If you and I are not coughing, do we need to socially distance from one another? That is a $64 trillion question. So I propose an experiment.
Take 300 volunteers who all test negative for the virus. Repeat the test, if necessary to be reasonably confident that they begin the experiment virus-free. I’ll explain where to get the volunteers shortly.
Put 100 of the volunteers in a room with someone who has the virus but is asymptomatic. Make sure that they all get a chance to get close to the infected person. Put 100 of them in a room with someone who is symptomatic. Make sure they get a chance to get close to the infected person. Next, have a symptomatic victim cough on his hand and touch a doorknob 100 times, meaning 100 different doorknobs. Then have the last 100 volunteers each touch one of the doorknobs and then touch their faces.
Over the next few days, measure the difference in infection rates. The goal is to compare two strategies.
1) Isolate people who cough
2) Encourage broad-based social distancing
If the infection rate is zero except among the group that meets in the room with the symptomatic sufferer, then you know that (2) has no marginal social benefit over (1). Instead, just focus on executing (1).
Even if a few people in the other rooms do get infected, if the number is much smaller than the infection rate in the symptomatic sufferer’s room, you might calculate that the costs of (2) exceed the benefits, and you prefer (1).
As for the volunteers, I suggest that they come from the upper ranks of the FDA, who seem to be the ones most responsible for resisting testing or trying out drug treatments for the virus. Make them “volunteer.”
Actually, don’t let that snarky comment mislead you. I seriously think that this would be a valuable experiment.
In fact, while we wait for the results we can do it as a thought experiment. If I could, I would ask leading epidemiologists to predict the outcome of the experiment. One could use their estimates to make better assessments of policy.
ASK: Evidently, you have not gotten the memo. Debate-time on COVID-19 is now closed
Sign of the times:
A prominent libertarian-prof, associated with a right-wing economics department where idolatry of free-markets is (usually) the norm, has just given $50,000 prize to a public university in a socialist nation that advocated lockdown of their economy and citizenry by government ukase.
A few days after 9/11 is not the time to make national policy. That is what happened however. Hysterical mindsets demand action! And once you are a few trillion dollars into a boondoggle…well, saying “sorry” is not an option.
And that is the problem: The prominent libertarian aforementioned is now trapped. He cannot soon say, “I bungled this one. Sorry, that I helped collapse the global economy, aided and abetted fear-mongers on a public-health scare.”
Should we investigate if elderly and older smokers are the bulk of “victims” of the cold virus going around? People with one leg in the grave already, with multiple co-morbidities?
That line of inquiry is now closed, for the duration!
And if public healthcare agencies are in control of the information, that line of inquiry may be permanently blocked. That kind of info may never even be collected and collated.
Ponder the parallels to national/global security outlays. Who controls the information, and frames the debate?
But at least the national security guys don’t collapse the economy…
The “libertarians” have doffed the epaulets and jodhpurs of the statist martinets.
All you can do is short the market.
The other experiment that I would like to see is to test immunity. Let’s get 100 people who have recovered from the virus and given them ample new exposure to symptomatic and asymptomatic carriers. If none of them get sick, then we should be able to allow all certifiably recovered people to resume normal activities.
This might not be a $64 trillion question, but its value could still be substantial. As much as I would love to see your experiment, I think the advantage of this one is that it at least stands an epsilon chance of surviving ethical review somewhere.
Please Arnold, we are in a dire OODA Loop. Timing is of the essence. The experiment you suggest has been approximated in real world conditions with millions of people. The only question is whether there is a flaw in my logic. I can’t see a flaw. It is the core of every strategy I’ve seen but it also works when health system capacity is exceeded.
The important question is why people read the 4C Plan and don’t recognize it is a life saving message worth sharing. This is about meme spread as much as it is about viruses. Your network includes influencers. We need them and we need everyone to stay on message. This meme doesn’t spread naturally.
The Four C’s of COVID-19: Coughs, Contacts, Communication, and Calm:
1. Cough Isolation: watch each new cough for 3 hours, Self-Isolate immediately for 14 days and Self-Monitor if persistent. Keep a journal and track the date and time of each entry (e.g. body temperature reading for fever) and especially the first cough.
2. Contact Tracing: Carefully trace your contacts from the moment of your first 3-hour persistent cough for the critically contagious first 7 days, and for a cautious full 14 days to make sure.
3. Communicate Transparently: phone your public health officials, tell your close contacts of your Self-Isolation, and tell anyone in your Contact-Tracing list to Self-Quarantine as a precaution.
4. Calm: very few people get very sick but the true danger is people ignoring the first three C’s and causing undetected Community Transmission. Even with widespread Community Transmission, following the first three C’s will first slow then stop the spread.
This advice is not perfect but it is good enough. Trust the plan. Trust the people that trust the plan. Social Distancing without effective public health Testing and Tracing doesn’t work. Don’t be Korean Case 31. Be safe. Build your circle of trust.
But, of course, that is NOT the plan. The plan is “shut down” most things that involve a number of people getting together. When to wind down that plan–or even to make it more severe–requires guesses to Arnold’s questions. Actual factual answers would be even better.
British Columbia Early Onset Curve:
The Charts
Arnold;
As someone who knows quite a bit more about this than you might expect, pay attention to this study: https://journals.lww.com/ajg/Documents/COVID_Digestive_Symptoms_AJG_Preproof.pdf?PRID=AJG_PR_031820
The difference between asymptomatic and ‘not fitting the clinical case definition for COVID-19 pneumonia’ is complicated at the moment. I personally know of a family in Washington state in which all four family members were ill; two of which went to the hospital and were told they had viral infections, only one of them has a pneumonia, and none of them are being recorded as PCR confirmed. Now the last one is [hopefully, presumably] recovering at home.
The gap between our clinical case reports and our actual health status is as bad as it was 5-6 years ago when I was pitching the ‘iceberg’ of health, in which subclinical cases are the vast majority of infectious disease, and cause a huge amount of ‘non-infectious’ exacerbations of chronic disease – obviously diabetic foot infections for example, but also colitis flareups, migraines, or even cardiopulmonary events.
We need a different kind of study than the one you describe in the sense that it should be in a community setting with physiological monitors and privacy-maintaining information technology…
When a new bad disease pops up, one needs to immediately perform all kinds of different tests, on thousands or even tens of thousands of volunteers who literally have nothing better to do, and a ton to gain personally from compliance and cooperation, who can be controlled completely and isolated from the general population in a completely controlled environment, and who aren’t at liberty to mess us the results. It would be ideal if your facilities could keep some people in solitary isolation, while others could be in pairs or groups.
These people are prisoners in prison. Yes, prisoners aren’t as demographically or genetically diverse as the general population since they are mostly younger males. But you go to war with the prisoners you have.
Now, of course it’s totally wrong to experiment on unwilling prisoners, by means of coercion, against their will.
But it’s totally right to experiment with voluntary participation and consensual help from willing prisoners, in a win-win exchange of freedom (also rehabilitation, redemption, and the personal pride of having contributed to something important) for very rapid access to comprehensive information about the disease, and if I need to explain why having such info quick is a Public Good potentially worth Trillions after the world has spent three months mired in uncertainty, I can’t help you.
People react to this proposal with negative emotions partially because of past historical abuses, but mostly because saying it signals you are a person who is socially dangerous because you can’t be relied upon to not violate taboos.
But we shouldn’t throw the baby out with the bathwater when millions of lives and the global economy is at stake. That’s why we have the Nuremberg Code for research ethics to guide our investigations, and there would be no difficulty in complying with those standards in such willing-prisoner trials.
+1 – most prisoners wanting to get out sooner would volunteer.
‘Tipping Point’ at New York Area Hospitals as Virus Cases Mount
A less controlled version of this experiment is called “the real world”. We are a high-risk household because of a family member’s rare autoimmune disease, when we make a trip to the grocery store it is like a military precision excursion, with all precautions possible.
And what we see in the stores is numerous people bumping into one another in the aisles, some distracted on cellphones, others just selfish and clueless. Many people eating in the store, touching their face, touching others, while store employees scurry around wiping down after them. This is in a higher-end store in a college town with little of the least educated and lower income shoppers.
I’m increasingly pessimistic that we can avoid the most difficult and unpleasant outcomes.
Here is a model showing that public face mask usage is really quite effective. Potential reduction rates far greater than those hoping to be achieved by implementing the imperial college model measures, and in < one month, not ~one year.
Granted this is modeling influenza not covid-19, but alas so is the imperial college model (!?)
Modeling the Effectiveness of Respiratory Protective Devices in Reducing Influenza Outbreak
https://pubmed.ncbi.nlm.nih.gov/30229968/
pdf
https://t.co/2rq5IvNAgY?amp=1
I suppose Japan is a good place to observe it in practice?
Yes on FDA workers being allowed to volunteer, or not — with those not volunteering almost certain to not get future promotions.
Explicitly.