1/ The way I see it there are 4 "schools" on how to respond to this crisis (with a lot of levels in between of course):

1. #ZeroCovid (eradication)
2. Suppression until vaccine
3. Mitigation in parallel to vaccine and treatment development
4. Do nothing
2/ 1 and 4 are extremes. They both have serious flaws. On the one hand humanity has only eradicated very few diseases with very particular characteristics.

ncbi.nlm.nih.gov/books/NBK98114/
3/ On the other hand "do nothing" is not ethical, we must ethically strive to minimize damage caused by the pandemic.

What to do then?
4/ Option 2 (suppression) and 3 (age-focused mitigation) are somewhat represented by the John Snow memorandum and the Great Barrington Declaration.
5/ I believe both camps have in principle noble goals, and it is not constructive to label them as either libertarians or pharma lobbyists. I'm more comfortable on the GBD camp for various reasons.
6/ First, mitigation is not a radical or barbaric idea as some have put it. This is exactly the idea behind "flatten the curve" (remember?) and is what several documents on pandemic flu NPI mitigation describe (CDC, WHO), for instance see:

apps.who.int/iris/bitstream…
7/ Now, there are several debates about C19 vs. flu, and some more knowledgeable people than me can discuss that (@BallouxFrancois) but I think it is reasonable to compare this to a pandemic flu in many regards (we have other coronaviruses in circulation as common colds).
8/ Several things are not recommended in pandemic flu NPIs, under no circumstance, after reviewing 100 years of epidemiological evidence in the subject. Among these are quarantine to exposed (lockdowns anyone?), border closure and contact tracing.
9/ There are long discussions on lockdowns, masks, contact tracing and their evidence and impact. For instance on contact tracing, some exceptions are mentioned such as "early stages" and "isolated communities".
10/ Those are from the WHO guidelines in 2019, but perhaps we felt that in 2020 we could do a leap using technology, maybe this was like Sars-1 or MERS, and after all Taiwan, NZ etc. managed to contain.
11/ I think it is fair to say that that window of opportunity is gone already in many countries (practically continents) and although suppression was somewhat achieved here and there, we had in practice a lot of "mitigation" experiences.
12/ Still many in the global debate (see JS) believe we should continue to attempt suppression. The word "lockdown" is kind of avoided now that is not so popular, but this is what an "accordion" of suppression looks in IC's R9.

imperial.ac.uk/media/imperial…
13/ Can we afford indefinite suppression, with periodical LDs and constant alert? What are the costs of that in terms of overall health and wellbeing? Even if we want to now try TTI again to avoid LDs that is tricky due to infectivity and relative mildness, so closures may come.
14/ To me the spirit of GBD is: let's us focus and resources in the most vulnerable population, in order to minimize overall harm (deaths, mental health, economy).
15/ There is no global recipe for this. Each country has to find its own concretization, incentivize vulnerable to shield, while others can carry on as normal as possible. This implies probably a lot of educational campaigns on what true risks are, and what HI truly is.
16/ Perhaps some isolated areas that have managed to contain can continue to do so, if they think is a good idea (tricky on a globalized world where tourism is important mostly everywhere).
17/ In the meantime, if you want to better understand what herd immunity is and what is not, this might help!

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More from @maestro_rayo

17 Oct
1/ Quisiera ampliar un poco este comentario, que tuvo un efecto inesperado, aunque también generó un debate interesante.

2/ Primero que todo, el tono del mensaje no fue precisamente el deseado, más que proclamar una verdad absoluta o sabotear algún esfuerzo, mi intención era dar un mini-resumen de algo que pienso en un contexto más grande.
3/ Y aclaro que aquí no quiero posar de "experto", es un análisis personal, como ciudadano interesado en el debate sobre el manejo de esta crisis. Esta crisis es transversal a toda la sociedad y más que un debate estrictamente científico, es un debate social y ético.
Read 27 tweets
16 Oct
1/ I remembered a joke that has many versions (the one I knew was about mathematicians, but similar). I think it applies well to many of the debates we are having in 2020:

"A group of wealthy investors wanted to be able to predict the outcome of a horse race...
2/ So they hired a group of biologists, a group of statisticians, and a group of physicists. Each group was given a year to research the issue. After 1 year, the groups all reported to the investors. The biologists said that they could genetically engineer an unbeatable racehorse
3/ ...but it would take 200 years and $100 billion. The statisticians reported next. They said that they could predict the outcome of any race, at a cost of $100 million per race, and they would only be right 10% of the time.
Read 5 tweets
2 Oct
1/ Age-targeted mitigations vs general mitigations. Who should isolate? On a paper by @WesPegden and @ChikinaLab.
2/ We’ve come a long way in our C19 journey, we have learned so much. We recently just learned how this pandemic affected people differently by age...we are all wiser now. If only we knew…
3/ Well, not exactly. Relatively good IFR estimates by age groups were available since March (Verity et al.) and were shouting something: the difference in IFR between ages 10 and 80 was 1000x.

Read 16 tweets
29 Sep
In case you are wondering, the real Maestro Rayo was one of Colombia's most famous artists:

en.wikipedia.org/wiki/Omar_Rayo

I'm unrelated to him.
My name here makes tribute to the great satire song by @Ariasvilla and @karltroller where Rayo gets sick at a cocktail/exhibition party at an 80s disco.

soundcloud.com/ariasytroller/…
I have no clue if this actually happened but the song is a great summary of (upper class/snob) society in Bogotá in the 80s. I think it hasn't changed that much.
Read 4 tweets
27 Sep
1/ La estrategia Sueca se puede resumir así: proteger a los vulnerables, dejar que los menos vulnerables socialicen dejando colegios, restaurantes y bares abiertos.

2/ Esto tiene sentido porque desde Marzo sabemos que la tasa de fatalidad (IFR) es entre 2 a 3 ordenes de magnitud inferior para grupos menores a 60 años (los menos vulnerables).

3/ Suecia necesitó 600 UCIs en el pico y ha convergido a una fatalidad general de 600/millón, que es un orden de magnitud inferior a lo que había sido predicho por modelos tempranos (y pobremente calibrados).

Read 13 tweets

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