Stop almost everything, restart when the coronavirus is gone


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Nobody likes to talk about the final of COVID-19, but we need to choose one. Appropriate measures — public health, government spending, and freedom of movement — all depend on which game we choose.


The differences between endgames are tens of thousands of avoidable deaths, hundreds of thousands of avoidable hospital admissions, and the profound and systemic consequences for Australia's economy and society.

Many discussions underestimate the likely political reactions when the number of deaths increases.

They also underestimate the economic and social consequences of an open epidemic, which will have huge real consequences for small and medium-sized businesses, as well as for many non-profit organizations in every sector of the economy and society. We will not face social consequences if many are closed and credit markets collapse.

We see three possible finals.

None are attractive, but one is better than the others.

Endgame A: “smooth the curve”

Endgame A is plan “Smooth the curve” – restriction of movements in order to reduce the peak in cases, while accepting that infections will continue to grow until the epidemic passes. There will be many deaths.

Imperial College demonstrated that even if Britain smooths the curve, the peak months will still reduce the possibility of intensive care in hospitals (in particular, mechanical ventilation devices) by eight times instead of 30, possibly halving the final number of deaths.

Australia may also run out of intensive care when there is about 45000 infections are a small part of the population.

In reality, political economy is likely to impede the further growth of infections. Public pressure to “close everything” will become overwhelming as infections grow and hospitals struggle. But by then, with the exponential increase in the number of infections from a larger base, the containment problem would be much more serious.

one day infection because interest rates are cut off, there is a risk that public pressure will reopen too soon, leading to an increase in the number of infections until the mortality rate becomes unacceptable again, as economist Tyler Cowen called.yoyo epidemic".

Regardless of whether this happens or not, smoothing the curve will require us to suppress economic and social activity for at least 12 months and possibly much longer. The economic and social costs will be huge.

No matter how much money the government spends on the economy, most enterprises cannot survive in the absence of normal activities for more than a few months.

It is not just tourism and hospitality. Small and large companies in various sectors – from domestic services to production and construction – are developing and implementing plans to lay off hundreds of thousands of people.

Unemployment will probably increase as a result of a sharp drop in housing prices, which creates big problems for banks.

The Endgame A option is to isolate everyone over 60 years of age (the age group most at risk), infect as many young people as possible, and then hope that this disease fades.

This is not entirely believable. In many places, foci of infection will persist, and they will quickly turn into local outbreaks, especially in nursing homes. It would be very difficult to keep everyone over 60 years old separate from people who provide them with food and services (which may become infected) for several months.

And, of course, there will be a fatal outcome among people under the age of 60.

Endgame B: Track and Track

Endgame B – track and track every infection that governments are trying to do.

But, as NSW has now discovered, when thousands of potentially infected people leave the aircraft every day and practically do not use voluntary isolation, it is easy to detect untracked infection, and then subsequent tracking is almost impossible to turn off. The number of new infections suppresses the tracking system too easily, and then we are back in endgame A.

Endgame B is only possible if you start with a very small number of infections and have closed borders. Tasmania is now in this world, while other Australian states are not.

Endgame C: “Stop, then Restart”

Endgame C should stop, then restart. This means minimizing activity and interaction, as well as closing the borders for passenger traffic, including citizens (although not for trade), until the infection rate drops to zero.

Only basic services will be supported (in particular, food supply chains and utilities such as electricity, water and the Internet).

It makes no sense to try to determine which strategies work best; instead, it would be necessary to introduce as much as possible immediately, including the closure of schools, universities, colleges, public transport and retail trade of non-essential goods, and to limit as much as possible people in their homes.

The police must visually enforce the ban, and all confirmed cases must be placed in government-controlled institutions. It may seem unimaginable, but it is exactly what has already happened in China, South Korea and Italy.

Once the number of infections reaches zero and stays there for two weeks or so, in order to avoid asymptomatic cases, economic and social activity can resume sequentially, although international borders will have to remain closed for passenger traffic until a vaccine arrives.

We track people better.

Governments will also need to implement widespread testing and tracking to identify and eliminate any repetitions (which will give them time to tweak and improve).

It will be much easier if we do not deal with the constant flow of new infections from Passenger Transportation,

Some epidemiologists, for example, from Imperial College, reject this approach, saying that the resumption of major outbreaks is "inevitable." But this is only based on history and past tracking and tracing measures. Todays has no precedent,

We do not yet have China's ability to track and track. But in the event of an emergency in the country, creating systems to track people and their contacts using mobile data can cost both money and invasion of privacy.

While some people would like to implement this strategy without closing passenger borders tightly and for a long time, this is implausible.

Even today, almost half of new cases in Australia are getting off planes, and each of them increases the risk of recurrence. Simple voluntary isolation is not at all safe.

An alternative would be to allow Australian citizens to enter, provided that they end up in forced quarantine at the station, for which it would be possible to redesign hotels at airports.

China, South Korea and Tasmania do it

In fact, Endgame C seems to be the strategy of China and South Korea, and Tasmania is moving in the same direction domestically.

Endgame C seems to still work in China, where the only new cases on Thursday were arriving passengerseach of whom is obliged to spend 14 days in controlled isolation in a hotel designated for this purpose.

In Endgame C, it is likely that the shutdown will last only about eight weeks.

Mathematics of exponential growth also works in the opposite order: if the infection level is lower than 1, but not higher than 2, as now, then a large number of cases quickly turn into a small number.

In China, the number of infections has declined from 4,000 to 20 per day for six weeks, and the incidence rate has fallen below 0.5.

In Australia, if we reach an infection rate of even 0.8, the number of new infections per day will drop from 100 to 10 in about six weeks, after which tracking and tracking becomes much more effective.

If Endgame C is the dominant strategy, it makes sense to implement it immediately and aggressively. The longer we wait, the longer economic activity must remain at an impasse to return to zero cases.

Endgame C can give hope

Endgame C is not good Until the vaccine is deployed – and we expect it to appear – there will be no meaningful international travel, tourism or students for at least 12 months. But most of these things will not happen in endgames A and B.

At the very least, Endgame C will allow domestic travel and tourism, hotel business and other home activities when the stop is completed. If our main trading partner – China – also successfully implements the same strategy, our main export can also continue.

More importantly, if this is made clear, Endgame C will give enterprises a probable end date.

They would have a reason to hold back if the government intervened to drive them away.

Measures may include tax forgiveness, payment of a share of wages (but also requiring workers to be paid less overall), the introduction of a large temporary reduction in rents (usually lessors have more options for covering losses than small businesses), and loans and encouraging – or demanding – banks suspend payments on loans and possibly interest.

Psychologically, this would give real hope. We must strive for eight weeks, and twelve in case it is more difficult than we expect.

Shutdown from eight to twelve weeks

This relatively short duration will allow governments to intervene better to keep society and the economy together.

The government's strategy will focus on providing a large social insurance policy that covers people and businesses until the closure is complete.

The goal is for us to get out of the trough with human and physical capital and institutions in good shape. We need to avoid abuse and demoralization of workers and the destruction of enterprises that will not be easily revived.

This will require very large expenses from the government, which the government can afford if the stop is short enough.

Endgame C is not available for every country. The disease has already spread too far in Iran, and perhaps this happened in the United States. This is a complex strategy for countries with large land borders with neighbors that allow the spread of the disease.

Australia can do it, while others cannot

Australia's advantage is that it is an island, and its main trading partner seems to follow the same strategy. This time we can be a less unhappy country if we can act quickly and decisively.

It is possible that Endgame C may not work. Despite all our efforts, we will not be able to reduce the number of infections, or the disease may recur if we think it has been eradicated.

But the costs of trying are relatively low – both in lives and in economic costs – compared to Endgame A.

In the worst case, this gives us more time to increase the possibilities of intensive care and prepare for endgame A.

The logic is convincing: if we are not going to chase Endgame C (stop and then restart), at least the authorities should explain why this is technically impossible.

Each of the finals is unpleasant. COVID-19 is real life. ”trolley problem“In which someone is asked to choose between killing several or killing many.

When any of us is faced with the problem of the cart, the only universal reaction is to give up the choice.

That is what we are doing now, and this will only exacerbate our problems.

We must recognize this psychology and decide to choose the smallest bad endgame.

The faster we do this, the worse it will be.


KOVID-19: How many people will die?


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citation:
Endgame C: stop almost everything, restart when the coronavirus disappears (2020, March 20)
retrieved March 21, 2020
from https://phys.org/news/2020-03-endgame-restart-coronavirus.html

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