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Comment by triyambakam | Hacker News Reader

Contact tracing is not needed - identify the people at high risk and protect them from the virus. People at low risk should be expected to circulate the virus and develop immunity. Contract tracing among low risk defeats the purpose.

If we're ever going to get our lives back, and not be on indefinite timeline of "maybe there will be a highly effective vaccine" we actually need the virus to circulate among people who can safely get it, get over it, make antibodies which historically - before the advent of highly effective vaccines - is how pandemics ended.

Total isolation policies prevent broad population immunity. We know from decades of medical science that the population develops immunity while acquiring antibodies.

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> "identify the people at high risk and protect them from the virus. People at low risk should be expected to circulate the virus and develop immunity."

Well, sure. That is what has been happening anyway. But it's hard to keep the low risk people away from the high risk people all of the time. Or are you really not going to ever visit grandma again, potentially for years?

So, even if you're low risk, it helps to know if you've been exposed so you can isolate yourself and protect the high risk people.

I'm on day 11 of this shit. You really do not want this.

As someone in a low risk group (I’m 30 without co-morbidities), the risk of surviving but having an awful time is highly underrated. That’s part of why I stay at home now, I’d prefer to not experience that.

General pontifications aside, I’m sorry that you’re sick, and hope that you recover quickly and cleanly.

I'm on week 8 of this shit. If you're one of the 5% that are going to have it turn into a relapsing form like me you really do not want this.

I think I have it. Going on 4th week with mild symptoms (severely itchy hands/arms, constant headache, muscle fatigue recently) that don't match published ones. I was probably infected going to grocer 6 weeks ago and took 2 weeks to manifest. The itch/red spots move around like every 8 hours ( I don't scratch it). What happened to you? Did it get in your lungs? What does a relapse behave like? I'm just trying to figure out what might happen.

You should go and get tested.

If you have it then it is in your lungs (it's a respiratory disease)

They still wont test until you are near death. CDC and Kaiser tell me to stay home. Plague has at least 2 forms: one if its in your lung and another in the skin. I'm wonder if this might not be similar.

What country are you in? Surely most places have solved the testing bottlenecks by now?

You really should go to a doctor for the skin condition at least.

> Plague has at least 2 forms: one if its in your lung and another in the skin. I'm wonder if this might not be similar.

There's no evidence of that. There are some very occasional skin conditions associated with COVID but they don't don't sound much like this.

The more I learn about this disease, the less happy I am about the idea of getting it.

There's a lot we don't know and some worrying signs that it might not just be an brief, acute, occasionally severe, illness.

This absolutely does not work.

In Australia we tried to keep aged care homes isolated, and it was catastrophic - something like 25% of deaths were from a couple of cases that were undetected and made it into aged care homes.

In Sweden this was explicitly their plan and here's what happened:

“It’s very difficult to keep the disease away from there,” he said. “Even if we are doing our best, it’s obviously not enough.”

But he said: “We are not putting anybody’s lives above everybody else’s lives – that’s not the way we’re working.”

Tegnell said in late April that at least half of the country’s deaths had been in nursing homes.

“We really thought our elderly homes would be much better at keeping this disease outside of them then they have actually been,” he told Noah

https://www.businessinsider.com.au/coronavirus-sweden-lockdo...

As someone working with large health non profits on COVID tools, whose head is deep into the reporting and news around it, and who has 3 school age kids in NYC, I am of the opinion that there is no low risk population, no "safe to get it" group.

There are groups where symptomatic incidence is lower. Sure. But JFC some of those symptomatic cases are awful, with lifelong impact.

Someone used the Russian Roulette metaphor early on and it continues to resonate with me. We see over and over again surprising case histories all across the demographic, age, and health history map. Too many that are completely unexpected and for which there are presently no predictive metrics.

We are slowly learning more about what this virus can do, and we have a sense of what it will do when presented with a known vulnerable population. It is remorseless.

But even for "low risk" populations it is exactly like Russian Roulette. You and 9 others might be at the peak of known clinical health measurements and it may leave those others unscathed- that we know of- while it will destroy your lungs or your liver or cause you to have a stroke.

With all respect to the goal of broad population immunity, for my family- we stay carefully isolated and adopt all defensive protocols, we wait for a vaccine, and we advocate for govt entities to provide the liquidity to keep safely running the various life sustaining machines that our interdependent world depends on.

> we advocate for govt entities to provide the liquidity to keep safely running the various life sustaining machines that our interdependent world depends on.

There is a very real risk that won't work. If it worked, why would we only do it in emergencies? Government may as well provide funding for essential services all the time.

The government would simply be handing out money to the people working in essential services who are doing real (and quite risky, apparently) work while. You would be receiving the benefits without doing anything. That is almost the 'paid in exposure' meme that artists have to put up with.

The economic system is crafty, it will figure out that there is dead weight somewhere and start to optimise around it. This might be unprecedented so the failure modes are beyond me - but it won't be pretty if it goes on like that. Gluts would probably not be the end of the world but severe shortages are possible.

In Australia we had an official government inquiry into why the price of milk was so persistently low. No other problems. Just low milk prices. That is what happens when a free markets run the food delivery system. That won't happen if the government steps in and starts making decisions about what is fair and who needs which items.

Russian roulette has a much higher risk than a coronavirus infection.

If you're ignoring the rates then you might as well say that driving to work is like Russian roulette.

Do you have any figures (graphs ideal) for the lung damage (or other long term health effects) distributions?

It is beyond ironic for this comment to get downvoted.

This is a ridiculous comment, totally disconnected from reality. The risk of a seriously bad outcome from SARS-CoV-2 infection are far less than 1/6 (Russian Roulette) for most people. Hiding in our homes until a vaccine appears at some unknown point in the future is obviously not a viable strategy.

If we drive the economy into another Great Depression that will kill many people as well. Federal government liquidity injections are not a solution. At some point if people aren't out working to create value then society will disintegrate.

Appreciate your opinion, and agree the ratio isn't 1/6, but it's not de minimus and there is no safe population.

There is essential work, those jobs are wartime/highly hazardous jobs, and deserve all of the support and gear that actual war fighters get. That isn't happening.

Finally, Fed liquidity is a tool with far greater power than we are utilizing. To not exercise that power, and to not equip hazard roles- is simply barbaric.

Good luck and good health to you.

You say there is no safe population, but isn't the risk to healthy preteens less than 1 in a million?

No. In NYC, in the teen and pre-teen set, we have thousands of confirmed/symptomatic infections, hundreds of hospitalizations, dozens of deaths, and dozens of strange case histories. That's what's reported. I speculate based on anecdotal conversations with other parents there is much still unknown/unreported.

We don't have a model for how to understand exposure and immunity dynamics for this population. My personal sense/estimate is that between 10% and 20% of the child population has been sufficiently "exposed" to now be considered "safe" but I would not bet my children's lives on that measure. I am eagerly awaiting the day I can get my kids tested for antibodies, but even if they test positive I can't consider them or us to be "safe" until we know a whole lot more.

At any rate, given just the reported numbers, a conservative back of the envelope risk-of-significant-impact from "exposure" in the teen/pre-teen set is somewhere between 1 in 1,000 and 1 in 10,000.

Your statement is contradicted by this page here: https://www.worldometers.info/coronavirus/coronavirus-age-se...

Which says there been three coronavirus related teen+preteen deaths with no underlying conditions (all of which were teens IIRC) in NYC and another 6 with underlying conditions.

Do you have a more reliable source?

Also, 1 in 1000 is close to the estimated infection fatality rate for the general population (estimated between 0.1% and 0.5% normally) and kids are supposed to be a couple of orders of magnitude less at risk than the population average. So your numbers all seem utter nonesense to me.

I've never even heard of a preteen death of covid.

> Hiding in our homes until a vaccine appears at some unknown point in the future is obviously not a viable strategy.

Yes, this is the point I am trying to make. But most of the demographic here (who already work from home or easily transitioned to doing so) likely don't find it difficult and are mostly unaffected.

Nothing like attacking your audience when your crazed ramblings go over like a lead balloon.

How is outlining the demographic reality an attach? Do you feel attacked when someone points out your eye colour?

Iceland has done quite fine through this with contact tracing as one of the main tools in the toolbox. I think a blanket statement of "not needed" needs something more behind it.

We have better tools that don't involve invasion of privacy. How many people praised the Patriot Act after 9/11?

Iceland does not have the Patriot Act or anything like it, so I'm not sure how that's relevant here.

Contact tracing is a world wide privacy issue, and especially in the US. I'm talking more generally here, especially that the overwhelming sentiment here on HN towards contact tracing is indifference or praise. We should not be praising further encroachments on our privacy, especially when contract tracing is hardly an effective way to mitigate the disease

I respectfully disagree that "we should" do what you would prefer to happen. Contact tracing is not a privacy issue here.

> identify the people at high risk and protect them from the virus

Nice idea on theory but in practice it's shown to be very difficult to do.

That depends on the disease. Is there any proof that people develop immunity to covid 19 after getting it?

We don't have evidence due to disease being so new, but there's enough reason to suspect we'll develop at least short term neutralizing immunity.

But yes, caution is necessary. We don't have enough evidence to push forward a national strategy that's based on people developing immunity without a vaccine.

Here's WHO's statement on this matter:

https://www.who.int/news-room/commentaries/detail/immunity-p...

"Herd immunity" without a vaccine, as a strategy, is equivalent with doing nothing and let the virus wreak havoc on the population.

What's worrisome is that some people are testing positive again, after being diagnosed as positive. Crew on the CVN-71 Roosevelt have tested positive, been quarantined for 14 days, then tested negative twice (two days apart), but then still testing positive a few days later.[1]

The possible scenarios for this I can come up with are:

1. No immunity after initial infection

2. Bad test methodology (contamination etc)

3. Bad tests. The article doesn't mention the test type, so perhaps they were initially misdiagnosed (false positive), then infected upon return to the ship. The implication from this would be that the virus is still prevalent in the crew on board the Roosevelt...

In South Korea, they discovered that all of the many potential reinfections they had detected were due to faulty (overly sensitive) tests. There are no confirmed cases of reinfection and many thousands of people on 'front line' jobs who have recovered form the disease, returned to work and never been reinfected. In a study done on monkeys, scientists were unable to achieve reinfection.

Here is a recent article with some useful links discussing immunity: https://www.sltrib.com/news/2020/05/13/coronavirus-immunity/

Risk vs reward. If there is immunity, then developing herd immunity sooner rather than later is important (even more so if there's immunity but it's only short-term). If there's no immunity, we're, excuse the expression, fucked anyhow.

Can vaccines even be developed if there's no natural immunity?

If there is short term immunity yes (diphteria, tetanos is an example, polio too).

Being exposed to the same antigen while you have an immunity should reactivate this immunity, that's a reason why a "herd immunity" tactic could work, at least for a time

However if the natural immunity w/o reactivation only last a year or less, you will end up with a new outbreak at the end of the period. And if the immunity period is shorter than the recuperation one, you will have a virus that will be a lot more lethal.

> Total isolation policies prevent broad population immunity. We know from decades of medical science that the population develops immunity while acquiring antibodies.

Look at the bigger picture. In today's immensely innovative world there will almost certainly be a vaccine or anti-viral or some effective treatment within a year or two.

The goal for those of us who are lucky enough (in normal times it can be a curse) to live on an island is not to hide out forever - it's to hide out until that treatment is available.

You're sincerely willing to wait an entire year for a vaccine that may not work when we already have effective treatments? That's insane

> when we already have effective treatments

Please don't spread misinformation.

How clever. Yes, we have high confidence that hydroxychloroquine, azithromycin and zinc are very helpful at treating it. We should let the virus circulate among low risk population, isolate/protect the vulnerable, and focus on treatments that we know have been effective in the past or are showing good results now. This perpetual waiting is insane.

> we have high confidence that hydroxychloroquine, azithromycin and zinc are very helpful at treating it

We most certainly do not (https://blogs.sciencemag.org/pipeline/archives/2020/05/04/hy...). No effective treatments are currently known. There's hope that monoclonal antibodies will work, but they come with their own list of caveats (https://blogs.sciencemag.org/pipeline/archives/2020/05/14/mo...).

Again, please don't make things up. Stop spreading misinformation! It's already incredibly difficult for laypeople to make sense of the chaotic, frequently changing, and often conflicting reports at this point.

I'm not making things up as much as you'd like to sound cute and demeaning. Here are just a few easy to find sources:

https://www.ncbi.nlm.nih.gov/pubmed/32205204

https://www.ncbi.nlm.nih.gov/pubmed/32171740

https://www.ncbi.nlm.nih.gov/pubmed/32373993

> as much as you'd like to sound cute and demeaning

My intention wasn't to demean but rather to provide a clear and understandable message for other readers who might lack the scientific background to critically evaluate your claims. I was also hoping that you'd take the hint that perhaps you lack the requisite background knowledge to commentate usefully on the topic.

The first two links are the ones with unexplainable results (to put it charitably) by the now infamous Dr. Raoult. The third one is a review which identifies previous successes in vitro and argues for further clinical trials to take place. In vitro studies are useful for identifying drug candidates to test but say absolutely nothing about whether something will work in practice.

Meanwhile, the link I provided in my previous comment neatly summarizes the current clinical data on the topic. In a nutshell, hydroxychloroquine does not appear to be particularly useful for treating hospitalized patients. It might or might not have some mild beneficial effects and it definitely has serious safety concerns; the arrival of additional clinical trial data in the near future should hopefully give us a more complete picture.

I stress again that there are currently no known effective treatments.

> In a nutshell, hydroxychloroquine does not appear to be particularly useful for treating hospitalized patients.

The early reports suggested it was only useful in combination with zinc supplements, which seems to have been largely forgotten or ignored, from what I've picked up on in comments and links across multiple sites over the past month or two.

Two of those are the discredited French study and the other is a metastudy that includes those findings along with lab results (ie, not actually showing it works in people).

... have I somehow fallen back in time into early April? Ridiculous chloroquine optimism is pretty passé these days.

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