Some comments on the VIC path to getting its epidemic under control. A 🧵

Victoria hit over 700 cases a day, and now has gotten into single digits per day.
When cases first started doubling each week, there were a few relatively mild restrictions put in. I believed at the time it was an appropriate scale of response. Many felt it was an over-response.
Cases kept growing with a similar rate. More restrictions were put in, and then finally when cases continued to grow, they put in place a fairly strict lockdown (about this time we hit 700 a day).
Cases started falling quite rapidly after that. The last week or so it's not fallen so quickly, and anxiety was growing. It's started dropping again, and while we aren't out of the woods yet, it's looking hopeful.
Lessons that I hope are learned:
1) Err on the side of over-reacting. Had they gone straight to the lockdowns when cases were less than 100, it would have seemed an over-reaction, but the lockdown time needed to go 100->single digits is a lot less than to go from 700.
2) Underprivileged communities are the highest risk for sustained spread. It is essential that people have access to continued pay if they have to isolate, and that they all know it. People not being willing to get tested for fear of losing their income is a serious risk.
3) We need high quality facemasks in healthcare settings. If just a small fraction of the population is infected, asymptomatic people will come in for broken legs, or car accidents... Close physical contact in hospitals spreads infection and the recipients are often high risk.
4) Protecting the elderly is harder than simply saying "protect the elderly." Everyone knew the aged-care facilities were high risk, and yet, it was very difficult to keep it out, and once it got in, even harder to prevent it spreading.
Some residents need help to shower or dress, so contacts are close. Infection control measures like gowns and masks are much less effective when people need to be physically lifted or require other assistance.
5) The sacrifices made by people in Victoria should be appreciated by other Australians. Without that effort, many infections would have reached other states/territory, and overwhelmed their test & trace response.
The impact on the health and the economy of the rest of Australia Victoria's control so far is significant. As the treasurer is quick to point out, the economy has grown outside of VIC. I seriously doubt the growth would be anything like that if the had infection spread.
The federal government should support those people who have been harmed by the lockdown policies. The reality is that many people have lost a massive amount. All of Australia has benefited from their loss, so all of Australia should help them.
Life is very much back to normal in most of Australia. If you look at Europe and North/South America, you can see what Australia would have faced if the epidemic got out of hand.
I am hopeful that with summer coming, people will focus on opportunities to interact outdoors, that people will seek out testing if symptomatic, and if so, I think we will be able to suppress the virus and deal with future flareups without needing to go through this again.

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More from @joel_c_miller

3 Oct
@apoorva_nyc This reminds me of the short story that I sometimes wonder about writing up... It would absolutely be panned for over-use of foreshadowing.

My wife, daughter and I live in Melbourne . I was talking to my Mom who lived in Texas. I had commented on it being windy...
@apoorva_nyc then I mentioned we were going hiking. My mother responded that I should be careful of falling trees because she knew of a person who had been killed by one.

Sure Mom... will do.
@apoorva_nyc On the drive to where we were going hiking, we noticed a fair number of fallen trees alongside the road.
Read 20 tweets
22 Sep
You know that feeling when it's 4am and you've just finished recording a lecture, but the recording still needs to be uploaded?
and then you realize that it's 10% too big to upload because the university's system has an arbitrary filesize limit?

all done.

I don't hear the birds yet, which means apparently I've been going to bed even later the last few nights.
Read 4 tweets
21 Sep
A few words of caution to those who would read too much in from this figure that's making the rounds: Image
It is clear that Sweden has suffered similar economic decline to its comparable neighbors, but at a much higher cost in lives, as well as long-term disability.

We still do not know what the future holds. If Sweden has somehow built up enough immunity that it can maintain suppression at less cost next year, it may yet be the winner in this race.
Read 5 tweets
20 Sep
A 🧵on whether we can protect high risk individuals by increasing infections in low risk individuals. Can it work?

We need to be aware of what assumptions have to be true for this to reduce deaths.
First a caveat: I'm focusing on deaths here. There are other things that matter.

If you are arguing for this strategy because of other concerns, that's fine. But too many people suggest this strategy saves lives without understanding what they are talking about.
While reading this, bear in mind that long-term care facilities have many high-risk individuals.

Once it is in, the disease spreads well, no matter how many low-risk individuals have immunity.

It also spreads between facilities by patient transfer or movement of employees.
Read 26 tweets
15 Sep
"We used tongs to pick them up by their tails for measurements, because these scorpions are big and nobody wants to be stung"
When I was 8 or 9 years old, I did a "reading comprehension" test about a reading that involved a child picking up a scorpion by the tail. I got the question wrong b/c apparently I was supposed to realize that "by the tail" was the most dangerous way to pick up the scorpion.
I thought it was self-evident that when picking up a scorpion you would absolutely want to hold it by the tail.

This says something about the childhood I had had to that point, compared to the person writing that standardized test.
Read 5 tweets
7 Sep
A thread on how the lockdown in Victoria has affected Victoria and Australia.
First to anyone who argues that "lockdowns don't work", objective observations disagree.

We need reasonable discussion about whether lockdowns are justified, but if your starting point is "lockdowns don't work", you've disqualified yourself from reasonable discussion.
What has been gained from lockdown in Aus & Victoria:

The first round of lockdowns successfully eliminated disease from most of Australia. (New Zealand had similar success) It has meant that most states have had much more normal life than most of the world.
Read 19 tweets

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