A national strategy for the “new normal” of life with Covid | Hacker News Reader

A national strategy for the “new normal” of life with Covid

jamanetwork.com

21 pointsnradov69 comments

To cope with pandemic, and eventually, endemic SARS-CoV-2 and to respond to future public health threats requires deploying real-time information systems, a public health implementation workforce, flexible health systems, trust in government and public health institutions, and belief in the value of collective action for public good.

I agree with all that. Now - can we have paid sick leave and workers rights, so that someone who is COVID-positive can stay home and cure their infection instead of having themselves drag back to work after five days?

The paper suggests data infrastructure. How about quarantine infrastructure? How about lower housing prices and better salaries so that only one parent has to work and schools don't have to be in session at a time of high COVID incidence?

We can't even have access to proper testing - everyone remembers Jen Psaki pulling a smirk when a reporter asked why the government can't send tests to every citizen. Now we are promised a website where you can order two tests per adult. And real soon you can even get reimbursed for tests that you bought yourself, if you could get any.

Sorry, trust in government is lost. Maybe it can be rebuilt, but it'll take two generations, by which time everyone who is susceptible to COVID has died of it and humanity has evolved to coexist with the virus.

We are screwed.

what about someone whose kids are sick with covid? make sure that is included.

I mean my government got out a novel vaccine in a year and distributed 3 to four doses to those who have wanted it. I'm impressed. Ask any other entity in the world to accomplish that...

The US, UK and Germany all did this,I believe? With Cuba not far behind (theirs was approved July 2019).

They are all impressive entities and I have high levels of trust for all of them in comparison to all the other institutions of the world and my own lone abilities.

I don't know how a strategy that involves "change the majority of people's minds about government" and "change the heavily entrenched 11 trillion dollar health care industry" is a realistic one.

One of the more bizarre aspects of this whole ordeal, to me at least, is that at this point in the pandemic the government in the US is still only talking about vaccines, masking, and social distancing. Why? Are there not therapeutics out there (there are) that limit severity and reduce duration? Half of my friends have gone from a feeling of relief once they got their booster to a feeling of abject terror when they realized you can still get Omicron despite being boosted. Trying to pretend that we're going to vaccinate our way out of this is nuts, it's just whak-a-mole. Why are treatments for once you get it - and we're all going to get it - not a thing?

I don't really want a national strategy written by "the experts" for life with Covid. Everyone remember when all of the restrictions that we endured because of 9/11 were "temporary" while we addressed the "emergency" of Islamic terrorism? 20 years later and I still have to take my shoes off at the airport, and get occasionally gently caressed by a low level federal employee to get on an airplane.

With that in mind ...

>How about quarantine infrastructure?

Yeah no thanks, man.

You need to take therapeutics early enough to make any difference, ideally as soon as you test positive. By the time you reach inflammatory stage and are admitted to hospital it's too late. But the way we are doing right now, the testing infrastructure is completely overwhelmed. Tried buying a kit recently? Around here they are all sold out!

We need quarantine. Here's what I don't get: when AIDS came, everyone got used to condoms very quickly, and all the gay sex clubs closed down. Why can't we change our attitude today as the homosexuals did back then?

I mean, I suppose I agree with you that the government and our elites' management of it and the pandemic has been gawd awful, and particularly awful over the last ~6-9 months. What I don't understand about your point is that you're on the one hand saying "they can't even mass produce tests via the Defense Production Act and put them in the mail" and then on the other saying "government managed quarantine is a good idea".

Perhaps because contracting HIV meant near-certain death after a long drawn out decline, and Omicron looks to be less deadly than the flu for a vaccinated elderly person?

Magic Johnson is still in good health after > 20 years, due to very effective antivirals. Nowadays HIV is a chronic condition, manageable with medication, not a death sentence, but people haven't gone back to fucking like rabid badgers.

>due to very effective antivirals

Magic Johnson is still in good health because he was unimaginably rich when he got it. Others who got HIV at the time he did died of AIDS.

I'm not sure what your point is.

What I'm saying is that today life expectancy of a 21 year old who is HIV-positive is only 9 years less than of a seronegative individual. If you are diagnosed now as a young person you can expect 30 or 40 years of decent health, it's a very manageable condition, but people haven't gone back to full-on crazy. Outcomes like Magic Johnson are the rule nowadays.

Which just proves the point that HIV and AIDS are in no way comparable to COVID.

I'm still lost.

That’s today. The prognosis when the behavior change you’re referring to happened was much different.

When AIDS first came some politicians and public health zealots seriously proposed forcibly quarantining HIV carriers. That was actually a fairly mainstream position back in the 1980s, not something from the lunatic fringe. Fortunately we came to our collective senses and never imposed quarantines on any major scale.

https://www.nejm.org/doi/full/10.1056/nejmp1413425

The AIDS fatality rate at the time was virtually 100% (effective anti-viral medications weren't available yet). By contrast the CDC estimated the COVID-19 fatality rate at 0.6% since the start of the pandemic, and rapidly falling now due to vaccines and other improved treatments. A difference in fatality rate of over 2 orders of magnitude between the two diseases surely calls for dramatically different policy responses.

https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/burd...

One valuable lesson we did learn from the AIDS pandemic is that shaming people for making unhealthy choices is not an effective public health measure. It's better to focus on education and harm reduction.

> Trying to pretend that we're going to vaccinate our way out of this is nuts, it's just whak-a-mole.

I had to explain this recently, people still believe "Vaccine is freedom" and "Vaccine is the solution", because "people are less likely to end up in hospital". Maybe that's true, but hospitals are still full, new cases are still as high as ever, vaccine effect is getting weaker in short time and variants are coming up.

We need something else. More early treatment, limit mass spreader events.

> Are there not therapeutics out there (there are) that limit severity and reduce duration?

Yes, but they are super expensive and limited right now.

> Trying to pretend that we're going to vaccinate our way out of this is nuts, it's just whak-a-mole. Why are treatments for once you get it - and we're all going to get it - not a thing?

Trying to pretend that we have the resources to treat this once someone gets a severe case (both in terms of medicine and hospitals beds) is nuts.

If COVID is going to become endemic (and it looks like it will), then Omicron is actually a good representation of what that looks like: not as horrible as previous strains, but a lot more contagious and less vulnerable to vaccines...just like the flu that goes around every year now. But until we can establish that this is just another flu, we should be careful and do what we can (get vaccinated, boosted, wear masks, cancel that mosh pit session). And once it is just determined to be like the flu, does this mean flu season will be twice as sucky as one can get hit by the flu and then COVID every year? Ugh, even that end would not be ideal, better get vaccinated yearly for both COVID and the flu now, and health insurance premiums are definitely going up (more than they are currently going up, anyways).

>Yes, but they are super expensive and limited right now.

Okay. Make them not super expensive and limited. It's not like the Fed is going to stop printing money any time soon.

>Trying to pretend that we have the resources to treat this once someone gets a severe case (both in terms of medicine and hospitals beds) is nuts.

Why? Both of those things (medicine and hospitals) are limited by money and physical infrastructure right now. We're 2 years into this pandemic, and I think it's time for a dose of reality that should covid become endemic we'll need more of those. It's like we just said "get vaxxed and the pandemic ends" over and over and enough people actually believed that and in the meantime we did nothing to solve production issues or build more hospital beds.

They are hard to make, so currently the "expensive" part simply corresponds to the amount of effort and material needed to make them, see https://www.knoxnews.com/story/news/2021/10/04/monoclonal-an...

> Both of those things (medicine and hospitals) are limited by money and physical infrastructure right now.

We are spending stupid amounts of money on healthcare right now. I wouldn't be surprised if a lot of our inflation problems build up from the amount of resources we are redirecting into healthcare.

> It's like we just said "get vaxxed and the pandemic ends" over and over and enough people actually believed that and in the meantime we did nothing to solve production issues or build more hospital beds.

We underestimated how many people would not want to get vaxxed, and how many don't want to wear face masks, how many idiot governors don't want to take responsibility for their states. But ya, if this gets endemic, we will live on, but we will also pay the price for that.

> we will also pay the price for that.

You won't, you'll be vaccinated and wearing a mask.

It doesn’t matter, the costs are socially distributed even if just through insurance premiums.

Vaccines and masks don't prevent all the other health ailments that might require medical attention (and someone can still get a breakthrough case, even though it is less likely, and in that case less likely to need intervention).

We all pay the price when treatment is delayed or denied because the hospital is overflowing with COVID patients. Or because all our medical staff have quit because society feels they should bear unlimited amounts of trauma.

> >How about quarantine infrastructure?

> Yeah no thanks, man.

It’s going to be fascinating to see how New Zealand fares with Omicron and future variants. Quarantine has served us well (it was setup in hotels).

100% agree, but while it need not be said that New Zealand is not the United States ... New Zealand is not the United States.

> One of the more bizarre aspects of this whole ordeal, to me at least, is that at this point in the pandemic the government in the US is still only talking about vaccines, masking, and social distancing.

This is simply false.

> Why? Are there not therapeutics out there (there are) that limit severity and reduce duration?

Yes (those there's evidence that existing monoclonal antibody treatments are ineffective, or at least significantly less effective, against Omicron), and the government has been talking about them regularly, and pretty much nonstop recently, even (for the newest ones) before they were submitted for approval.

https://www.whitehouse.gov/briefing-room/statements-releases...

https://www.whitehouse.gov/briefing-room/press-briefings/202...

“In delineating a national strategy, humility is essential. The precise duration of immunity to SARS-CoV-2 from vaccination or prior infection is unknown. Also unknown is whether SARS-CoV-2 will become a seasonal infection; whether antiviral therapies will prevent long COVID; or whether even more transmissible, immune-evading, or virulent variants will arise after Omicron.

Another part of this humility is recognizing that predictions are necessary but educated guesses, not mathematical certainty. The virus, host response, and data will evolve. Biomedical and public health tools will expand, along with better understanding of their limitations. The incidence of SARS-CoV-2, vaccination rates, hospital capacity, tolerance for risk, and willingness to implement different interventions will vary geographically, and national recommendations will need to be adapted locally.”

I was ready to reject any policy recommendation from the AMA as biased and self-serving. Their track record over decades has not been flawless.

This is the most succinct, coherent and downright wise guidance for managing COVID in 2021 I’ve read.

And a call for humility by the medical community? That’s downright unprecedented. Of historic import, like acknowledging that the new-fangled “germ theory” might have some merit after all.

Science-informed, not “science”-determined.

No new humility developed for the vaccine strategy: https://jamanetwork.com/journals/jama/fullarticle/2787946

Mandate full steam ahead.

A 5-year plan for a (hopefully happy) new normal:

- Reduce unnecessary social contact to a minimum: all-remote workplaces, ubiquitous and fast grocery delivery, a culutre of avoiding "window-shopping" and mall-going.

- Significantly reduce residential density: reduce the need for work commutes, dismantle crowded public transit, minimize public spaces and the need for them, preferentially live at a distance from the urban core, incorporate more single-family homes into natural wilderness and parklands.

- Reverse the "unbundling" of family and home activities: prefer to home-school children instead of packing them off to overcrowded schools, or at least share private instructors with a few other parents in your "pod," eat out less and cook at home more (or hire an in-home cook, as many of my peers did).

Disease needs density and crowding. Get more fresh air and put more space between people, and we'll all get healthier and happier.

Before someone comments that not all of these measures are affordable or accessible to everyone: you're right! But don't let perfect be the enemy of good! Lots and lots of people, many people on HN among them, can pursue many of these changes in their lives. And improving the lives of an entire class of people is surely a better outcome than inaction and defeatism, no?

The operative word is “can”…people should be informed of risks and then they can/may choose to restrict contacts and the like. Not must, but can respond in helpful ways.

Many people will be personally motivated to “do the right, and feasible, thing” and feel good in the process. If it turns out to be overkill, they won’t be resentful, just bemused.

Any external social incentives should be taken with great care. A heavy-handed or meat-ax approach, especially in situations of significant uncertainty, will cause more long-term harm than good.

Translation: don’t be an overbearing buffoon if you aren’t very certain about the consequences of what you are doing or requiring of others. You can be a buffoon (there is still a lot of “fog of war” on this and inaction is an action itself), just not an overbearing one. Defer to individual choice, it really is the Americasian way. (Want a descriptor for all the Americas, North and South, so trying Americasian. Too clunky?)

The first two items sound like a dystopian nightmare. That's just... continuing the suffering we've been experiencing for the last two years.

So you want to roll back the clock to lifestyles typical in 1889, a simpler time when it seems another coronavirus pandemic probably swept unchecked throughout the world and killed a lot of people.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7252012/

Most of us enjoy our "unnecessary" social contacts. If reducing those is the price then no thanks, I'd rather have the disease.

But feel free to go hide in the woods with your family if that's the life you prefer. Just watch out for the COVID infected animals.

https://www.nbcnews.com/science/science-news/covid-rampant-d...

Upvoting because I think this strategy would be effective, and people should see what an effective strategy looks like, but I find the long-term social consequences very worrying, and don't think it's worth it. What you're proposing feels like a Black Mirror episode.

That is rather a 2-week plan, most people can't take it in isolation for much longer. I agree some mass events/mass transport should be rationalized, either greatly decrease density of people and maintain distances, or cancel them.

sigh, here we go again with extra loss to civil liberty

Yup, abandoning "zero covid" is abandoning the one thing the government should do - protect us from external threats to our life.

If some country were threatening to invade, the government would use every means at its disposal - including temporarily suppressing the civil liberties of certain people by drafting them into the military - to protect us. When a couple thousand people died twenty years ago, the US jumped headfirst into a twenty-year war against a country loosely linked to the people behind it and an uninvolved neighboring country that we didn't like, too, just in case.

But now that we have a hundred-fold more deaths in this country and no signs of it stopping, just because we can't see the enemy, we're surrendering? It's nonsense.

And besides the actual cost, it's going to make a lot of people feel like the only government that can fulfill the legitimate limited role of government competently is a giant authoritarian one. A whole lot of people are saying things like "I wish the government would tell me what to do to keep safe. I find it exhausting to figure this out for myself." They aren't going to be particularly open to pro-civil-liberties arguments after this experience.

Given that the current vaccines don't prevent transmission, and there are multiple animal hosts, how exactly could "zero covid" be accomplished?

https://www.nbcnews.com/science/science-news/covid-rampant-d...

Testing and quarantine, as well as work-from-home where possible and proper ventilation/masking where not possible. Why on Earth do we have schools open at a time when Omikron is rampant?

Those measures might slow down transmission slightly. But they wouldn't be anywhere near sufficient to achieve "zero covid". In the end we'll all eventually get exposed. Fortunately the vaccines and other therapies are fairly effective at preventing deaths.

https://www.medpagetoday.com/opinion/vinay-prasad/94646

https://youtu.be/GklHGYY8vN8

The only major country still even attempting a "zero covid" strategy is China, and they're failing. In open societies the measures that China is taking aren't even practically or legally feasible.

https://www.cnn.com/2022/01/03/china/xian-covid-outbreak-loc...

South Korea seems to be doing well, and they qualify as open and democratic. Current incidence 8 cases per 100000 people (US: 200 cases per 100000), tendency falling. It's unclear why people are talking defeatism. The current state of affairs in the US is a political choice, one that is unacceptable.

(And why do you quote Vinay Prasad on COVID? He is an oncologist by trade, and some of his pronounciations are frankly loopy.)

Cases in South Korea have risen and fallen many times. They have never reached "zero covid", and their current measures obviously can't be sustained forever.

South Korea also has highly secure international borders. That situation will never exist in the USA.

Everything Dr. Vinay Prasad stated in the linked article seems scientifically accurate. Do you have a substantiative criticism, or are you going to stick with ad hominem attacks?

Incidence in South Korea has been consistently two orders of magnitude less than in the US, due to adequate containment methods. I haven't read about unrest or concerns about exonomic output because of the COVID measures in Korea. Have you?

No idea where the notion comes from that the dismal state of affairs in the US is due to porous borders - there's enough community transmission going on so we won't have to worry about imports through air travel or illegal immigration. Once local transmission is squashed we can worry about quarantining international travelers or corralling migrants.

Come on, Prasad invoking the Nazis over mask mandates? That was out of order.

> Current incidence 8 cases per 100000 people (US: 200 cases per 100000)

This page says 100k active cases, they have 51m population, that’s the same 200 cases per 100k people: https://www.worldometers.info/coronavirus/country/south-kore...

> tendency falling

The graph below on that page only shows it’s only falling for the last few days.

BTW, South Korea population is ~6 times less than the US, yet they are making 33 times fewer COVID tests: https://ourworldindata.org/grapher/full-list-covid-19-tests-...

I laugh when I see people say “country X is doing well now”.

South Korea was having record infections months ago. You know, it comes in waves. No use comparing one country who is on the tail end of a wave with another country in the middle of a wave.

Just saying that "record infection" means something different in Korea than it does in the US: https://ourworldindata.org/explorers/coronavirus-data-explor...

Sure, but acting like South Korea “has it under control” is laughable. They were panicking months ago.

If they are panicking, how about us? The stories from r/nursing are frightening. Lots of people are going to quit nursing in the coming months over working conditions and burnout, and since immunity against coronavirus is not persistent, there's going to be a re-run next winter, but with less healthcare personnel.

Same with teaching. Working conditions are shit, salary is poor, and spending time in a classroom with current incidences is an invitation to catch the plague. Many won't be back, come next August. Some will be underground.

Cellular immunity is highly persistent. While reinfections can occur, symptoms are typically mild. Sure you can find isolated cases where symptoms were more severe the second time around but those are very rare.

I think some people get confused because they see lower antibody levels and assume that means loss of immunity, but that's not how the immune system works at all.

https://youtu.be/GklHGYY8vN8

And you can't seriously expect us to act based on random Reddit posts. We all know that site is heavily manipulated by a small group of moderators and it isn't a reliable source for anything more important than funny memes.

Don't look to social media for a good sample of how things are. It attracts extreme views like flies to dog poop.

It's pretty clear Covid is straining the health system everywhere. Yes, plenty will quit, maybe wages will rise, the system will recover.

But COVID isn't really an external threat. It is very much internal, it is now almost endemic virus, a very different problem from a foreign organization invading country. You can't fight it the same way a military fights a foreign enemy.

Iraq isn't a direct neighbour to Afghanistan. And invasion to Iraq didn't have anything to do with protecting Americans "just in case", it was a war crime that killed half a million people on false pretenses, probably pushed through just to benefit military contractors and few people egos.

I don't think governments are surrendering on COVID, but they're not putting in much heroic effort either. It's a moderate-to-weak crisis, and those get milked and not let go to waste.

Yes, some people are inclined to demand stronger even authoritarian government restrictions and action, in the hopes that will help to end this. That kind of cure may turn out to be worse than the disease. We should demand better healthcare instead.

Given that Omicron is swamping hospitals to the point that getting healthcare has become questionable, it's a bit premature to talk about any "new normal". Like sure we can look ahead and try to plan, but don't assume we're heading towards some steady state where things make sense again. For example, would this "new normal" include the expectation that you'll be promptly treated after a serious car accident, or not? Right now that's kind of indeterminate, depending on how bad the nursing burnout is.

This article is also talking like there is some overarching policy that is perhaps being overcautious and could be dialed back. But there is no coherent policy - rather there is the dumpster fire of laissez faire, and there are those who can avoid it. So we've got a bifurcated society with some people having the power (or making sacrifices) to insulate themselves. And those who cannot just end up in harm's way regardless of the absolute risk being low or high, possibly rationalizing their predicament. cf "What Keeps Mankind Alive".

Planning wise, if you're continuing to be cautious spring and summer will most likely be the time to go out and enjoy a year's worth of social activity in open air. That's about the extent of what you can rely upon right now.

Summary: It would be far too much trouble to actually do anything about Covid, so we are giving up (and pretending it is just the flu).

What would actually doing anything look like? Does rapid distribution of free vaccines not count as anything?

Universal vaccination, with mandates as necessary.

Distribution (and enforcement) of N95 masks.

Rebuilding schools with sufficient ventilation.

WFH as the default.

Hospitality moves outside.

Restrictions as necessary to keep R below one until suppression/elimination has been achieved.

I disagree in varying degrees with all of your points, but I'm going to pick on this one because it speaks to a certain elitism and bubble thinking that's been increasingly rampant on this topic.

>WFH as the default.

The percentage of the population that can actually do this is much smaller than I think people realize. That percentage is highly over-represented on this website because we're part of the Laptop Class, and privileged as such. Regular people in the vast majority of the country, working hourly wage jobs and the like, cannot do this. Manufacturing, what's left of it in this country, cannot do this (fanciful aspirations of an impending automation revolution aside for a moment, and hey someone has to manufacture and install the robots). This is to say nothing of the fact that most people who aren't wealthy do not have the space at home to facilitate actually working from there.

Many regular people work in offices, talking to a computer. Indeed it is offices that cause the most transmission risk, as they tend to be small and ill ventilated. Certainly WFH can be the default in those cases.

Of course, this detracts from the social performative aspect of work - bosses with the corner office and so forth.

> keep R below one until suppression/elimination has been achieved

This likely isn't possible. R0 would only low because of the restrictions, so as soon as you ease up on them, it starts spreading again. What you're proposing was the April 2020 fantasy that if we just flatten the curve, cases will be gone by September.

So you get it to zero, or to low enough to test trace isolate.

China is a good example of how this can work.

If Chinese-style totalitarianism is the means necessary for an elimination strategy, I'd much rather take my chances with the disease.

I do not understand why people think it is reasonable to expect that humanity can completely control diseases. That has never been the case. Disease is a fact of life. We get better and better at managing our responses, as we learn more, but we can only reduce, never eliminate the risk.

Disease was a fact of life -but since antibiotics and vaccines we live much more disease free than we did before. Covid is reversing this progress.

We do not have to become totalitarian to stamp out Covid, we just have to enforce the necessary policies for a limited and specific circumstance. I'd like to think our democratic institutions are capable of doing so in this instance, as they did so in previous times.

You realize this will not get us to zero Covid?

You’re basically trying to stamp out the common cold (same virus, Covid-19 being more severe) which has been with us..forever?

Not the same virus, but a similar virus.

As much as we would like to wish, Covid is not going to become the common cold anytime soon, or indeed ever. We should act according to what we see with Covid, and understand that any naïve attempts reduce it to other known pathogens can only lead us into tragedy.

> and pretending it is just the flu

With vaccines, it's pretty close to that.

What we learned from that past two years is that covid zero isn't possible. You'll never get enough people or countries to agree with the restrictions required, and as the article mentioned, there are animal reservoirs. Realistically, the amount of "trouble" looks like what China's doing right now.

New Zealand seems to be doing just fine.

New Zealand has abandoned zero Covid and has new cases reported every day.

Did they abandon Covid Zero? I thought it was a case of omicron giving false negatives on the tests they used allowing it to break through the border.

Animal reservoirs don't seem to be causing trouble in China - my understanding is that animal to humantransmission has been observed only in minks.

Vaccines have indeed been a great success - but we wait to see how much protection they give against long COVID, and how COVID might evolve to evade them. With wide circulation, there is a strong selection pressure for such evasion. Luckily Omicron was inherently milder than Delta, so the vaccines' protection against severe disease held up. Maybe we won't be so lucky the next time (and the next time, and the next time...)

Are you sure animal reservoirs aren't causing trouble in China? The leading hypothesis for SARS-CoV-2 origin is zoonotic transmission from bats. Assuming that's correct, the bats are still out there somewhere...

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