The Imperial College Report

The Imperial College in the United Kingdom has issued a "not for public release" report on the corona virus which of course has been leaked to the public. It has a lot of disturbing conclusions.

Two fundamental strategies are possible: (a) mitigation, which focuses on slowing but not necessarily stopping epidemic spread – reducing peak healthcare demand while protecting those most at risk of severe disease from infection, and (b) suppression, which aims to reverse epidemic growth, reducing case numbers to low levels and maintaining that situation indefinitely.

Both of these strategies relate to the rate of reproduction number R. Essentially mitigation looks to lower R without necessarily getting it below 1.

Suppression looks to bring R below 1 which would result in an eventual decrease in the number of cases over time.

We find that that optimal mitigation policies (combining home isolation of suspect cases, home quarantine of those living in the same household as suspect cases, and social distancing of the elderly and others at most risk of severe disease) might reduce peak healthcare demand by 2/3 and deaths by half. However, the resulting mitigated epidemic would still likely result in hundreds of thousands of deaths and health systems (most notably intensive care units) being overwhelmed many times over. For countries able to achieve it, this leaves suppression as the preferred policy option.

I think everyone with more than half a brain has pretty much come to that conclusion as well.

We show that in the UK and US context, suppression will minimally require a combination of social distancing of the entire population, home isolation of cases and household quarantine of their family members. This may need to be supplemented by school and university closures,

So yes, we are well on the way to implementing a suppression strategy. How far we’ll have to go remains to be seen.

Overall, our results suggest that population-wide social distancing applied to the population as a whole would have the largest impact; and in combination with other interventions – notably home isolation of cases and school and university closure – has the potential to suppress transmission below the threshold of R=1 required to rapidly reduce case incidence.

This is basically what New York, New Jersey and Connecticut are trying but it’s way to early to see how effective it will be. Over the last three days New Jersey has announced 80, 89 and 162 new cases as testing has ramped up.

They’re putting 18 months on the table as the time frame that suppression techniques will need to be in place since that’s probably the best time frame that we can hope to have a vaccine.

The major challenge of suppression is that this type of intensive intervention package –or something equivalently effective at reducing transmission – will need to be maintained until a vaccine becomes available (potentially 18 months or more) – given that we predict that transmission will quickly rebound if interventions are relaxed.

The other question is how long will it take for the initial actions to be effective? There isn’t a lot of good news there either.

... it is difficult to be definitive about the likely initial duration of measures which will be required, except that it will be several months.

And then a reiteration of the 18 month window and a suggestion for triggered adaptation rather than arbitrary fixed durations.

To avoid a rebound in transmission, these policies will need to be maintained until large stocks of vaccine are available to immunise the population – which could be 18 months or more. Adaptive hospital surveillance-based triggers for switching on and off population-wide social distancing and school closure offer greater robustness to uncertainty than fixed duration interventions and can be adapted for regional use

Yeah, lots of luck organizing that without a ridiculously strong and competent central authority. So we're pretty much fucked. Not only can you bid farewell to hockey and basketball but I wouldn't hold out much hope for baseball or football either.