Safe bubbles

If the government fails with its response to Sars-Cov-2 and our fellow-citizens don’t believe in the pandemic— what can we do?

There are some well known measures:

• face masks
• staying put at home
• disinfecting hands
• etc

They reduce the probability of infection, but over time the risks add up. When there are so many cases around and so long wait for the possible vaccine it seems inevitable that eventually nearly everybody will get the virus. I see people losing hope. We cannot beat it by individual actions, many governments seem helpless, and around us we see people completely disregarding the precautions.

But there is a intermediate step between individual and state actions — we can self-organize in smaller groups. This can be more effective than it seems. Most of the contacts that bring the most risk of infections — the close and long term contacts — happen inside our stable relations. So if the people around us adhere to the rules we also become safer. Family, neighbours, co-workers, friends — these are people with whom we can negotiate rules and procedures.

But it is also effective in a different dimension. There are more and less risk averse people, and there are more and less vulnerable people — any global solution will never fit everybody. We need to split. And we need to think up ways to make that splitting effective. People who are more risk tolerant should be allowed to go with their lives as they wish with a few minimal concessions to the other side. People who are afraid of the virus should be able to isolate effectively.

I guess this would be perceived as not far from ‘The Swedish’ model with no lockdowns and minimal measures mandated by the government. Maybe — but with some additions:

1. People should declare themselves and join three (or maybe more) groups of vulnerables, moderates and fearless (immune, infected?).
2. Similarly gatherings of people should declare their risk tolerance levels and rules for people wishing to join them. The rules could be different depending on how risk tolerant is the newcomer.
3. We need the cheap, at home, rapid antigen tests!!!

It is tempting to moralize the choice, and for example ask if fearless should be admitted to hospital when there are not enough places for everyone, but lets not do that. The fearless have a role in the society — they are needed to keep the economy running and if they quickly infect each other they would get immune and help us with herd immunity. And maybe even save the vulnerables with their blood plasma donations. I would also expect their impact on the health care system to be not too big — as it would be mostly people who really don’t need to fear the virus.

But the gatherings would maybe be more important than the individual declarations. The gatherings could be anything — from countries to schools to households. The more informal gatherings like families maybe don’t need to make any public announcements. But they need to discuss the rules between them. What could be the rules:

• Testing (entry testing, regular testing, testing after exposure)
• Quarantining
• Isolating the infectious
• Contact tracing in parallel with the government (where the government tracing it completely fails)
• Face masks and distancing rules
• Allowed exposure

Quick at home testing is at the core of this strategy. If we are moderates and we want to visit our vulnerable parents — we should be able to quickly test ourselves. Or if we are moderates and we nevertheless want to go to a restaurant, which as a public closed space should be fearless probably, and have to declare ourselves fearless for a few days — later we should be able to test ourselves to retain our moderate status (if the test is negative). But there will be many more strategies, we just need to give people effective tools, good information and let them innovate.

Just to be clear — I don’t want the above to be a public policy — I am just thinking about what we can do, citizens of states that completely failed here. But there still is a public policy change that is needed for this plan to be effective — the regulators should allow us to buy the antigen tests. There is a place for regulations— we want tests that comply with their stated specs — but the sensitivity threshold (90% in the US) that was stopping the tests from the market for so many months is really dumb. We can work with the ambiguity of having a not 100% sure test. Now many of the tests do have sensitivity way over 90% — but they still require the nosopharyngeal swab so none yet is sold to the general public. We need tests that can be done at home even if that means slightly lower sensitivity. Personally I have bought and used tests sold for medical institutions on the grey market — but the demand is huge and the sources dry up. It is curious how many of the Western countries proved to be not authoritarian enough for any effective pandemic response — but are authoritative enough to prevent their citizens from buying the antigen tests.

Resources: https://www.microcovid.org/