm in a vulnerable demographic…)

But anyhow in recent days I've started seeing reports of permanent effects
among "recovered" victims: cognitive impairment, permanent lung damage,
etc.  Which makes the herd-immunity approach even less attractive.

On Wed, Apr 22, 2020 at 7:42 AM Srijith Nair  wrote:

> Got to say I am trying to understand the herd immunity concept as well and
> falling short with COVID-19.
>
> With a basic reproductive rate of around 3, it has been calculated that
> about 70% of population need to be infected. With a fatality rate of
> 0.5-1%, about 0.35-0.7 percent of a country's population will die! That
> seems a bit...hmm..bad!
>
> The biggest assumption we seem to make with the herd immunity approach is
> that surviving infection once creates immunity in the host. With COVID-19
> that seems to be still a rather big unknown and seems to completely
> undermine the approach towards herd immunity.
>
> The way I see it, herd immunity would work well only when we have a
> vaccine (and second best when we have clear proof of immunity after
> infection, but at the cost of rather high number of fatality) and not as a
> preventive measure.
>
> Talking of the Dutch approach, I find it rather astounding that the PM
> says two things in the same breath - we don't seem to know what kind of
> contribution children have made to spread of the virus, the study results
> will come out in June but hey, let us start the primary school (which is
> the least affected by a month or two of missed or virtual schooling) in
> May, because (I live in Amsterdam, have primary school going kids so I
> find this whole approach very weird, especially given that before the
> school closed there were 3 confirmed cases of kids/parents who kept coming
> to school with early symptoms!)
>
> Regards,
> Srijith
>
> On Wed, Apr 22, 2020, at 2:42 PM, Alaric Snell-Pym wrote:
> > On 22/04/2020 12:11, Amit Varma wrote:
> > > On Wed, Apr 22, 2020 at 4:28 PM Udhay Shankar N 
> wrote:
> > >
> > >>
> > >> I assume you mean that it is not a good thing to actively work
> towards.
> > >> This also presumes that teh authorities can affect this outcome one
> way or
> > >> another.
> > >>
> > >
> > > Well, the idea is to delay and mitigate till a vaccine is ready, while
> > > treatment protocols that will lower mortality also evolve at the same
> time.
> >
> > Also, controlling the spread means that the number of people seriously
> > ill at any one time isn't greater than the local health service capacity
> > to give them quality care.
> >
> > One big unknown that's making it hard to say what's right to do - and
> > therefore giving licence to various nutjobs to claim that any given
> > strategy is wrong with great certainty - is that we don't really know
> > how many people are infected.
> >
> > *MAYBE* COVID is highly contagious but not very serious, with only a
> > fraction of people showing anything more than a mild cough, and a tiny
> > fraction getting seriously ill. It's already been spreading for months,
> > and we only noticed it when enough people had it to make a notable
> > number of people properly sick. We've all mainly had it already and
> > we're nearly at herd immunity and all this lockdown stuff is barely
> > necessary as we're unlikely to overrun health services unless we let it
> > get REALLY out of hand; the worldwide confirmed-infected and
> > confirmed-dead-of-covid rate is mainly just rising as more testing rolls
> > out and we've already plateaued, with the lockdowns just flattening out
> > the tail end of the rise to the plateau a bit.
> >
> > *MAYBE* it's actually pretty rare, and the published infection figures
> > from various nations are nearly all the people who have it, because
> > almost all people who have it show enough symptoms to get noticed and
> > tested, and quite a high fraction of them get seriously ill. In which
> > case, we're sitting on a ticking time bomb of it getting out of hand in
> > the population.
> >
> > There's some evidence for the former due to a few random population
> > sampling exercises, but the only way to really know either way is to
> > test as many people as possible. And to avoid bias in the testing, test
> > the population at random, rather than just people who start coughing, as
> > otherwise we won't know how many people are asymptomatic carriers. Test
> > people who died of lung failure, so we know whether to count them or not.
> >
> > > Also, it is impossible in India, except for privileged elites like us,
> to
> > > separate the vulnerable from the non-vulnerable. So many poor in
> congested
> > > cities, more co-morbidities than other nations, and a horrendous
> healthcare
> > > system -- there would have been carnage. (There still might be carnage
> down
> > > the road.)
> >
> > :-(
> >
> >
> > --
> > Alaric 

Re: [silk] 'herd immunity strategy'

[Dave Long]

> This also presumes that teh authorities can affect this outcome one way or
> another.

It's pretty clear that lockdowns have worked much better than we had any reason 
to hope they would have.  (our lockdown is working, and we still have 70-75% of 
our workforce active).

So the question is, can one massively reduce the physical connectivity of the 
social graph long enough to drive infection rates down to a containable level?

My hypothetical working model at this point is that polities with lower 
wealth/income ratios will be less able/willing to sustain the effort than 
polities with higher wealth/income ratios.

The US as a whole is currently the major counter-example: it, like CH, has a 
net wealth/GDP ratio of about 5.  But they seem to be much more eager to reopen 
than we are.  (then again, their unemployment has skyrocketed, while ours has 
barely budged.  So there may be structural issues at work, as well)

On the other hand, this model predicts that rich countries (CN, IN, NL, PT), 
with a net wealth/GDP ratio of 4 (the world average) will last longer than 
poorer countries, such as DK (3,6) or even TZ (1,4).  It also predicts that 
richer US states (CA) will not be as eager to reopen as poorer (GA, TN).

I hope I am wrong.

-Dave

Re: [silk] 'herd immunity strategy'

[Dave Long]

> There's some evidence for the former due to a few random population
> sampling exercise

The random population sampling exercises I've seen say that *MAYBE* there are a 
small fraction of people who have had it: say 3% of the population.  (plus 
minus, but call it more than 1% and less than 10%)

I find that most likely, but hope it isn't true, as that number would be too 
large for containment to be applicable, and too small for hopes for herd 
immunity (without a vaccination program, which would require a vaccine) to be 
anything but wishful thinking.

-Dave

In Switzerland we've actually been testing, and counting, dead (as well as 
symptomatic) people.  And we have enough of them: currently ~200/million in my 
region.

We have also had random population antibody tests ongoing (designed for six 
weeks, running for four), but as I understand it, they're waiting for the 
results of the studies on the accuracy of the antibody tests themselves before 
they're going to publish anything.

Srijith, we're planning to reopen primary schools 11 May (only if the first 
reopening step on 27 April goes well).  As I understand it, that decision was 
based on (a) looking at sweden, where they don't test enough and have a (for a 
nordic country*) lousy death curve, but have kept schools open (providing a 
useful pediatric control), and (b) our own experiences, that most children have 
been infected by their parents rather than by each other.  In any case, we'll 
have a few weeks to see what happens to *other* country's children before we 
experiment with our own.

(sorry if I'm behind; I'm on digest. do we have archives anywhere now?)

Re: [silk] 'herd immunity strategy'

[Srijith Nair]

Got to say I am trying to understand the herd immunity concept as well and 
falling short with COVID-19.

With a basic reproductive rate of around 3, it has been calculated that about 
70% of population need to be infected. With a fatality rate of 0.5-1%, about 
0.35-0.7 percent of a country's population will die! That seems a 
bit...hmm..bad!

The biggest assumption we seem to make with the herd immunity approach is that 
surviving infection once creates immunity in the host. With COVID-19 that seems 
to be still a rather big unknown and seems to completely undermine the approach 
towards herd immunity.

The way I see it, herd immunity would work well only when we have a vaccine 
(and second best when we have clear proof of immunity after infection, but at 
the cost of rather high number of fatality) and not as a preventive measure.

Talking of the Dutch approach, I find it rather astounding that the PM says two 
things in the same breath - we don't seem to know what kind of contribution 
children have made to spread of the virus, the study results will come out in 
June but hey, let us start the primary school (which is the least affected by a 
month or two of missed or virtual schooling) in May, because (I live in 
Amsterdam, have primary school going kids so I find this whole approach very 
weird, especially given that before the school closed there were 3 confirmed 
cases of kids/parents who kept coming to school with early symptoms!)

Regards, 
Srijith

On Wed, Apr 22, 2020, at 2:42 PM, Alaric Snell-Pym wrote:
> On 22/04/2020 12:11, Amit Varma wrote:
> > On Wed, Apr 22, 2020 at 4:28 PM Udhay Shankar N  wrote:
> > 
> >>
> >> I assume you mean that it is not a good thing to actively work towards.
> >> This also presumes that teh authorities can affect this outcome one way or
> >> another.
> >>
> > 
> > Well, the idea is to delay and mitigate till a vaccine is ready, while
> > treatment protocols that will lower mortality also evolve at the same time.
> 
> Also, controlling the spread means that the number of people seriously
> ill at any one time isn't greater than the local health service capacity
> to give them quality care.
> 
> One big unknown that's making it hard to say what's right to do - and
> therefore giving licence to various nutjobs to claim that any given
> strategy is wrong with great certainty - is that we don't really know
> how many people are infected.
> 
> *MAYBE* COVID is highly contagious but not very serious, with only a
> fraction of people showing anything more than a mild cough, and a tiny
> fraction getting seriously ill. It's already been spreading for months,
> and we only noticed it when enough people had it to make a notable
> number of people properly sick. We've all mainly had it already and
> we're nearly at herd immunity and all this lockdown stuff is barely
> necessary as we're unlikely to overrun health services unless we let it
> get REALLY out of hand; the worldwide confirmed-infected and
> confirmed-dead-of-covid rate is mainly just rising as more testing rolls
> out and we've already plateaued, with the lockdowns just flattening out
> the tail end of the rise to the plateau a bit.
> 
> *MAYBE* it's actually pretty rare, and the published infection figures
> from various nations are nearly all the people who have it, because
> almost all people who have it show enough symptoms to get noticed and
> tested, and quite a high fraction of them get seriously ill. In which
> case, we're sitting on a ticking time bomb of it getting out of hand in
> the population.
> 
> There's some evidence for the former due to a few random population
> sampling exercises, but the only way to really know either way is to
> test as many people as possible. And to avoid bias in the testing, test
> the population at random, rather than just people who start coughing, as
> otherwise we won't know how many people are asymptomatic carriers. Test
> people who died of lung failure, so we know whether to count them or not.
> 
> > Also, it is impossible in India, except for privileged elites like us, to
> > separate the vulnerable from the non-vulnerable. So many poor in congested
> > cities, more co-morbidities than other nations, and a horrendous healthcare
> > system -- there would have been carnage. (There still might be carnage down
> > the road.)
> 
> :-(
> 
> 
> -- 
> Alaric Snell-Pym   (M7KIT)
> http://www.snell-pym.org.uk/alaric/
> 
> 
> Attachments:
> * signature.asc

Re: [silk] 'herd immunity strategy'

[Alaric Snell-Pym]

On 22/04/2020 12:11, Amit Varma wrote:
> On Wed, Apr 22, 2020 at 4:28 PM Udhay Shankar N  wrote:
> 
>>
>> I assume you mean that it is not a good thing to actively work towards.
>> This also presumes that teh authorities can affect this outcome one way or
>> another.
>>
> 
> Well, the idea is to delay and mitigate till a vaccine is ready, while
> treatment protocols that will lower mortality also evolve at the same time.

Also, controlling the spread means that the number of people seriously
ill at any one time isn't greater than the local health service capacity
to give them quality care.

One big unknown that's making it hard to say what's right to do - and
therefore giving licence to various nutjobs to claim that any given
strategy is wrong with great certainty - is that we don't really know
how many people are infected.

*MAYBE* COVID is highly contagious but not very serious, with only a
fraction of people showing anything more than a mild cough, and a tiny
fraction getting seriously ill. It's already been spreading for months,
and we only noticed it when enough people had it to make a notable
number of people properly sick. We've all mainly had it already and
we're nearly at herd immunity and all this lockdown stuff is barely
necessary as we're unlikely to overrun health services unless we let it
get REALLY out of hand; the worldwide confirmed-infected and
confirmed-dead-of-covid rate is mainly just rising as more testing rolls
out and we've already plateaued, with the lockdowns just flattening out
the tail end of the rise to the plateau a bit.

*MAYBE* it's actually pretty rare, and the published infection figures
from various nations are nearly all the people who have it, because
almost all people who have it show enough symptoms to get noticed and
tested, and quite a high fraction of them get seriously ill. In which
case, we're sitting on a ticking time bomb of it getting out of hand in
the population.

There's some evidence for the former due to a few random population
sampling exercises, but the only way to really know either way is to
test as many people as possible. And to avoid bias in the testing, test
the population at random, rather than just people who start coughing, as
otherwise we won't know how many people are asymptomatic carriers. Test
people who died of lung failure, so we know whether to count them or not.

> Also, it is impossible in India, except for privileged elites like us, to
> separate the vulnerable from the non-vulnerable. So many poor in congested
> cities, more co-morbidities than other nations, and a horrendous healthcare
> system -- there would have been carnage. (There still might be carnage down
> the road.)

:-(


-- 
Alaric Snell-Pym   (M7KIT)
http://www.snell-pym.org.uk/alaric/



signature.asc
Description: OpenPGP digital signature

Re: [silk] 'herd immunity strategy'

[Nishant Shah]

In The Netherlands, they have stuck to their guns about 'herd immunity' but
have also talked about managing it rather than just letting the virus run
its course. There was a lot of scepticism at first, but it looks like it is
working - though it is a model that perhaps only works for a country that
has so much disproportionate wealth and number of citizens. Despite the
anxiety that the 'intelligent lockdown' which did shut down some large
gathering spaces and forced a large community to work from home, the
Netherlands has been open. We have all been working and now from next week,
they claim that they have reduced the rate of infection while also
increasing testing and ICU capacity to an extent where they want to start
relaxing the measures more. The day care and primary schools are the first
targets. They are going to monitor it to see if this structured opening
leads to a sustained rate of infection which can be managed, till we have a
large population covered, and protected.
There have been bad casualties, and the mass infections in the nursing
homes have been the worst in it all. But I have come to appreciate the
steps taken to  'manage infection', buying time by closing space, and
opeinng up space to stagger time.
Nishant

On Wed, Apr 22, 2020 at 1:12 PM Amit Varma  wrote:

> On Wed, Apr 22, 2020 at 4:28 PM Udhay Shankar N  wrote:
>
> >
> > I assume you mean that it is not a good thing to actively work towards.
> > This also presumes that teh authorities can affect this outcome one way
> or
> > another.
> >
>
> Well, the idea is to delay and mitigate till a vaccine is ready, while
> treatment protocols that will lower mortality also evolve at the same time.
> The lockdown is a blunt tool, and needs to be combined with
> testing-and-tracing etc. India's limited state capacity makes it that much
> harder, and there are costs no matter what you do. We'll never know what
> the optimal approach was even in hindsight, because you cannot calculate
> the costs of any counterfactual. But just letting the virus run amuck and
> letting herd immunity do its thing is surely the worst option.
>
> Also, it is impossible in India, except for privileged elites like us, to
> separate the vulnerable from the non-vulnerable. So many poor in congested
> cities, more co-morbidities than other nations, and a horrendous healthcare
> system -- there would have been carnage. (There still might be carnage down
> the road.)
>
>
> >
> > Udhay
> >
>
>
> --
> Amit Varma
> Writer and Columnist
> Podcast -- The Seen and the Unseen 
> Blog -- India Uncut 
> Twitter -- @amitvarma 
>


-- 
Dr. Nishant Shah (Ph.D.)
Vice-President Research, ArtEZ University of the Arts, The Netherlands.
Knowledge Partner, Digital Earth Project, Hivos
Mentor, Feminist Internet Research Network, APC
https://nishantshah.online

Re: [silk] 'herd immunity strategy'

[Amit Varma]

On Wed, Apr 22, 2020 at 4:28 PM Udhay Shankar N  wrote:

>
> I assume you mean that it is not a good thing to actively work towards.
> This also presumes that teh authorities can affect this outcome one way or
> another.
>

Well, the idea is to delay and mitigate till a vaccine is ready, while
treatment protocols that will lower mortality also evolve at the same time.
The lockdown is a blunt tool, and needs to be combined with
testing-and-tracing etc. India's limited state capacity makes it that much
harder, and there are costs no matter what you do. We'll never know what
the optimal approach was even in hindsight, because you cannot calculate
the costs of any counterfactual. But just letting the virus run amuck and
letting herd immunity do its thing is surely the worst option.

Also, it is impossible in India, except for privileged elites like us, to
separate the vulnerable from the non-vulnerable. So many poor in congested
cities, more co-morbidities than other nations, and a horrendous healthcare
system -- there would have been carnage. (There still might be carnage down
the road.)


>
> Udhay
>


-- 
Amit Varma
Writer and Columnist
Podcast -- The Seen and the Unseen 
Blog -- India Uncut 
Twitter -- @amitvarma 

Re: [silk] 'herd immunity strategy'

[Amit Varma]

On Wed, Apr 22, 2020 at 4:11 PM Peter Griffin 
wrote:

>  I keep hearing about a 'herd immunity strategy.'
> Isn't that, like, no strategy? Serious question. I mean, just let people
> get infected and let the chips fall where they may? What am I not smart
> enough to understand?
>

Herd immunity kicks in if around 60% of the population gets it. At a
conservative mortality rate at 0.5%, that would mean 40 lakh people dead in
India. It simply cannot be an option.

(I discussed it briefly in the first part of this episode:
https://seenunseen.in/episodes/2020/4/19/episode-169-taking-stock-of-covid-19/
)


-- 
Amit Varma
Writer and Columnist
Podcast -- The Seen and the Unseen 
Blog -- India Uncut 
Twitter -- @amitvarma 

Re: [silk] 'herd immunity strategy'

[Vijay Anand]

The logic is that you isolate the vulnerable - those who are older and have
pre-existing conditions and then let the rest of the folks mingle. The
infection will spread by by enlarge won't cause any serious problems and
once the 2-4 weeks is over, and the immunity is built and they are no
longer carriers, they can neither catch it nor be carriers and hence the
vulnerable would be safe too.

In theory it works, but isnt as easy to implement.

On Wed, Apr 22, 2020, 4:11 PM Peter Griffin  wrote:

>  I keep hearing about a 'herd immunity strategy.'
> Isn't that, like, no strategy? Serious question. I mean, just let people
> get infected and let the chips fall where they may? What am I not smart
> enough to understand?
>

[silk] 'herd immunity strategy'

[Peter Griffin]

 I keep hearing about a 'herd immunity strategy.'
Isn't that, like, no strategy? Serious question. I mean, just let people
get infected and let the chips fall where they may? What am I not smart
enough to understand?