COVID-19: Where are we? #2
A week ago I wrote, “We are one week from disaster. If from RIGHT NOW, you stay at home then perhaps we can have a chat about priorities or whatever, & decide as we gaze into the eternal hell of Mt Doom, whether we want to become Italy, or Spain” ../2

We did that. The day I was writing was the peak of new cases in Australia ( https://covid-19-au.com/ ). The exponential increase from 3-24 March was reversed & now the number of new cases has dropped to 141/day. ../3

But what about the rising deaths? We have had 35 Covid-19 deaths. Roughly, it takes a week from infection to symptoms, +/- 2 weeks from admission to death. So when I wrote, most of those people were already on the path that killed them. We will have 2 more weeks of that. ../4

But what about the untested? There are untested COVID-19 cases, & it is hard to tell what those numbers are, other than two things: 1) They’re unlikely to outnumber the % tested who are +ve; 2) They are less than half of those needing hospital. We’ll return to them. ../5

That’s where we are, but where from here? Lots of people are making suggestions. Some say restrictions should be lifted now; others say keep them until we have a vaccine; or the virus weakens, or so many have been infected & immune, that the virus stops spreading. ../6

There is an old rule in management that a good manager doesn’t have just a Plan A, but they must have a Plan B & Plan C in the background, just in case the first one doesn’t work. ../7

There is an even better way, & that is to have a fallback plan. One that, if everything else has failed & luck is dead against you, will still work. For us, that plan is called “The Hammer & the Dance,” & was first proposed by Tomas Pueyo. This plan has 3 steps. ../8

Step 1: (And how we get got here). Look at the table of State-by-State cases @ https://covid-19-au.com/ . Notice most states are not trying to find out whether cases recovered or not. VIC was way ahead on this, & have been using tests to count them as a priority. This is why: ../9

VIC & NSW are prob the most similar states. VIC finds ~45 new recovered cases/day; NSW has 2x the cases & isn’t checking, but assume a proportional rate: A total of ~135 cases recovered/day. Add a few more for the other states, & the deaths & you have a remarkable thing: ../10

The numbers of new cases & the numbers recovered or died have crossed over today. More people are recovering than getting sick. ../11

Step 2: If we keep this up, if we hold fast, every day the number of infected people, who infect others, who need hospital, who need ICU services, who need ventilators, & who can die of COVID-19, drops. And just as we climbed an exponential hill, we can slide back down it. ../12

But the process will need more testing – far more testing. It will need more quarantining, more public health checks. Those untested people will need to be identified, tested & followed until cleared. To find them now, perhaps the entire population will need to be screened. ../13

But the outcome is that within weeks – perhaps 6-8 weeks – we can be back where we were in January, with relatively few cases & their contacts to trace & put into quarantine. ../14

Step 3: This is “The Dance” – every new case & every outbreak needs to be identified & isolated. This means a LOT of testing. Some can be done with the new, faster, cheaper antibody-based test. But we will still need the original PCR test to show someone has recovered. ../15

How long does this go on for? If the virus doesn’t get weaker, if we can't make a vaccine or drug, if herd immunity isn’t actually possible because immunity isn’t lasting, or 20% of people never clear the virus, or a dozen other reasons, Step 3, The Dance, goes on forever. ../16

The Hammer and the Dance has a built-in fallback position that involves things we now know we can do; that as a society we have done with other diseases before; that we impose (through WHO) on other countries with other diseases. ../17

It will be invasive – but so are many public health interventions that keep us safe & that we got used to. The advantage is the lockdown can end & most of us can go back to a semblance of normal life; economic activity can re-start & this is the fastest way to achieve it. ../18

Reference: You can read Tomas Pueyo’s very clear and accessible discussion here: https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-the-dance-be9337092b56 -end-