Exit Strategies. A thread:
"I saw the first results and I thought: "Holy fuck, that timeline."
Dutch scientists are working on a #Coronavirus exit strategy that could last anywhere between one and two years. "One sneeze, one cough and the virus could explode again..."
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"I saw the first results and I thought: "Holy fuck, that timeline."
Dutch scientists are working on a #Coronavirus exit strategy that could last anywhere between one and two years. "One sneeze, one cough and the virus could explode again..."
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- Dutch government doesn't know how long strict measures are needed to suppress the new virus SARS-CoV-2.
- The population may have to do some degree of social distancing for one or even several years before the pandemic is over.
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- The population may have to do some degree of social distancing for one or even several years before the pandemic is over.
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- But the estimates are highly uncertain: no numerically substantiated long-term plans are ready to get out of this pandemic.
- The 'exit strategies' now being hastily devised & calculated are all very difficult to maintain, socially disruptive, expensive & time-consuming.
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- The 'exit strategies' now being hastily devised & calculated are all very difficult to maintain, socially disruptive, expensive & time-consuming.
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- Forty epidemiologists, psychologists, mathematicians and modelers from all over the Netherlands set up a Slack Channel led by Prof. Hans Heesterbeek, a theoretical epidemiologist at Utrecht University.
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Working through consultation channels named "transmission", "uncertainty", "immunity", "behaviour", "R0" and "exit strategy". Scenarios for the whole of the Netherlands are devised and discussed in this ad hoc group, from regional lockdown to flattening tactics.
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Without exception, all scenarios take time. The x-axes of graphs in recent scientific publications also demonstrate this. In an article from Utrecht University and Imperial College London, in The Lancet magazine dated March 9, the contamination chart runs until spring 2021.
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A much-cited calculation model from Stanford University, shows a new spike of contamination in the spring of 2021. There's the alarming study from Imperial College in mid-March (after which the UK govt acutely switched to a lockdown) in which the graph runs well into 2021.
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One to two years is what scientists are looking at.
'And don't think that if you let the virus spread freely, you will be there in a few weeks: "In our model, 200 days of a completely uncontrolled outbreak, you'd have so many patients the ICUs could no longer cope."
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'And don't think that if you let the virus spread freely, you will be there in a few weeks: "In our model, 200 days of a completely uncontrolled outbreak, you'd have so many patients the ICUs could no longer cope."
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The Light Switch Method: One possibility, according to simulations, is to let the virus smolder. It may flare up here and there, but it shouldn't really break out. That gives people some freedom of movement, and immunity increases, which slows down the spread.
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Imperial College London suggested such a thing in a March 16 report. The strategy of "temporary suppression" or "pump braking" means that the social distancing measures are relaxed, until the degree of contamination exceeds a certain threshold value.
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The restrictions must then be temporarily ramped up again, to avoid overcrowding hospitals: 'go to school and work for a while, and then lockdown again for a while. Like a light switch: on, off, on, off.'
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The 'On-Off' model shows that it is possible. Only, the British scientific crisis council SAGE wrote after reading the study: "These measures should be in place for at least a year. With the strict regime applied for at least six months.”
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Unlocking By Region: Dutch scientists De Vlas and Coffeng have deliberately not taken into account the arrival of a vaccine, in order 'to see what happens next.' They also have doubts about the British 'light switch' proposal.
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Coffeng: "If the govt limits contact to say, 40% of what is normal, the fire can be kept smoldering. But, at 55% it flares up too much. That's such a small bandwidth, it's not possible." De Vlas: "How do you impose that on a population? How long do people remain obedient?”
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They propose a geographical model. Divide the country into ten regions with the same number of inhabitants. Impose strict measures on all regions, but "let go" of the virus in one. At the same time, open up ICU capacity throughout the country to the sick from that one area.
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If area one passes its peak and there is sufficient immunity there, area two may be released. In regions where the virus breaks out, vulnerable people must be protected as much as possible.
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In the "normal" scenario, all restrictive measures are then lifted after 800 days. In the "positive" scenario, with more IC beds or effective medicines, the duration can be shortened by almost half to just over 400 days.
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De Vlas and Coffeng understand this social experiment raises impossible dilemmas. Which region unlocks first? Which last? Who determines that? How do you keep the people of the areas apart for so long? And is it ethical to deliberately expose people to this virus?
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"More than two years, up to 120 deaths a day?"
"We are not saying that it should be this way. That is up to politics and society. We only give schools of thought to how it could theoretically be done.”
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"We are not saying that it should be this way. That is up to politics and society. We only give schools of thought to how it could theoretically be done.”
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Individual measures: Epidemiologist Hans Heesterbeek: "Whether a country wants to wait for a vaccine or work on group immunity, the method is more or less the same. The virus must be suppressed without completely destroying social life."
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"Individual measures can ease the yoke of mass social distancing. Like a phone app that keeps track of contacts and alerts if you were around an infected person. Then you need to isolate yourself until a test shows that you are virus free."
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"Then you have to see which people want such an app. That may not be a good reflection of the population. For example, people who are already careful. As the only measure, this cannot work.”
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And the German plan to give people "certificates of immunity" when they have had the virus? Heesterbeek: “Do you want such a dichotomy in your society? Do you think people stay in obedience for a long time when they see their neighbour go to work and the cafe?”
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Each plan is highly uncertain, raises bizarre social questions and is disruptive. Faced with the damage from the British lockdown, one of the main government advisers argued this weekend to release the virus among healthy British people.
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“An exit involves economics, behavior, public health, ethics. And no one has a ready-made answer. ”
A strategy will have to reached soon, otherwise it will only be philosophising without obligation. In the slack group, someone asks, "How much time is there exactly?"
Ends.
A strategy will have to reached soon, otherwise it will only be philosophising without obligation. In the slack group, someone asks, "How much time is there exactly?"
Ends.
