This is a tragic US centric point of view. From an international point of view there are 2 camps: aggressive and complacent. Aggressive means contact tracing every single case. This is only possible with using all the gold standard tools to reduce virus spread: massive testing, travel restrictions, universal masking, and sanitizing. South Korea has demonstrated that this works fairly well even in a democracy even with few social distancing policies. They only recently closed bars.

The biggest dividing line here seems to be masks. Countries whose leaders initially told them not to wear masks are struggling to achieve universal masking compliance. Most seem to have given up on being aggressive and are now having these debates of complacency.

What's the evidence again that universal masking compliance works and is necessary? It seems that some jurisdictions like California (or, hell, Wyoming, way lower than any country in Asia) have had very low transmission rates without it.

California had early, aggressive social distancing orders and large parts of California had/have manditory mask orders in place.

Bay area: https://www.mercurynews.com/2020/04/22/coronavirus-bay-area-...

San Diego: https://www.10news.com/news/coronavirus/what-to-know-about-t...

Los Angeles: https://losangeles.cbslocal.com/2020/05/14/coronavirus-covid...

Mandatory masks orders for enclosed spaces, but not for outdoors, which is presumably what is meant by "universal".

Nope, also outdoor. If you're queuing up for e.g. shopping, you must distance and wear a mask.

From the first article I linked: "Are you leaving the house? Facial coverings are required to be worn by anyone older than 12 while waiting in line or inside any essential business, using public transit, riding in a taxi/Lyft/Uber or seeking healthcare, as well as anytime you come within 6 feet of someone from outside your household."

Exactly. if you're outdoor and 6 feet away from people (walking in the park, etc) you don't need a facial covering.

California also has a large proportion of East Asians, where mask-wearing is common, especially when you might have a cold, so that you don't spread it to the next person. Epidemiology is culture-bound. By now everyone knows that the incubation period for coronaplague is long and that pre-symptomatic people are a significant source of spread. It's not a long leap for an East Asian person to think that they might carry the disease without knowing and want to minimize spreading it.

This kind of speculation is cryptically racist. My observations are anecdotal, but walking around in public areas such as parks where mask wearing is asked for I see east Asians ignoring the requests as much as non east Asians (I'm of east asian extraction myself)

This is still a very us centric view. California isn't low compared to Asian countries. But all California shows is that you can achieve low transmission rates with lockdowns done early enough. But of course lockdowns are not sustainable. It's really odd to bring up Wyoming. Any rural area can potentially avoid outbreaks. South Dakota has outbreaks now though.

I remember when the first "we suggest wearing a mask" came out. It was followed with a worry about masks becoming a bigger deal than they should. I remember hearing over and over during the same meeting that masks were not a replacement for keeping a 6' distance between people. Now it seems the whole country is Mask vs No-Mask when the actual experts suggest it's the 6' distance that really counts. Masks were just as an additional precaution and not meant to be front and center.

Meanwhile, in other countries where they actually want to get their economies going, people simply wear masks, because they're an added layer of protection, cheap, easy, and current evidence is that they do help contain the spread of the disease.

https://www.usatoday.com/story/opinion/2020/04/04/czech-gove...

Sure, the US isn't as advanced or well-run as... the Czech republic, but we should at least try and aim for what those kinds of countries can accomplish.

https://www.youtube.com/watch?v=ICc_H75R05A

yes they do help some but they're not the end all be all of protection which was my point. Wearing a mask or not wearing a mask has become a much bigger deal than it should be. People are protesting over a mask and people are social shaming over a mask, it's not that important. Maintaining distance and washing your hands is much much more important than a mask.

I think a 'defense in depth' strategy is what masks are part of, and since wearing them is fine for 99% of healthy adults... why not?

https://en.wikipedia.org/wiki/Defense_in_depth_(computing)

They're a bit uncomfortable, but so are ventilators...

Unless you believe we should wait for a vaccine, we don't need "the end all be all of protection", we only need adequate protocols to stop the spread of the virus from overwhelming healthcare systems. If we can find low impact ways (washing hands, wearing masks) that are effective enough to allow us to curtail physical distancing, that is hugely advantageous.

Testing and tracing has already been tried and shown to be more or less impossible in dense cities with no immunity. It’s not for lack of trying that many cities failed to contain the outbreak in February. Granted, it’s a lot simpler when people are aware, but it’s still likely that cities will fail again as soon as people move about normally.

I suspect a reasonable middle ground strategy is to aim for just some immunity (say 15% or 25%) while not overwhelming healthcare, after which tracing and isolation has a chance of working while also allowing a somewhat functioning society (Note: I mean for dense cities. This could still mean 5% in a country, as in Spain for example). The hard part is ensuring that as few as possible of those that are infected are in risk groups. This is something that proved difficult in many places.

There is a set of restrictions that allows the aggressive testing/tracing/isolation work for a naive population, and a different set of restrictions that is sufficient for to contain the spread in a population with 20% immunity. My feeling is that the former set of restrictions isn’t viable in democratic countries, or sustainable for the time we are talking about (1-2 years) without leading to something that costs more than is won.

South Korea has fewer cases - and deaths - than Iowa.

I mean, I know Iowa is a really dense place where everyone uses public transportation, but maybe they could at least make an effort...

I think random comparisons are pretty much completely lacking in information. Fewer died in country X than country Y doesn't mean policy is better. Nor does "they have fewer cases", or "they have fewer deaths". A tiny outbreak will yield few dead regardless of policy. Not all small outbreaks necessarily become large outbreaks, despite poor policy (why, we don't know yet). What would impress me is a region that with sustainable and accepted policies contain an outbreak in a population with very low immunity. Or a region that can reach a high level of immunity without the disease reaching vulnerable groups.

South Korea's initial outbreak was fairly large, if I recall correctly, as it was connected with a church.

This isn't some small, statistically insignificant difference. It's a massive difference in the number of cases and deaths.

300 dead is a pretty small outbreak by today’s standards I’d say. It was the second largest after Wuhan for a short while.

They have 300 deaths and 10k confirmed cases, suggesting they have confirmed 10% to a third of all cases.

It’s also impressive that they managed to keep the outbreak so small without extreme mitigations like other places with similar outbreaks.

I don’t think that most western countries can emulate it though. Next time, perhaps (this is South Korea’s second SARS outbreak).

> I don’t think that most western countries can emulate it though

They certainly can't if they don't even... try.

The "gold standard" idea is not what is actually happening. Look at the various European countries that have opened up. There are as many different sets of protocols as there are nations, and only a few might qualify as the gold standard. So there is at least a third camp between "aggressive and complacent", and that is where the vast majority of nations and US states currently fall.

Exactly.

Given the terrible situation in Brazil (and Mexico), is it not possible that the whole of the Americas could be cordoned off, while Europe and East Asia continue with efforts to suppress the virus?

I tend to stay out of these discussions but there has been a huge shifting of the goalposts.

>My understanding at the start of lockdowns was that these were intended to "bend the curve" so we could get control of the situation and then allow the virus to spread at a rate that would not overwhelm healthcare capacity.

Yes. The standard argument went along the lines of we have to limit movement and interactions for a while so that we can "flatten the curve" and not overwhelm the hospital system. Now that that has happened in most cases, though, the goalpost has moved towards the availability of a hopefully effective vaccine in the next year or two [ADDED: and/or maybe effective testing/tracing whose effectiveness in general is TBD]. Which, even if we assume some behaviors change, doesn't seem like a practical long-term strategy.

Bingo. It seemed like most people were on board with the idea of flattening the curve because it was a compromise: don't overwhelm the healthcare system, but continue life as much as possible. No unnecessary extra deaths, but no unnecessary shutdowns. Now we seem to have thrown that message out the window completely and it feels super deceptive.

I think flattening the curve was always more generally about creating a time delay so that progress could be made on multiple fronts.

It was about health care capacity. It was also about testing capacity. It was also about producing/procuring PPE and logistical planning for all the things to come. It was also to learn more about this thing, since there are so many unknowns.

Perhaps "flatten the curve" was given as a supporting argument for what we needed to do first, not as the only thing we needed to do.

> whose effectiveness in general is TBD

Only if you don't look at countries where it seems to be working pretty well, mostly in Asia.

But those countries don't actually believe contact tracing is effective. When China sees a cluster of cases, they don't say "it's cool because contact tracing will protect us", they lock down the city until the cluster goes away.

You are lumping in a lot of quite diverse places. China and South Korea took quite different approaches. China's is, as you state, very blunt. South Korea has used contact tracing to good effect.

My comment wasn't "all countries in Asia", it was about countries in Asia using contact tracing well.

And what's going to happen when there is a vaccine and it's only 50% effective or whatever it's likely to be? Will they move the goalposts again? The economic toll of these lockdowns is going to have real effects on economic well-being (and health outcomes!) worldwide. I'll bet the cost just in human life will end up being greater from the lockdowns than from the virus.

You only need a certain level of vaccine effectiveness in order to reach herd immunity and reduce the spread of the virus. Even a 50% effective vaccine might also reduce the overall danger of the coronavirus if you do end up catching it as well.

Frankly speaking, the idea that opening up will somehow fix everything isn't true. People are still going to be afraid to go to public places, and we have multiple examples of cities or areas that decided to open up too early getting slammed by a second wave of infections (See: Hokkaido, Texas).

So yes, in this case it's a 'moving goalposts' situation because our knowledge and way of dealing with the coronavirus evolves over time. That's the entire point of slowly opening up with a viable test infrastructure. If you don't adjust as the situation evolves, then you get hit with a second wave making the lockdown pointless and prolonging the economic effects. Especially if people start suing local businesses when they get sick for not following the guidelines.

> and we have multiple examples of cities or areas that decided to open up too early getting slammed by a second wave of infections (See: Hokkaido, Texas)

Where are you seeing that Texas is getting "slammed by a second wave"? I'm looking at Worldometers, and their daily new cases looks relatively flat. Apparently there was a big jump yesterday, but the state is claiming that correlates with a much higher rate of testing. (This is part of why we should look at the 7 day average, not just the day by day numbers.)

If their rate does happen to be increasing, what makes that a second wave, vs them just not hitting the peak of their first wave yet?

The state has been lying and politicizing the coronavirus problem since the beginning and in general they've been inflating the # of tests done in order to justify reopening the state. A great example of this politicking is that they've been fighting tooth and nail to prevent cities and counties from implementing their own coronavirus measures.

As for the second wave, the fact that we've hit a large jump in cases is specifically what I'm talking about. It does not bode well for the next few weeks, especially because there has been little to no effort from the state to actually implement measures to ensure that we keep the curve flat. Local health officials have also been raising the alarm on both our lack of testing infrastructure and the idea that a second wave is already occurring.

you're going to have to back that up with at least something.

https://apps.texastribune.org/features/2020/texas-coronaviru...

Yeah, I've seen so many "in two more weeks things are going to be much worse" predictions that haven't come true in the past 6 weeks or so that I've mostly started ignoring them (unless they're backed by some level of evidence).

> The state has been lying and politicizing [...]

They're not hiding bodies, so the excess fatality rate would reveal any lies they're telling.

Deaths from COVID-19 can take weeks from the initial infection. I'm not disputing or supporting anything else in this thread, but "there aren't a lot of extra deaths" doesn't really offer much data either way. Maybe in a few weeks.

I've been hearing this for weeks.

Texas has only been re-opened for a couple of weeks, so I don't know what you're talking about. If you're talking about the epidemic more generally: the virus has killed nearly 90,000 Americans in less than eight weeks, so it's not like it's let anyone down in the 'killing loads of people in a short period of time' department.

I get your point, but to me hospital underutilization implies that whatever restrictions there are, they can be eased more. Ease the lockdown restrictions in a reasonable way and watch for runaway growth in cases.

> we have multiple examples of cities or areas that decided to open up too early getting slammed by a second wave of infections (See: Hokkaido, Texas).

I haven’t seen any evidence showing Texas getting slammed by a second wave. All data sources I have seen, including the linked article, show a stable rate or relatively small uptick.

I don’t think this framing is correct. No one wants things to be shut down until we have a vaccine, they want it to be shut down until we have a test and trace infrastructure in place. California’s reopen plan is gated by test and trace. It’s What every other developed country in the world is doing to allow them to reopen. We see this framed by right wingers as “stay closed” vs “open up” because they understand that this administration isn’t capable of launching an effective spread prevention program and are now solely focusing on shifting the blame.

Test and Trace was never going to work in the way we think. The US is too dispersed, too large, and too opposed to government restrictions/intervention. If we had actually listened to GWB about pandemics when he was in office, and set up realistic T&T mechanisms, we might have had a chance in early January. But it quickly became apparent that we were not going to be able to contain SARS-CoV-2, and would have to try to mitigate it.

While it's easy to take political sides with this, that's in the past. We could have had better CDC leadership than Redfield. We could have had better leadership on the NSC than we had after the advisory committee was disbanded. We could have had better presidential leadership. We could have used testing kits from Germany until US kits were effective.

There's a lot of shoulda/coulda/woulda. But here we are.

None of this stuff is in the past. It could be anywhere from 12 months to forever until we have a vaccine. We might have missed the boat on our first wave (in frankly, the most unforgivable way possible), but we still have lots of time to improve in case we get further waves. And we damned well better assume those are coming.

> We might have missed the boat on our first wave (in frankly, the most unforgivable way possible), but we still have lots of time to improve in case we get further waves.

In much of the country that isn't NYC, including many of the places aggressively reopening, the first wave hasn't even peaked yet, so it's not so much that we missed the boat on the first wave and are now into preparing for potential later waves, we’re still actively screwing up the first wave.

Hopefully we'll have better plans in place, and leaders willing to act on them for COVID-20. My point about T&T was that it doesn't work when you have 1M infections. It's ideal when an epidemic/pandemic first starts to show up. But for now, it's useless health theater.

Contact tracing requires that:

a) You give the contact tracing system a complete and accurate history of your contacts.

b) You actually self-isolate when told you've had contact with an infectious person.

The civil liberties crowd will fight tooth and nail against a such that it is not possible to compel b. In the absence of enforcement, the conspiracy theorists will ignore it and the merely lazy will cheat.

Not even a competent attempt at contact tracing is going to work on the American people.

I can’t even imagine the levels of civil disobedience in America if a track and trace program is mandated. WA state, left leaning, already proposed track and trace to go to restaurants and already walked it back after pressure. People are starting to run out of money and food and they will turn to violence. We need to follow the same light social distancing approach as Sweden and Florida imo.

What's the reasoning for the pushback on track and trace? Concerns about government overreach?

Which government contractor do you trust with that information?

Getting sued because you happened to be in same restaurant as someone who got covid.

Im curious how effective do you think a test and trace program is likely to be? It seems like the kind of thing that works in isolated cases where things aren't yet widespread. Has it worked anywhere "at scale" ? And then even if it is implemented super well and everyone lets apple and google track them on their phones and stuff, how effective can it possibly be if symptom-free people can transmit it for weeks? One person who commutes on the subway in new york must come within 6' of hundreds maybe thousands of people every day. How can this possibly work? (Honestly asking)

South Korea and a number of other countries have had real world success with it, and have been able to open up fairly safely.

Of course, they had politicians who reacted quickly, firmly, universally, and most importantly early. In the USA, Corona was allowed to grow much much more and far fewer resources were brought to bear in an effective way against it. So its going to be much more difficult to get back under control, but not impossible, if we can turn it around.

Whats really happening besides that though is that the world is watching the self proclaimed world leader be the least competent and most impotent in their response, and throw its hands up and give up on good strategies like contact tracing. Its embarrasing.

This seems to be something Americans are scared of more than something that actually happens. Which ought to make sense; the average Californian's commentary on New York or Italy isn't "heh, sucks to suck".

> California’s reopen plan is gated by test and trace

California’s plan has multidimensional standards, it's not accurate to say it's “gated by test and trace”. But yes, the ability to effective monitor leading indicators of caseload and isolated the infected and exposed is fairly significant, and test is key to both and the trace part of test and trace an important factor in the second.

> No one wants things to be shut down until we have a vaccine, they want it to be shut down until we have a test and trace infrastructure in place.

I wouldn't say "no one":

> Los Angeles Mayor Eric Garcetti said Wednesday that the city will "never be completely open until we have a cure,"

This is also a mentality I've seen numerous times on the web, including this site.

> "never be completely open until we have a cure,"

This is absurd, and indicates a politician pandering for the next election.

For ebola, with 25% to 90% mortality, it can be justified.

For corona, with under 0.1% mortality for working-age people, it's madness.

"The average EVD case fatality rate is around 50%. Case fatality rates have varied from 25% to 90% in past outbreaks."

https://www.afro.who.int/health-topics/ebola-virus-disease

yes, I don't understand it, but there seems to be a large group who want the lockdowns to remain no matter what. A commenter in a thread last week even went so far as to say the lockdowns were, overall, good for society. I have no explanation except maybe the national election. I hope that's not it because the wholesale destruction of livelihoods just to stick it to the other side is a very depressing thought.

There are a variety of reasons IMO:

-- Many of those making these comments are probably WFH with some level of normalcy so they don't really see how and why a lot of people are anxious to open things back up.

-- In the same general vein, they see a push to reopen as part of an agenda that puts "the economy" over people for the benefit of Big Business/The Rich.

-- They think there must be a near-term technological/policy fix if only the bad politicians would stop messing things up.

Almost all US states have now eased restrictions and with barely a test and trace program among them (maybe some programs in the Northeast, but where else?).

And if California is truly waiting for testing capacity, they may be waiting a long time because their rate of testing is extremely low compared to places that have opened up. New York has twice the per capita testing as CA and they have already began opening up parts of the state (despite being hit many times harder by the virus). Even NYC is about to hit the criteria for some reopening. Meanwhile, LA announced they would continue their lockdown until August. That sure sounds like they are on a "wait for a vaccine" plan.

The European nations that have eased restrictions have higher per capita testing than most US states. But they do not all have robust test and trace programs. Denmark opened up weeks ago, including many schools, but only last week announced a test and trace program.

> No one wants things to be shut down until we have a vaccine, they want it to be shut down until we have a test and trace infrastructure in place.

Speak for yourself. The US doesn't have a vaccine, enough testing or tracing.

Wishing doesn't make it so. End the lockdown now.