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Bill's avatar

Some of the restrictions definitely don't jibe with what I've been reading about how covid spreads. Outdoors is safe, unless you are in somebody's face, jabbering away unmasked, which is maybe what was happening on patios.

House hold spread is a problem, which is why there has been no inter household contact since November, but seriously how long could people be expected to follow that rule? Not six months.

In specific terms I don't think we really understand all aspects of how this spreads. Why is it dropping quickly now, when the restrictions are almost the same (except for patios) as when it was rising exponentially?

We pursued the first dose strategy to curb the spread in the population, as one dose gives a significant amount of protection. Yet we are instructed to act as if we are unvaccinated and follow all rules. In reality single dosed people (two weeks after vaccination) meeting other vaccinated people indoors is low risk.

Comparisons with American jurisdictions are tricky. Many of those states have much higher population immunity because they had much more severe first and second waves. Most of them weren't exposed to these new variants that are wreaking havoc here. So I would urge caution in these comparisons. We need to vaccinate!

In general the public health messaging in this pandemic has been confusing and paternalistic. People can see the inconsistencies, and at this point are barely paying attention. We really do need to hold on a bit longer as the hospitals and especially the ICUs are at breaking point and the health care staff are burned out and miserable.

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George Skinner's avatar

Public health authorities have been very resistant to accept that COVID spreads in an aerosolized form. WIRED had a good long form explanation of the history - doctors and epidemiologists aren't very knowledgeable of fluid mechanics, and in their ignorance clung to inapplicable assumptions about disease transmission rooted in TB epidemiology. If you don't understand the root cause of transmission, it's very difficult to craft effective mitigations. You can also fall prey to the fallacy of being right for the wrong reasons, which seems to be part of the problem here: the lockdown measures in the first wave seemed effective, but mainly because isolating people stopped aerosol transmission. Probably 80% of the mitigations did nothing, such as the hygiene theater and lockdowns of outdoor activities.

This leads to a second problem described in this article: people are making individual decisions to ignore mitigation measures that are rational in themselves, but lead to problems in aggregate. We've all probably had friends or family over to our houses in violation of COVID restrictions. We've limited the number of people we visit with, and we trust them to tell us if they're exhibiting symptoms. 99% of the time this assessment is probably correct - no transmission occurs. 1% of the time, it might be wrong. Somebody may be asymptomatically infectious, or fail to take heed of their symptoms. Then the infection spreads between households, and the caseload rises. Again, this may just be a small fraction of all interactions, but it adds up to significant numbers when scaled over a million households. Each decision is a rational independent assumption of risk; in aggregate, it can overwhelm the health system and return us to exponential spread.

Tying these two points together, I think the latter problem could've been mitigated by more intelligent public health measures informed by an understanding of how COVID actually spreads. Instead of simply blocking all sorts of activities, focus on the high risk activities and provide guidance on how to assess risk based on principles like number of people, proximity, and ventilation. Rules that are easier to follow get better compliance.

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