I am amazed at how many people repeat the point about the area under the curve being the same. It's just completely irrelevant unless we believe that we will make no medical advancements.

You flatten the curve to buy time for medical advancements, which will reduce the total area under the curve. It can be any or all of:

1) flattening the curve enough to make contact tracing viable, which can eradicate breakouts before they take hold

2) finding a decent anti-viral treatment so that number of deaths or "permanent damage" cases decrease, even if # of cases does not

3) developing a vaccine

This thing about "area under the curve remaining the same" is only true for calculus, it has no bearing on real life because we are making medical advances.

The other possible outcome is to get enough testing and contact tracing in place so that we don't have to all get sick. Other countries have successfully done this, but it seems impossible in the US.

It would have been possible in the USA, but we've seen a failure in leadership to prevent the spread of the virus.

If we had taken decisive action in January or February, we would have had enough resources for contact tracing, and really limit the spread. Instead we'll see at least 200K deaths from this before it is over.

Looking at the new case counts for the USA vs. the EU makes me sad and angry.

California has plenty of contact tracers and testing. Rt is still above 1.

Because we have a whole bucketload of idiots who can't be bothered to wear a damn mask and stay the hell home.

When 2 Mother's Day gatherings account for 50% of the cases in Santa Cruz county, what can you do short of saying "You're a moron."

It probably also doesn't help that a lot of Arizonans travel to California at this time of year to escape the heat.

To me (as a layman) it seems like if you take drastic measures early and get procedures and infrastructure for testing and contact tracing and isolate the sick and those who have been in contact with the sick it’s possible to get it under control so that you can start opening up schools and loosening social distancing rules/guidelines.

Look for example at Norway and Sweden. Norway took drastic measures early and were able to stop the spread to such a degree that schools opened up again after Easter and everything is almost back to normal now. Sweden did not take very drastic measures early and have had massive spread and 20 times more fatalities than Norway and now they have in many regards stricter social distancing rules than than Norway.

After a certain point it seems like you have to either shut down society for a long period of time (Italy) or just let it run its course through society somewhat controlled.

Comparing countries like this does not make sense. The spread of the virus is more a reflection of how people live, what they do day to day, rather than what measures they took protect themselves.

Austria and Italy, share a border, have ski lodges in the same Alps. Austria got off easy even though they had a one of the first outbreaks, Italy got hammered for two months. Yet Italy locked down harder during all this time.

I don't know in what way is Norway different from Sweden, Norway looks and feels a lot more rural and sparse. Sweden more cosmopolitan.

Sure there's lots of factors. My point is that if you can stop or limit gatherings and contact points early the spread will decrease dramatically. It will still spread within smaller communities like families, but as long as you can limit spread outside of smaller communities the virus will have no where to go. So it seems more like a timing issue than how people live. Oslo is similar to Stockholm, just smaller, but have dramatically less cases (Oslo was hit hardest in Norway).

You could also compare Sweden to Denmark which is more similar than Norway. Denmark took drastic measures quite early and were able to get it under control.

Further to that I agree it's too early to say what is the best strategy long term. All epidemiologists in Scandinavia basically agreed with the Swedish approach in the beginning of the outbreak, but politicians in Norway and Denmark thought otherwise. I guess epidemiologists didn't think it was an option to basically lock down a modern country for several months and maintain social distancing rules for months on end. If this works until the end I assume the books on the subject will be rewritten ...

At this point the pandemic is so widespread that testing and contact tracing would be unlikely to achieve containment. We would have to first impose a very strict lockdown for several weeks, which would be politically difficult.

You're never going to achieve containment with just contact tracing, testing, and politely requesting that people stay at home. People won't comply. Containment requires mandating compliance:

* Forcibly testing people regularly

* Forcibly quarantining people who test positive

* Mandating contact tracing regardless of personal preference

* Imposing travel restrictions on hot spots with actual blockades

* Restricting any gatherings that aren't essential, with "essential" actually meaning essential (grocery stores, pharmacies, hospitals, etc) rather than politically necessary.

* Mandating correct wearing of masks

* Closing borders or requiring quarantine upon entry

In effect, we need to do what China did. We absolutely lack the political will to do that in the US for a variety of reasons, and so we will not be able to approach containment until we get a vaccine.

uhhh, it is not political will that we lack

most people do not want that at all

I most certainly not want to be forcibly tested or mandated to "correctly" wear the mask and you can fuck off you do

Well, unfortunately your opinion doesn't change the fact that those are the requirements for containment outside of vaccine development. Any other strategy will likely ultimately fail. Sorry if that makes you unhappy; sadly the virus doesn't really care about our opinions.

4) find out that dexamethasone can reduce mortality for ICU patients by a lot.

Aside from medical advancements, if the health care personnel is not overworked, overstressed, overtired, patients have a better chance to survive.

Flattening the curve means lives saved.

This is something that people often forgot - even if hospitals do not reach their full "paper" capacity, you can easily burn out or even kill your irreplaceable (in the pandemic timescale) medical personnel, if they have to deal with constant influx of infected patients over long periods.

Not to mention hospitals usually shutting down elective procedures once the amount of infected patients in their care crosses a certain threshold.

The way that we discovered dexamethasone can reduce mortality in ICU patients was through enough people being infected and dying to run studies testing a whole bunch of potential treatments on them. There's very limited potential to decrease the number of deaths by buying time for this to be discovered, at least from a global perspective.

“Flatten the curve” is a different strategy from “minimize until medical advances come through.” It’s the difference between finding a version of life that keeps hospitals just under saturation vs. maintaining full lockdown as long as it takes.

afaik not true; google for "epidemic overshoot"

I just did, and the first 6 answers do not really clear it up.

Do you have a specific source that can explain it?

The mainstream media coverage of overshoot in publications like the New York Times is intentionally misleading in order to push the (false) narrative that herd immunity requires infecting and killing far more people than you'd naively think. (Their numbers are only accurate if you assume no social distancing at all, which probably isn't even possible at this point.)

Basically, the number of infections peaks at the point where - due to some combination of immunity and measures like social distancing - each person infects at most one other person on average. However, there are still a whole bunch of infected and susceptible people spreading the disease, meaning that quite a lot more people then become infected than is actually necessary to end the outbreak. If you assume no attempt to flatten the curve, then a lot more people become infected than the herd immunity threshold, and that's what the NYT and co have focused on. However, one consequence is that flattening the curve without fully surpressing the outbreak reduces overall infections and deaths - the peak is lower and happens after fewer total infections, making it possible to build a whole bunch of herd immunity without all the extra infections and deaths from massively overshooting it.

Thank you for your explanation. That makes a lot of sense, and was a lot better than anythign i could find.

that's in the case that we even have to arrive at herd immunity through infections. By far the bigger factor here are the dozens of vaccines and treatments (eg monoclonal antibodies) in development, if any of them work in time, the "area under the curve is the same" idea is blown out of the water to the tune of millions of preventable deaths.

Millions of preventable deaths? Do you have a source handy? I’m wondering how that aligns with the latest data.

(number of uninfected that need to be infected to achieve herd immunity) * (case fatality rate) = future deaths

With the assumption that every vaccinated person counts towards herd immunity and isn't likely to die, you can plug in your own numbers to the equation above. Even with really conservative estimates, it's easy* to get into the millions when you consider the entire planet.

*Barring some highly effective treatments that may or may not surface.

> (number of uninfected that need to be infected to achieve herd immunity) * (case fatality rate) = future deaths

You need the lower IFR, not the CFR, here.

Every vaccinated person will not count towards herd immunity. Vaccines can be tremendously helpful in controlling infectious diseases, but not every person who is vaccinated will produce neutralizing antibodies. This is why it's important to vaccinate as many people as possible in order to surpass the herd immunity threshold.

At this time we don't know how effective any of the vaccine candidates will be.

in addition it is also not clear if the vaccine will have a lower incidence of side effects than the virus itself

kids and young adults have less than 1/100,000 chance of dying of COVID. The vaccine needs to be better than that. There is an ethical issue at hand of vaccinating people that are not at risk to save those that are at risk.

For reference after administering 3.1 billion vaccines the US paid damages in about 3,000 cases thus across all vaccines the rate of serious side effects is about 1 in a hundred thousand (considering about 10 vaccines per individual).

There is an ethical issue at hand when people are unwilling to protect 30-40% of the population because they fear a miniscule risk of vaccination.

I think you deliberately avoid taking an effort to appreciate the ethical side of the issue.

There is no vaccine that we currently mandate for the sole reason of protecting someone else.

The fundamental requirement of the Hippocratic Oath is "First, do no harm". If you are vaccinating someone, you better cause less damage to that person than the disease itself would do.

I have a kid, I am not an anti-vaxxer by any stretch of imagination: the whole family gets flu shots every single year.

But will I rush to get my kid vaccinated with a new thing rushed to market during a exaggerated hysteria, a vaccine not properly vetted for long term effects ... uhh most certainly not. I am going to wait a couple of years to see how others will fare.

(FYI I work in life sciences and I like to believe that I understand the inner workings of a living cell better than overwhelming majority of the population)

We impose many restrictions on individuals in the name of protecting others. Off the top of my head, my city doesn't allow driving under the influence, discharging firearms within city limits, public nudity, yelling fire inside a theater. We also vaccinate to build up community immunity, not just to address the health of an individual person.

And as far as COVID vaccinations go, you're trying to have your cake and eat it. Either COVID-19 isn't risky/dangerous for young people, (meaning we can safely vaccinate them), or it's dangerous to them. If you're trying to say that a vaccine for COVID-19 would have worse effects than the disease itself, I think this would be extremely unlikely, since it doesn't occur with other vaccines.

If a COVID vaccination has a 1 in 100K rate of deleterious side effects (up to and including COVID-19) in the general population, then vaccinating the US population (330M) would result in 3300 cases of COVID (or bad side effects). The benefit of this would be saving roughly 2M people from death, and countless others from hospitalization and long term complications.

Comparing vaccinating someone to driving under the influence makes no sense whatsoever.

As for the other content, it just shows you don't understand what kind of problems an insufficiently tested vaccine could cause. You should educate yourself better:

https://www.sciencemag.org/news/2019/04/dengue-vaccine-fiasc...

You're moving the goalposts. You originally were talking about the risks of vaccinating kids and young adults, and saying that the vaccine had to be better than 1/100k. Now you're saying concerned about insufficiently tested vaccines. These are completely different issues, but you're trying to muddy the water.

Of course no one wants to take a vaccine that didn't undergo proper clinical trials. The argument was whether a vaccine that had typical side effect ratios would be ethical.

You are correct that there is a utilitarian argument that vaccinations will save lives. You and the parent post disagree about the new vaccine risk level. Do you think that they should be compelled to vaccinate their child with the unproven vaccine. What if the risks outweigh the benefit for the child, but are positive for society at large?

I don't think anyone should be vaccinated with an unproven vaccine. Any vaccine issued should have cleared Phase IV, with minimal short-lived and long-lasting side effects. I won't take a vaccine, nor have my children vaccinated until then. I'm also looking at the current rush for a vaccine with a jaundiced eye. I think the likelihood of ever finding a vaccine for SARS-CoV-2 is small, however I hope we get lucky, and the tremendous resources being applied to finding a vaccine pay off.

I don't think we disagree about the new vaccine risk level, since we don't have a vaccine, nor know anything about its side effects.

If a vaccine is has differing risks based on age group, then I would hope that we vaccinate the lowest risk group; assuming the risk variance is significant.

As a society, vaccinations are naturally government infringement upon individual rights. But a well-functioning society routinely infringes on individual rights. We place children in protective services when their parents don't care for them properly (in the mind of the government). We (in extreme times) invoke a draft for military personnel. As my dad used to say, your right to swing your fist stops at my nose. Rights are not inviolable; though care should be taken to limit infringement.

As SC Justice Robert Jackson once said, the protections afforded by the Constitution "must not be discredited by an interpretation to mean liberty without law."

I agree that we wont have an understanding about the vaccine risk until it is developed, and would add that we wont have a good understanding until many years after it is developed.

I don't feel that you answered my questions directly, but if I understand correctly, it appears that you would hypothetically favor compulsory vaccination of children for the greater good, even if the personal risk outweighs the benefit.

I wholeheartedly disagree, as I do with the draft. Similarly, I 'think the right not to be punched, is analogous to forcing someone else to vaccinate for your benefit.

As a society, we get to decide what impositions we impose on individual liberty. Where would you draw this line?

I draw the line at criminal charges for failure to vaccinate.

case fatality rate is the observed death rate based on known cases

infection fatality rate is the observed death rate based on all (known+undetected) cases

the Swedish report indicates of infection fatality rate of 0.1%

<the Swedish report indicates of infection fatality rate of 0.1%>

That's incorrect. The IFR in Stockholm (the epicenter for COVID-19) in Sweden is .6% currently [0]. Only if you exclude anyone above 70 do you get an IFR of .1%. According to [1] 20% of the population is 65 and older, roughly 2m people.

[0]https://www.folkhalsomyndigheten.se/contentassets/53c0dc391b...

[1]https://www.indexmundi.com/sweden/demographics_profile.html

ok, valid point I recalled it incorrectly,

FWIW the IFR is getting tiny as for younger people so using the the same preventive measures for low risk people that we use for high risk ones does not make much sense

The issue is that's completely impractical in our society to expect to be able to protect the 30-40% at risk from the 60% that has a lower level of risk.

If everyone gets vaccinated a year from now, the total area under the curve will be lower if it's spread out over a long time than if everyone got sick before the vaccine became available.

More so as treatments improve and if the virus weakens (which they usually do).

I don't know, look at Europe, quite a few places have managed to do quite a bit more than flattening the curve. At the current rate, reaching even 50% of the population would take decades, hopefully there will be a vaccine well before them.

The area under the curve need not be the same though. There are many things that can change the area under the curve. A vaccine is an obvious one, once one hits the area doesn't change, so the less there is the better. (ecconmics can debate how much we should have reopened after that) the virus could also mutate and affect everyone again thus increasing the area.

I have never been able flattening the curve. If people would just stay home for a month and take precautions this would be over as it wouldn't spread and those who have it get over it. The details of living like that are tricky but too many people didn't try.

Exactly this, in fact we did such a good job, that people who were sick for other reasons didn't seek medical help and health care professionals have been laid off

https://calmatters.org/health/coronavirus/2020/05/health-car...