[conspire] Imperial College London COVID-19 COVID-19 Response Team report

[Rick Moen]

As Nick has suggested, _until_ two days ago, Boris Johnson's
Conservative Party government had a lackadaisical attitude to the
SARS-CoV-2 problem.  Official policy was to pretty much glide the UK
through the situation and let those who were going to get infected, get
infected, thus building up 'herd immunity' after a big lump of almost
everyone getting ill to various degrees.  

On Monday, that strategy came to a sudden screeching halt, because of a
report out of Imperial College London -- the same place whose advisory
group had crafted BoJo's 'herd immunity' laissez-faire policy:  The new report
(https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf) 
vividly traced, using data modeling drawn from Wuhan, what will result
from the virus's exponential trajectory in the UK and in the USA, under
several different scenarios:



Option 1.  'Don't Worry and Carry On' Strategy.  Treat SARS-CoV-2 the way we
treat the seasonal flu virus, go on about normal business, and let the
virus take its course (official UK policy until Monday).

In this scenario:
o  80% of Americans would get the disease (over the next 3-6 months).
o  0.9% of these would die directly from the virus.
o  Another group would need ventilators, but demand for ventilators
   would exceed supply by a factor of _30_.  So, nearly 100% of patients
   with severe COVID-19 would die by suffocation (Acute Respiratory 
   Distress Syndrome), in addition to those dying directly of the virus.
   So, put the total American deaths at about 4 million (out of 300
   million US population).
o  Deaths would include somewhere between 4 and 8% of all Americans over
   age 70.
o  Out of the small minority of hospitalised COVID-19 patients needing 
   ventilators and lucky enough to get them, 50% would die anyway.


In case 4 million is too big a number to get your head around, this is
the population of Los Angeles.  It's four times as many Americans as
died in the 1861-1865 Civil War, which is the bloodiest war we've had.



Option 2.  Mitigation Strategy.  All symptomatic COVID-19 cases get put
immediately into isolation.  Families of such patients get quarantined.
All Americans over age 70 practice social distancing.  This is the 
halfway-measure that parts of the USA, not counting outliers like the SF
Bay Area, have been shambling towards, badly and with a poor sense of 
urgency, partly because of the utter failure of the utterly useless
Toddler-in-Chief's administration to show leadership, and partly because
of widespread human cussedness and obliviousness and inability to
properly understand the concept of exponential growth and epidemics.
https://www.youtube.com/watch?v=fgBla7RepXU

This, to further identify it, is the _standard_ form in the USA of the 
'flatten the curve' initiative.

In this scenario:
o  Death rate gets cut in half, so that only 1.1 to 1.2 million Americans
   would be killed outright by the virus in the next 3-6 months.
o  Peak demand for ventilators drops by 2/3, but still exceeds the
   number of available units by a factor of 8.
o  Therefore, total death toll in 6 months gets cut to 'only' 2 million.
   Two US Civil War's worth of excess death within the next six months.

That is the middle-of-the-road option, the one that the US Senate is
dragging its feet on helping with.



Option 3.  Suppression Strategy.  Isolate symptomatic cases and quarantine
patients' family members, but also require social distancing for the
entire population, forbid/shutdown all public gatherings, schools, and
universities, and shut down most workplaces.  This is of course what the
Bay Area has been doing since Monday's shelter-in-place order -- but
nobody else in the USA is doing.

In this scenario:
o   Death rate gets truncated to a few thousand only, peaking a few 
    weeks from now, then declining to near-zero.  Ventilator capacity
    never gets exceeded.  All avoidable nightmare deaths from
    suffocation get averted.

Aside from the entitled-idiots-will-complain problem, there is a catch:
It would probably be necessary to iterate this sort of lockdown with 
few respites, for the entire country, until we have an effective vaccine
-- because otherwise after about a month of no more shelter-in-place, 
there is high likelihood of exponentially exploding epidemic _again_.




Option 4.  Are you kidding?  There is no option 4.  


Vaccines:  Lots of groups are working on one, and 45 volunteers in
Seattle were injected with an experimental hoped-for vaccine solution,
(by Kaiser Permanente Washington Health Research Institute) earlier this
week.
https://www.cnn.com/2020/03/17/health/coronavirus-trial-vaccine-neal-browning-trnd/index.html

Unfortunately, even if it's successful and its creator is going to be
the next Jonas Salk, we _cannot know that_ until test subjects have been
monitored for about 14 months to know that the vaccine is safe and
effective.  This simply cannot be rushed.  Therefore, given production
ramp-up after testing, a commercial vaccine is at _minimum_ 18 months
out if we're lucky, more if we're not.




And that's the new world we're in.  The UK appears to have responded to
the Imperial College report by doing a burned-rubber (belated) switch
from Option 1 to Option 3.  The USA remains in a muddle, with the Bay
Area fully engaged with Option 3, and most of the rest of the country
wandering around drooling and shouting at clouds, instead, while waiting
for epidemic doubling to cause megadeaths.