A nudge is as good as a wink…

by

by liberal japonicus

This Guardian piece is quite interesting.

With an estimated 5,000 to 10,000 coronavirus cases now present in the UK, the government has eschewed social distancing measures such as closing schools and banning large sporting events. Instead, it has opted for behavioural “nudges”: wash your hands, don’t touch your face, don’t shake hands with others, stay at home if you feel ill, and self-isolate if you have a continuous cough.

This approach differs starkly from the quarantine measures taken in China, South Korea, Italy and Iran. But it also marks the UK out as different from countries such as Ireland, Norway and Denmark, which have implemented school closures despite seeing only a relatively small number of coronavirus cases. Patrick Vallance, the government’s chief scientific adviser, has explained that part of the reason for not embracing bans is to encourage “herd immunity”. Allow enough of those who can survive coronavirus disease to get infected, and the virus won’t have new people to infect, meaning new cases will dry up. Other European countries seem to have judged this too bold an approach. Immunity will probably be temporary, so later outbreaks are to be expected, and dealt with by heightened contact tracing when they occur.

I don’t know if it is just because I’m going a little stir crazy, like one of those extras in a war movie who can’t take it any more and charges the pillbox because he just doesn’t care anymore (as opposed to the one who does it because he’s not going to get killed so the audience knows that he’s going to be around until the end of the movie), but I’ve wondered about this. It’s a bit like the parent of a brood of kids who just wants them all to get chickenpox at the same time. Understandable but…

Of course, given all the unknowns, probably a pretty stupid idea on the whole. But more cheerfully there is this

Patients treated outdoors were less likely to be exposed to the infectious germs that are often present in conventional hospital wards. They were breathing clean air in what must have been a largely sterile environment. We know this because, in the 1960s, Ministry of Defence scientists proved that fresh air is a natural disinfectant.[5] Something in it, which they called the Open Air Factor, is far more harmful to airborne bacteria — and the influenza virus — than indoor air. They couldn’t identify exactly what the Open Air Factor is. But they found it was effective both at night and during the daytime.

Am now looking for restaurants that have outside tables. You, me and the moon. Wear a tie so I can tell you apart…

55 thoughts on “A nudge is as good as a wink…”

  1. I was just reading this not too long ago and just to quote:
    The human species never developed “herd immunity” to polio or smallpox or any virus, really — ever, despite millennia of death and illness and misery. Why not? Because herd immunity depends on vaccines. We vaccinate a large number of people, and then all of us are protected, because transmission rates are reduced (among other things.) Let me make the point again. The human race never developed herd immunity to a lethal virus, precisely because herd immunity is not something that emerges naturally. What happens, instead, when we let a virus simply take its course? What happened with smallpox and polio: they just rampage through populations, forever.

  2. Great point! The Guardian just put it out there without thinking and I didn’t really think about that. Though if all the young people got it and stayed inside for 2 weeks, then they wouldn’t worry about transmitting it. Assuming that you can’t get it again and 2 weeks would sufficiently prevent you from shedding the virus. So maybe that is the thinking.
    I get the same impression that Japan is doing that, though as I have said, it is more to try and keep the Olympics a possibility. It’s incredibly cynical so it’s totally unsurprising.

  3. Though if all the young people got it and stayed inside for 2 weeks, then they wouldn’t worry about transmitting it.
    Oops.

  4. an estimated 5,000 to 10,000 coronavirus cases now present in the UK….
    And now we see why the UK got exempted** from the ban on travel from Europe. Because they have the problem under control, of course!
    Oh, wait….
    ** Yeah, I know. They got exempted because they had the foresight to locate Trump properties there. Medical considerations were not involved.

  6. Go to the comments following this local article and see what the world is up against with the extraordinarily organized and malignant worldwide conservative movement trolling every attempt to prevent the spread of infection:
    https://www.denverpost.com/2020/03/13/colorado-coronavirus-death/
    Also, think of the dreadful quiet if the balcony-hating architect Howard Roark of Rand’s “The Fountainhead” had spread his odd objectivist contagion across Italy:
    https://www.marketwatch.com/story/pasta-started-flying-off-supermarket-shelves-in-milan-as-italy-imposes-nationwide-coronavirus-lockdown-italians-struggle-to-adjust-to-the-new-normal-2020-03-09?siteid=bigcharts&dist=bigcharts
    See ya next week. Be well. Cough.

  7. I was just reading this not too long ago and just to quote…
    I think this article is confused.
    Herd immunity does is not the same thing as vaccinating to eliminate a disease, and is indeed a naturally occurring phenomenon, which tends to reduce infection across a population.
    The point about vaccination is that you can achieve in a very short time a level of herd immunity across a population high enough to completely stop a disease.
    How effective it might be depends on the infectiousness of the particular virus (we’ve virtually eliminated smallpox, for example, but are nowhere near doing so for measles), how widespread vaccination is in the population, and how effective a particular vaccine might be in creating neutralising antibodies which persist in individuals.
    If the virus mutates at a fast enough rate (influenza), then it’s even more difficult.

  9. Darkling,
    the herd immunity is not successful at stopping a virus. Instead, it lowers the incidence of a disease at a manageable level. For example, we did develop a sort of natural resisitance against smallpox. Smallpox epidemics come and went every few years, unstobbable, and killed and disfigured people. However, the disease did not wipe out populations, like it did in North America.
    We must acknowledge that we cannot do really that much against the coronavirus before we get a vaccine. Infecting the major part of populatuon means that afterwards, if we can build up a lasting resistance, the virus remains pocketed somewhere, breaks out every few years, infecting children and previously uninfected, and when it eventually mutates, we have some residual resistance that might protect us.
    Closing schools etc. is simply too much: we cannot stop the whole society, and those measures are still too little. Better have a few percent of us dead of the virus, if that is the price.

  10. Correct me if I’m wrong Lurker, but didn’t herd immunity established through vaccines lead to the eradication of some diseases like polio and small pox?
    Closing schools etc. is simply too much: we cannot stop the whole society, and those measures are still too little. Better have a few percent of us dead of the virus, if that is the price.
    I assume by this statement you’re someone who’s healthy, young and doesn’t have friends or relatives? I know a few people who will be at high risk from this disease so I find your attitude to be pretty monstrous (fell free to insert your own favourite expletives in there).
    The obvious thing we can do is to take precautions so that the health care services are not overwhelmed leading to an increased mortality rate.

  11. Closing schools etc. is simply too much: we cannot stop the whole society, and those measures are still too little. Better have a few percent of us dead of the virus, if that is the price.
    Are they too little ?
    Taiwan, Korea, Japan etc don’t seem. to think so – and are achieving a fair degree of success in halting the virus.
    The UK government’s choice is a gamble with the lives of around half a million people.
    Of course the opposite policy is, in its own way, a gamble too, but one which refuses to accept so easily so many deaths.
    We’ll find out one way or the other in due course. But to pretend it’s an obvious choice is ridiculous,

  12. Nigel, was the article as confused as the UK’s approach was? As you say, some level of herd immunity can be obtained naturally and vaccines haven’t been able to erradicate every disease. However, what do you think the human cost of attmepting to naturally acquire herd immunity might be in the case of coronoavirus?

  13. I’ve seen a figure of about 5% for proportion of people who catch coronavirus requiring life support. I don’t know how accurate this figure is but you can use it for some simple math. How many people live in your region, how many of those do you expect to catch coronavirus and how many icu beds are available (and will there be enough trained staff available)?. How many other people might also need those beds for different reasons as well (heart surgery, cancer, accidents, or illnesses that are not coronavirus)?

  14. Darkling,
    I have several elderly relatives at acute risk from the disease, and I love them a lot. I have some respiratory problems myself and look forward with avid interest to see whether I will survive.
    My point is that I don’t really see that there are any practical ways to stop the coronavirus from spreading. Yes, the isolation measures may work, but we still have the uninfected, vulnerable population. Even if a country would be successful in stopping the virus, it takes only a single country to maintain a base from where the virus can spread, and even with the virus eradicated from human population, the zoonosis will happen again.
    So, the only lasting solutions are either a vaccine or allowing the virus to infect most of the population. The isolation measures are not a solution, except for helping to avoid overburdening health care. And those measures carry a heavy human toll, too: social isolation, loss of work and income will create and exacerbate many problems. I would say we easily will end up ruining more lives with excessive response than we will be able to save.

  15. and will there be enough trained staff available
    Which may be impacted by school closings. How many medical personnel would end up with kids home alone.

  16. I agree with Lurker. The only two things the current social distancing and shutdowns are accomplishing are slowing the death rate in Hope’s a vaccine and allowing for some level of immunization of the people who do contract and survive, which will slow transmission further over time.
    Without a vaccine my expected life span is not very long after I isolate myself.

  18. I’m trying really hard to isolate folks from my commentary here, and, Marty, I certainly hope you are not going to die on us, but could you please explain in detail what the heck you are talking about?
    Are you trying to contract the virus?
    Or what?

  19. No, no I am isolated and hoping for a vaccine while I continue to do whatever gigs I can from home.
    I am watching eagerly for the result of China reopening. It seems unlikely the virus is eradicated so reopening will likely cause further spread. If so the current steps to slow the spread only allow the medical facilities to handle the flow, while continuing care for non virus patients. They offer no solution except survival waiting for a vaccine, which will only have some percentage efficacy. And they are unsustainable.
    At some point I will have to weigh the downside of never hugging another human being against the high likelihood I will die from the exposure. I meet just about every criteria for high risk.
    My kids wont let me visit, or visit me, for fear my grandchildren, showing no symptoms, would infect me. But I will only live with that limitation for so long.

  20. “The Coronope document says that after the team successfully constructs a synthesized plasmid, which they believe they could do in 2 to 4 months, they could begin “producing thousands of doses per day.” From there, the biohacker says, it’s simply “an economy of scale,” since replication of a bacterial-based DNA vaccine is far more efficient than a viral one that must be cultivated in slower-replicating animal cells.”
    Biohackers Are on a Secret Hunt for the Coronavirus Vaccine: DIY biologists propose creating a public domain SARS-CoV-2 vaccine with $25,000 in funding.

  21. I am not going digging for a cite, and anyhow everything about this is provisional. But I read last night that for people sick enough to be hospitalized, the death rate appears to be about 1% for those cared for in well-prepared, not-overloaded hospitals, but 5% for those in overburdened places like the tents I saw a picture of in Italy.
    If that holds true, then it’s *not* true that the measures being taken to slow the spread only slow down the rate of dying rather than actually lowering it. Or to put it the other way around, slowing down the rate of spread should save lives.

  22. I will point out that I have not seen that exposure, contracting the disease, creates immunity once survived. I question whether letting everybody get it accomplished any thing. It certainly weakens the lungs of many that survive, so without the immunity it’s just a bad idea. If I have missed that evidence I would be thrilled to know it has been confirmed as it is central to most estimates of the duration of the crisis.

  23. isolation measures are not a solution, except for helping to avoid overburdening health care.
    Definitely not a permanent solution. But what they might do is buy enough time for a vaccine to be developed and rolled out. Vaccines for viruses, specifically for corona viruses, is something we have lots of practice with. This one is nastier than most, but still a variation on a theme. So we know how to do it because we do it every year.
    Still, given the speed with which this one is spreading, and given how serious it is compared to most, there does seem to be something to be said for trying things like isolation to slow the spread. That does nothing for those who get it, but may temporarily keep some vulnerable populations from picking it up before a vaccine is ready. For some, that may be enough to justify the price.

  24. Some people seem to be gambling that the costs (economic and social) of not doing anything will be less than the costs of trying to control the outbreak. The growth rate of the outbreak will be exponential so although initially it won’t look too bad, the difference between not too bad and nightmare isn’t very large.
    Don’t forget doctors and nurses aren’t magically immune to this virus so they’ll be coming down with it at the same rate as the general population. What will happen once the health services are overwhelmed and everyone has a family member who needs care? What are going to be the economic costs of having a good chunk of the population ill (some seriously)?
    It just seems like a recipe for chaos to me.

  27. Or even, in a few months’ time, the result of clinical trials with Actemra (an antibody drug used for RA, which might have significant benefit in damping down the cytokines cascade which seems to be what causes the damage i the sickest patients) and Remdesivir (an experimental antiviral, which will take a bit longer)…

  29. The UK strategy just became awfully unclear. (assuming, which we must, that this is an authorised briefing )…
    https://www.bbc.co.uk/news/science-environment-51892402
    Prof van Schaik noted that the UK is the only country in Europe that is following what he described as its “laissez-faire attitude to the virus”.
    But a Department of Health and Social care spokesperson said that Sir Patrick’s comments had been misinterpreted.
    “Herd immunity is not part of our action plan, but is a natural by-product of an epidemic. Our aims are to save lives, protect the most vulnerable, and relieve pressure on our NHS,” he said.
    “We have now moved out of the contain phase and into delay, and we have experts working round the clock. Every measure that we have or will introduce will be based on the best scientific evidence.
    “Our awareness of the likely levels of immunity in the country over the coming months will ensure our planning and response is as accurate and effective as possible.”
    WTF is going on ?

  30. I’ve stopped going to restaurants and bars in Denver; besides I have a cold, and why pile on.
    Thing is, restaurants and bars operate on brutally thin margins, most of them, and the employees are incredibly vulnerable and quite frankly the restaurant boom is way overdone, like the stock market.
    I have a suspicion Denver is going to shut them down; today the Denver Public Libraries closed until further notice.
    If they do, I am going to cut a check to the owners, my friends, of my watering hole down the street to tide them over and to make up for my absence.

  31. STOP GOING TO RESTAURANTS
    If you’re going to restaurants, you’re not “being careful”.
    I think it really depends on your environment. In some places, that’s doubtless true. But consider places like here. Everybody is “being careful”, so the roads are deserted. (Well, except the street by Costco, I suppose.) So we went to our favorite local Japanese restaurant, and had no problem maintaining “social distance”. Maybe 3 couples in the whole place.
    Which is what we expected. And part of what we were doing was trying to help a business we like stay in business.
    I can see avoiding chain restaurants — you aren’t going to impact the company bottom line significantly anyway. Or any which are full of people, for obvious reasons. But there may still be options.

  32. John, I think buying a gift certificate a few times a week for the local places I care about is what I’ll do for that. Give them some cash flow. Then cash them in over a long time.

  33. It seems odd that some people are clinging to conspiracy theories when the zoonosis theory makes perfect sense to me (AIDS was also zoonotic – and, yeah, there were/are conspiracy theories about that disease as well).
    The nightmare that comes to my mind is, COVID-19 may just be the opening gun in a long series of shots fired. One of the consequences of GCC is supposed to be more epidemics of new diseases humans have no immunity to, as bacteria and microbes long-frozen in ice and the permafrost layer thaw out and re-enter the biosphere.
    Since the nations of the world decided not to address GCC, maybe they can devote some resources to establishing large-scale permanent epidemiology R&D centers, like…. the one the US used to have. Ah, well.
    As a natural introvert, I have to say self-isolating hasn’t been much of a hardship, so far. Working from home has not been problematic so far, and I’m checking in on my friends and relatives via phone and email.

  34. I guess this is the virus thread
    https://www.vox.com/policy-and-politics/2020/3/14/21177509/coronavirus-trump-covid-19-pandemic-response
    The Trump administration, with John Bolton newly at the helm of the White House National Security Council, began dismantling the team in charge of pandemic response, firing its leadership and disbanding the team in spring 2018.
    Why hasn’t John Bolton been asked to come on the programs and address that? And if he has been asked, why don’t they say ‘we asked him to come on, but he declined’?

  38. Bureaucratic inertia and infighting also slowed domestic testing efforts.
    “As luck would have it, Dr. Chu had a way to monitor the region. For months, as part of a research project into the flu, she and a team of researchers had been collecting nasal swabs from residents experiencing symptoms throughout the Puget Sound region.
    To repurpose the tests for monitoring the coronavirus, they would need the support of state and federal officials. But nearly everywhere Dr. Chu turned, officials repeatedly rejected the idea, interviews, and emails show, even as weeks crawled by and outbreaks emerged in countries outside of China, where the infection began.”
    ‘It’s Just Everywhere Already’: How Delays in Testing Set Back the U.S. Coronavirus Response: A series of missed chances by the federal government to ensure more widespread testing came during the early days of the outbreak, when containment would have been easier.

  39. wj, I think we thought we had a test. https://www.factcheck.org/2020/03/the-facts-on-coronavirus-testing/
    Note that CDC detected the first case January 18th and tested over 2000 people that week. The CDC was our experts that had a track record of successful testing. It wasnt until the first week of Feb we ran into problems.
    Then the time line for fixing them stretched further than expected, troubleshooting does sometimes.
    I’m not sure xenophobia had a lot to do with this issue.

  40. Under an appropriate combination of conditions — highly contagious, not particularly dangerous to youngsters, acquired immunity, no vaccine — societies will take the approach mothers did when I was a kid. Pretty much every school year, when the first kid developed chicken pox, the mothers had a “chicken pox party” and intentionally exposed every kid who had never had them.

  41. True enough Michsel, but even this morning I read my first account of someone identified as contracting it again. I’ve seen no evidence of acquired immunity.

  47. It’s my (woefully inadequate) understanding that if there’s no acquired immunity, then there’s little chance of producing a vaccine. There are always outliers — I had mumps twice about a year apart when I was a kid.

  48. My understanding is equally inadequate, but I hope it’s at least like the flu, where if I understand correctly we can have partial immunity (e.g. the vaccine for a given year isn’t quite on target, but may still help us have milder cases), but where since the virus mutates all the time, we have to formulate a new, hopefully correctly targeted, vaccine each year.
    And yes, there are always outliers, plus, we are only at the beginning of understanding this thing. Of course, maybe that’s just as likely to mean it’s going to be way worse than anyone imagines right now, versus not as bad.
    Here’s an article that addresses some of these questions rather superficially. It also mentions the duration of acquired immunity, reminding me that the concept is more nuanced than just a black-and-white do we have it or don’t we framework.
    If we hadn’t descended from being a sane country with university and research capabilities that were the envy of the world (so that people from everywhere wanted to come and study here) into a banana republic run by [words fail], I would have more hope.

  51. The problem for the Fed is that it isn’t that people aren’t willing to spend. It’s that they aren’t willing to go out. And, in a lot of cases, their employers aren’t willing to have them come to work either — regardless of whether they get paid if they don’t show up. Neither of which are things that zero interest rates or QE will help. It’s a serious case of only having a hammer, when you are faced with something that isn’t a nail.

  52. At best, expensive and ineffective. At worse, very expensive, ineffective and ends with making problems much worse and/or creating other problems. So, no supprise.

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