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Old 03-22-2020, 05:00 PM
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Getting my head around the cost/benefit of flatten the curve.


As I understand it if we let the virus set the pace of new infections we get a tall but narrow bell curve representing the rate of new infections. The economy would be only slightly affected and we would achieve herd immunity pretty quick. The downside of course is that mostly older people like me have a good chance of not having medical care available to them due to lack of available resources. That must be a hard thing for the rest of you to swallow.

Now I know the seasonal flu kills 10's of thousands of people each year without any economic interruption. Obviously our medical capacity is geared for it.

But if we flatten the rate of new infections , I'll still be in danger (with proper treatment available) but for a much longer period of time, perhaps for a few more years I hear.

The benefit is the number of lives that would have been lost due to lack of care.

The cost per life saved would blow our minds I'm guessing



So this is a long about way of saying to the younger generations that are out of work right now and on the front lines of this crisis, thankyou on behalf of all of us vulnerable
and elderly
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Old 03-22-2020, 05:36 PM
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Problem is death rates are all over the place. Is it 4%, or 0.4%? I don't know.

Also how many deaths will occur due to people not being able to get medical care due to strokes, heart attacks, diabetes, cancer, etc?

Also how many deaths will occur from political disruption or suicide due to the economic collapse?
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Old 03-22-2020, 05:40 PM
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I think you've got the basics.

However, your "tall bell curve" needs some numbers along the y-axis.

From what I can figure, the numbers of infected people are so great, they go beyond the old and decrepit. You'd have a mighty number of middle-aged and youth who will be very sick.

Medical care, which includes equipment, space, and trained personnel, is finite. As the number of infected rise, doctors and nurses will have to choose who gets unplugged, so the ventilator can be set up for a sicker patient. As more and more people present themselves for treatment, the selection process becomes almost arbitrary. People will offer to pay for ventilators. Fights will ensue.

The medical personnel will be dropping like flies. Fatigue and stress will make them vulnerable. Personal Protection Equipment is scarce NOW. Soon, a scary number of infected will be the very people we depend on to help us get well.

Flattening the bell curve will hopefully allow the number of respirators and hospital beds will be enough to accommodate most patients.

Look at Italy. They are attempting to share respirators between two patients, to stretch the resources. Yet each day seems to have a greater death toll. Cemeteries are full, coffins are unavailable. At night, under the cover of darkness, the military conducts a convoy of trucks loaded with dead bodies, to the crematoria.

Those dead aren't just "the old people."


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Old 03-22-2020, 06:13 PM
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I think you've got the basics.

However, your "tall bell curve" needs some numbers along the y-axis.

From what I can figure, the numbers of infected people are so great, they go beyond the old and decrepit. You'd have a mighty number of middle-aged and youth who will be very sick.

Medical care, which includes equipment, space, and trained personnel, is finite. As the number of infected rise, doctors and nurses will have to choose who gets unplugged, so the ventilator can be set up for a sicker patient. As more and more people present themselves for treatment, the selection process becomes almost arbitrary. People will offer to pay for ventilators. Fights will ensue.

The medical personnel will be dropping like flies. Fatigue and stress will make them vulnerable. Personal Protection Equipment is scarce NOW. Soon, a scary number of infected will be the very people we depend on to help us get well.

Flattening the bell curve will hopefully allow the number of respirators and hospital beds will be enough to accommodate most patients.

Look at Italy. They are attempting to share respirators between two patients, to stretch the resources. Yet each day seems to have a greater death toll. Cemeteries are full, coffins are unavailable. At night, under the cover of darkness, the military conducts a convoy of trucks loaded with dead bodies, to the crematoria.

Those dead aren't just "the old people."


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And that just counts the people who actually have COVID-19. Imagine trying to get an appendectomy, or deliver a baby with complications, or be treated for critical injuries in a car accident or a fire when all the hospitals are overfull and medical staff are overwhelmed or sick
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Old 03-22-2020, 07:39 PM
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Yeah, when COVID overwhelms medical resources, more will die from COVID, and also cancer, heart attacks, strokes, accidents, other infections, etc.
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Old 03-22-2020, 08:04 PM
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Dead is dead, whether COVID or something else.

Remember "Gone With the Wind?" The wounded, the dying, and the dead lay in row after row after row near the train station in Atlanta. And Scarlett expected the doctor to drop everything and deliver her baby.


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Old 03-22-2020, 08:12 PM
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Dead is dead, whether COVID or something else.

Remember "Gone With the Wind?" The wounded, the dying, and the dead lay in row after row after row near the train station in Atlanta. And Scarlett expected the doctor to drop everything and deliver her baby.


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Agreed. I'm just making the point that even a person with magic immunity to Covid19 will still be at risk from the effects of Covid 19 on the medical system.
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Old 03-22-2020, 08:16 PM
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The downside of course is that mostly older people like me have a good chance of not having medical care available to them due to lack of available resources.
Everyone will suffer from lack of medical resources. Car accident victims. Hunting accident victims. Cancer patients. People suffering from severe allergies and food poisonings. Babies, toddlers, teens, middle-age people.
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Old 03-22-2020, 08:38 PM
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Oops. Now I see that Wesley Clarke already made my point.
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Old 03-22-2020, 09:04 PM
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Dallas just went on lock-down. The data they were using suggested that with "social distancing" there would be over 400k deaths--not cases, deaths--in Texas alone. I don't know what data they are looking at, but 400k deaths is not an acceptable number. It would shit can the economy all by itself, so we are basically looking at the economy as a sunk cost. It will meltdown. What's the best path to be in a place to rebuild it?

In my mind, with 3 months of lockdown, we are like America in the great depression, or in the midst of WW2, when everything we produced went overseas. With millions dead, we are more like the UK after WW2: our actual productive capacity is upended. It took their economy a lot longer to recover than ours.
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Old 03-23-2020, 08:09 AM
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As I understand it if we let the virus set the pace of new infections we get a tall but narrow bell curve representing the rate of new infections. The economy would be only slightly affected and we would achieve herd immunity pretty quick.
I think you've got it wrong with the "the economy would only be slightly affected". People can't seem to look beyond the still fluctuating mortality rate to the much larger rate of "requires intensive care over several weeks" and the even larger "would be too sick to go to work".

If you look to Italy and see that backlog of funerals that's building up, you would get something similar, with the direct and the psychological effect that would have. Yes, not having a lockdown would mean more people would be available to do the burying, but it would also mean more people dead faster.

And then there's the aftereffects of being so sick you need weeks in the ICU. Likely a large portion of those will have permanently reduced lung capacity.

This is not about avoiding deaths among the weak and elderly. Those have the highest mortality rates, but the rates for other groups are still significant. The rates of cases requiring intensive care for all groups are definitely significant.

And we can add the psychological effect on health care workers living through a period of refusing life saving treatment to suffering and dying patients.
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Old 03-23-2020, 08:17 AM
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...an equal policy choice, advocated by others not me, have been to let this play out as for the vast majority of people the symptoms are minor and they quickly recover, and the flip side is the complete destruction of our economy..
A number of reasonable people have made that argument. The extreme economic cost of an economic shut down must be weighed against both moral *and* economic cost of possibly millions of people dying in the U.S.

The latest models show if it "played out" unhindered it might cause over 2 million American deaths. This does not include all the people that would die from heart attacks, etc. due to receiving inadequate treatment from a collapsed healthcare system. https://www.imperial.ac.uk/media/imp...16-03-2020.pdf

That same study showed that even moderate mitigation might still entail 1 million U.S. fatalities. Even if that was reduced to 500,000, the question is whether the extreme economic cost is a worthwhile societal tradeoff -- especially if it later appears the shutdown must be maintained for many months to achieve that.

There is another option which is being discussed, which is segregate people by age, and keep those 60+ years old under shelter in place, and let younger people go back to work. But even younger people have morbidity and mortality risk.

A variant of this is wait until serology tests are available, detecting those who have successfully recovered, then send those people back to work since they are possibly immune for at least a year.

The current PCR tests can only detect if a person actively has COVID-19, not after they recovered from it. Serology testing when available would likely be cheaper, faster and more amenable to mass automation. These are already being trialed in certain places and might be available within a few months.
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Old 03-23-2020, 08:47 AM
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..

There is another option which is being discussed, which is segregate people by age, and keep those 60+ years old under shelter in place, and let younger people go back to work. But even younger people have morbidity and mortality risk.
...
Plus: who cares for the elderly? Younger people. Multigenerational homes like ours would have one or more younger people coming and going and bringing the virus home to infect the elderly.

So even ignoring the direct risk to the younger people, this is not a perfect answer.
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Old 03-23-2020, 08:53 AM
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The Fed allowing for unlimited stimulus got me thinking about this again. At this point the federal government is probably going to spend 2-3 trillion dollars to prevent 1 million deaths which is about 2.5 million per life and well below the VFL from the EPA and DOT at around 9 million. Thinking about 8-12 trillion being spent and lost over the next 18 months freaks me out but that may be what we're looking at and it still being 'worth it'.
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Old 03-23-2020, 10:02 AM
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But if we flatten the rate of new infections , I'll still be in danger (with proper treatment available) but for a much longer period of time, perhaps for a few more years I hear.
Aside from the other points made around preserving some of the medical capacity by flattening the curve, playing for time gives us a chance to a) learn more about how the coronovirus spreads, b) build up testing capacity - including rapid testing capacity - so that we can isolate only people who are actually infected, and c) potentially develop treatments and vaccines.

This is a great, albeit quite long, article: https://medium.com/@tomaspueyo/coron...e-be9337092b56
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Old 03-23-2020, 12:06 PM
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Its astounding to me how callously people can just dismiss this as "well, tens or hundreds of thousands will die, but at least our economy will be slightly better off if we do nothing". First of all, you're wrong -- hundreds of thousands dead, even if they're all old and retired, would wreck our economy. Second of all, even if you were right, that's fucked up. How'd you feel if the rest of society decided you weren't worth protecting?
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Old 03-23-2020, 01:00 PM
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A number of reasonable people have made that argument. The extreme economic cost of an economic shut down must be weighed against both moral *and* economic cost of possibly millions of people dying in the U.S.

The latest models show if it "played out" unhindered it might cause over 2 million American deaths. This does not include all the people that would die from heart attacks, etc. due to receiving inadequate treatment from a collapsed healthcare system. https://www.imperial.ac.uk/media/imp...16-03-2020.pdf
Can you help me understand Table 3 in that paper?

Specifically, the last line.
R0=2.2, trigger is 3000 (cumulative ICU cases). It says that if we implement home isolation (CI), household quarantine (HQ), and social distancing of those over 60 (SDOL70), we can reduce reduce peak ICU bed demand by 49%.
It also shows that if we do that same 3 things, but additionally close schools and universities (PC), we will reduce peak bed demand by 24%.

Does this mean we will actually INCREASE peak bed demand by keeping students at home? Does that imply these students will spread the disease a lot more by being home?

The table also indicates that if we trigger on peak beds instead of deaths, adding PC will decrease peak bed demand, which is what I would expect.

Why would triggering on deaths rather than beds be worse?
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Old 03-23-2020, 01:03 PM
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Right? The moment the talking heads starting pissing and moaning about the economy, I decided our economic model sucks and we need one that is actually robust. Very fucked up all the people who saw the same news and decided human lives aren't actually that valuable at all.
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Old 03-23-2020, 01:09 PM
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How'd you feel if the rest of society decided you weren't worth protecting?
Honestly, Id be okay with it. Id understand the circumstances. Some other people have said even that theyd be willing to sacrifice themselves than wrecking society so severely and creating such a dystopian future for the young ahead of us.

Because a wrecked economy also bring massive suffering and to critical groups of people as well. On top of that the social and mental health effects, again on developing children and people, would also be devastating and leave decades long impact.

That doesnt mean Im not sympathetic to the people dying. Ive wavered back and forth on this, and either way I feel terrible.
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Old 03-23-2020, 01:44 PM
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Right? The moment the talking heads starting pissing and moaning about the economy, I decided our economic model sucks and we need one that is actually robust. Very fucked up all the people who saw the same news and decided human lives aren't actually that valuable at all.
There are the aftereffects of spending trillions now that might end up costing more lives later. If we could spend $4 trillion now to save 1,000,000 lives, maybe that makes sense. But spending $4 trillion now might mean millions of lives lost over the next 10 years that would otherwise be saved. People will lose their jobs, their homes and their health insurance. That money could have gone into research to treat other diseases, education or housing for those who run into difficult times. That $4 trillion has to come from somewhere.
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Old 03-23-2020, 02:36 PM
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I'm not seeing this so-called "economic stimulus" as a bailout, like the ones given to automotive manufacturers or the probable one to Boeing.

The money which is to be paid out to the citizens of the US is an effort to help people survive these hortibly uncertain times. Prices ARE going up on damned near everything, and hourly employees are being clobbered the worst, financially.

Dammit, I have paid my taxes all my working life. People like me have supported the US government. Instead of sending aid packages to other countries or buying a couple of fighter jets, it is right that Uncle Sam give back a small amount to the taxpaying legions.

As for however many trillions the US must spend fighting this virus, many have called the fight a war. In wartime, you do not complain about costs to arm the military. You expect sacrifices and "making do" all for the greater good of winning the war.


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Old 03-23-2020, 03:06 PM
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I'm not seeing this so-called "economic stimulus" as a bailout, like the ones given to automotive manufacturers or the probable one to Boeing.
The GOP plan funnels hundreds of billions of bucks to corporations who already sit on large cash reserves. I see no stimulus there except more campaign "contributions".

Quote:
The money which is to be paid out to the citizens of the US is an effort to help people survive these hortibly uncertain times. Prices ARE going up on damned near everything, and hourly employees are being clobbered the worst, financially.
Low-paid workers, the homeless, the most vulnerable, will get nothing. People with homes, accounts, and sufficient tax filings will get a pittance. I see little stimulus here.

We paid no tax on last year's small retirement income so we qualify for nothing. If we did receive a kilobuck, it would help pay off my pricey hearing aids; it would not go for new merchandise and stimulate the economy. YMMV.
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Old 03-23-2020, 03:56 PM
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As I understand it if we let the virus set the pace of new infections we get a tall but narrow bell curve representing the rate of new infections. The economy would be only slightly affected and we would achieve herd immunity pretty quick. The downside of course is that mostly older people like me have a good chance of not having medical care available to them due to lack of available resources. That must be a hard thing for the rest of you to swallow.

Now I know the seasonal flu kills 10's of thousands of people each year without any economic interruption. Obviously our medical capacity is geared for it.
The seasonal flu doesn't really kill that many people. It's absolutely worth getting vaccinated for, but that number is of "flu related illnesses," which includes anyone who died when they had the flu (even if of another cause) and often ropes in deaths attributed to pneumonia even if there is no diagnosis of flu. Precisely what the enhanced mortality caused by flu is would take substantial analysis but "tens of thousands" is just not the case.

Were Coronavirus to actually send hundreds of thousands to the ICU all in one shot it'd be a disaster. There's no way around it. There are maybe 100,000 ICU beds in the entire USA, and of course they're mostly being used for other things; that is why they exist. The health care system absolutely cannot sustain a pandemic that requires tens of thousands of ICU hospitalizations. People would die in hallways.
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Old 03-23-2020, 04:33 PM
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There are the aftereffects of spending trillions now that might end up costing more lives later. If we could spend $4 trillion now to save 1,000,000 lives, maybe that makes sense. But spending $4 trillion now might mean millions of lives lost over the next 10 years that would otherwise be saved. People will lose their jobs, their homes and their health insurance. That money could have gone into research to treat other diseases, education or housing for those who run into difficult times. That $4 trillion has to come from somewhere.
As of March 20, 8 trillion dollars of wealth has been destroyed in the market. Cite. The Fed or Congress printing 4 trillion dollars only makes up half of that.
It is not like them doing this will mean there will be less money in the future for research (which would be a trivial amount in comparison anyway.) Note that with this amount of wealth lost, inflation is not going to be a problem.
Since any bonds issued now are at almost 0 interest, it is a good time to do it. Not doing it, say not funding job retention - will cost far more in the long run in the loss of taxes as the economy tanks into a depression.
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Old 03-23-2020, 04:36 PM
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The GOP plan funnels hundreds of billions of bucks to corporations who already sit on large cash reserves. I see no stimulus there except more campaign "contributions".
The fight in the Senate is about tying bailout money to job retention, so the companies can't fire everyone anyway and then buy back more of their stock because it is so cheap. Keeping jobs - and health insurance - is more efficient than just putting all the money into unemployment insurance. Though that needs to be sweetened also.
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Old 03-23-2020, 05:00 PM
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As of March 20, 8 trillion dollars of wealth has been destroyed in the market. Cite. The Fed or Congress printing 4 trillion dollars only makes up half of that.
It is not like them doing this will mean there will be less money in the future for research (which would be a trivial amount in comparison anyway.) Note that with this amount of wealth lost, inflation is not going to be a problem.
Since any bonds issued now are at almost 0 interest, it is a good time to do it. Not doing it, say not funding job retention - will cost far more in the long run in the loss of taxes as the economy tanks into a depression.
How does this not affect future funding of research? I would think the bigger the debt and deficit, the more the government would need to cut non-essential funding. I guess that gets into the definition of non-essential, so maybe research is part of essential funding.
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Old 03-23-2020, 06:16 PM
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How does this not affect future funding of research? I would think the bigger the debt and deficit, the more the government would need to cut non-essential funding. I guess that gets into the definition of non-essential, so maybe research is part of essential funding.
The budget of the NIH is less than $42 billion, and the budget of the NSF is less than $8 billion. Not a pittance to you or me, but pretty small when you're throwing around trillions. It's really a matter of congress having the will to spend it on those agencies. The point being, funding research at even double current levels is still possible even when spending loads on other things.

Also, when has the government ever cut total spending? (It does occasionally drop for a year or two, but it bounces right back up again.)
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Old 03-23-2020, 06:16 PM
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The fight in the Senate is about tying bailout money to job retention
Which is why there really shouldn't be bailouts of companies at all. Money should be sent directly to ordinary people.
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Old 03-23-2020, 10:22 PM
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Which is why there really shouldn't be bailouts of companies at all. Money should be sent directly to ordinary people.
I would think the idea is that if a company can't meet payroll they will have to fire everyone and close up shop. Giving the money to the companies means they can meet payroll, at least for a bit, and when this is over go back to normal. If the money goes directly to the employees, they get a "bonus" check or three, but won't have a job in a couple of months. Hopefully giving it to employers means they continue to pay employees and can stay viable.
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Old 03-23-2020, 10:33 PM
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Which is why there really shouldn't be bailouts of companies at all. Money should be sent directly to ordinary people.
$1,200 isn't going to cover a month's bills. We need jobs far, far, far more than loose change.
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Old 03-23-2020, 11:10 PM
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$1200 a person won't motivate a company to keep you employed, either. You can't create jobs by handing money to companies. They have no reason to hire people because they get handouts; if it made sense to lay off X employees they will keep doing that even if you give them a bag of money. (Why wouldn't they?) You can try to base the bailout money on them keeping a certain number of employees, but such deals are complex and rarely end up saving jobs. You're also creating, of course, a gigantic moral hazard. No supporter of free markets and capitalism should support that.

Giving money directly to the individuals inevitably means that money will be spent on... stuff. The companies that provide that stuff will be rewarded for running effective businesses, and THEY will employ people.
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Old 03-23-2020, 11:50 PM
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$1200 a person won't motivate a company to keep you employed, either. You can't create jobs by handing money to companies. They have no reason to hire people because they get handouts; if it made sense to lay off X employees they will keep doing that even if you give them a bag of money. (Why wouldn't they?) You can try to base the bailout money on them keeping a certain number of employees, but such deals are complex and rarely end up saving jobs. You're also creating, of course, a gigantic moral hazard. No supporter of free markets and capitalism should support that.

Giving money directly to the individuals inevitably means that money will be spent on... stuff. The companies that provide that stuff will be rewarded for running effective businesses, and THEY will employ people.
If a company feels they have a viable and profitable business in the right market and under normal circumstances, they likely will do whatever they can to hang on until the market place reopens. Restaurants that were thriving before all this likely feel they can continue to thrive, for example, once the lock down is lifted. But if they are broke, what choice do they have but to let people go? They can only go into so much debt. Banks won't lend them anything right now. And if they have to fire people, they'd need to rehire in another couple of months, which is a huge hassle. Better to try to keep employees around until this passes. So the incentive they have to hand that money to employees is that once things reopen they can hit the ground running and not need to rehire, retrain and start all over.
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Old 03-24-2020, 01:44 AM
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$1200 a person won't motivate a company to keep you employed, either. You can't create jobs by handing money to companies. They have no reason to hire people because they get handouts; if it made sense to lay off X employees they will keep doing that even if you give them a bag of money. (Why wouldn't they?) You can try to base the bailout money on them keeping a certain number of employees, but such deals are complex and rarely end up saving jobs. You're also creating, of course, a gigantic moral hazard. No supporter of free markets and capitalism should support that.

Giving money directly to the individuals inevitably means that money will be spent on... stuff. The companies that provide that stuff will be rewarded for running effective businesses, and THEY will employ people.
First of all, both the Senate and House bills give money both to individuals and small businesses.
It is not true that if you give money to people they will spend it. They can also save it. They can pay down debt. Neither of these helps the economy. Plus, at the moment I have a problem spending anywhere but Amazon and the grocery store, both of which seem to be doing fine.

Money for businesses that involve keeping workers employed saves on unemployment and also keeps the workers covered by health insurance, which could be vital. We're not talking about creating jobs, we're talking about preserving jobs.

And speaking of moral hazards in this situation is bizarre, unless you think not pumping money into the economy will discourage the next virus.
Now, giving money to companies (or lending) without a requirement to preserve jobs does not have any of these benefits. Still not a moral hazard, since no actions by any of the companies created the problem.
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Old 03-24-2020, 08:02 AM
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$1200 a person won't motivate a company to keep you employed, either. You can't create jobs by handing money to companies. They have no reason to hire people because they get handouts; if it made sense to lay off X employees they will keep doing that even if you give them a bag of money. (Why wouldn't they?) You can try to base the bailout money on them keeping a certain number of employees, but such deals are complex and rarely end up saving jobs. You're also creating, of course, a gigantic moral hazard. No supporter of free markets and capitalism should support that.

Giving money directly to the individuals inevitably means that money will be spent on... stuff. The companies that provide that stuff will be rewarded for running effective businesses, and THEY will employ people.
Again, you're NOT going to create a job handing money to individuals. $1,200 is nothing compared to the loss of a job. You WILL lose jobs if businesses collapse. When that happens there will be taxes to pay for the $1,200 individual payment.

And as was pointed out, both businesses and individuals are getting funds. They serve 2 different purposes.
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Old 03-24-2020, 08:51 AM
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Again, you're NOT going to create a job handing money to individuals. $1,200 is nothing compared to the loss of a job. You WILL lose jobs if businesses collapse. When that happens there will be taxes to pay for the $1,200 individual payment.

And as was pointed out, both businesses and individuals are getting funds. They serve 2 different purposes.
So give people more than $1,200. The math just doesn't work for you. You could give every unemployed American $3,000 a month for three months and that'd be FAR less than the proposed legislation.

Or what about targeted bailouts? American Airlines is pushing for a share of a $45 billion bailout. Let's assume they get $10 billion of that, which is likely a low end guess. You could give FIFTY THOUSAND DOLLARS to every employee at American Airlines and that would still cost way less than the bailout.
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  #36  
Old 03-24-2020, 11:36 AM
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Herd immunity?


Bear in mind that the worst hit country in Europe (so far) is Italy, which not only has relatively fewer medical facilities per capita than, say, Germany, but was also the slowest to lock down. There were even people who defied the lockdown and when out for their evening drink as usual. The result was a rapid increase in cases and hey, the docs can get sick as well. As for the elderly, the lack of facilities means fewer respirators for those that need them. In short, if the pace of the new cases is slowed down, it does not overwhelm the hospitals, but the epidemic will most likely last longer as roughly the same number of people will get it eventually anyway.

The big question is how the virus will mutate, as they all do. The so-called Spanish 'flu of 1918 came in several waves and the second in particular was more deadly. The weird thing about this epidemic was that it hit worldwide and it killed many of the young and healthy, so it is not a case of being a result of the war and culling the weak and the elderly. We can only hope that it does not happen again, and bear in mind as well that many of the victims were left with impaired health afterwards. This could occur with the current virus, as it goes for the lungs.

Over here, the shops are open fewer hours, the number of people allowed in is restricted and they avoid getting close to one another, just about everywhere has closed down apart from food shops, and the town looks like a neutron bomb hit it. Those who can are working from hone, the others have been sent home and many are self-quarantining at home. I'll be doing that as well. So far, very few cases here in Poland, what with rapid and drastic action by the government.

Herd immunity is all and well, but the elderly tend to be left out of the herd.

As for a vaccine, it will be a long wait, at least a year. And despite claims to the contrary, there is nothing that actually stops you falling ill if you are infected.
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Old 03-24-2020, 11:38 AM
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Coming back to the OP, in France we had 2 weeks ago 33 deads and 1800 sicks of covid19. Today this is 860 dead, 2 000 people are in great emergency ("urgence vitale") and 19 586 are sick., Today in an olderly home in Vosges 13 are dead, 16 in another one in Paris, and so on even if there is containement mesures in effect for one week. And we are still in the increasing side of the curve.
Students and retired doctors are called back to help in hospitals and in call centers. Peoples in jail are contaminated also.
So this is a disease that is VERY contagious, that can stay undetected for up to15 days and that KILLS. Estimations without any slowing mesures are of 60% of people sick (37 millions in France potentially) and of these 2% will die ( far far more for the 60+, up to 30% mortality rate for them). That's a poteltial of 740 000 deads in France.
What can we do to escape this? If you slow the spreading of the virus(by isolating mesures), you will have less people sick, and they will not be all at the same time. SO you can have respirators for all of the critical cases, you will not overwhem your health care system. You save lives.
Tha quasi philosophical problem is what cost you put on this lives? is an economic shutdown of 3-4 weeks a too high price to pay? Are the companies willing to lose some of their money to spare the lives of theirs employees?
Here in France, we have perhaps a more centralized governement, with more tradituon of dealing with catastrophes (world warS for instance) by putting the needs of the many on the top priority... and there is a strict police-enforced containement at home, with even curfews in many cities. Going out is possible, with an attestation stating adress, hour and destination. Taxes and rents for stores are canceled, lines of production are redesignated to produce hydroalcoholic gel, masks and so.
So we hope to flaten the curve enough to avoid the majority of the casualties, and the economic price will be paid later and don't really come as important.
  #38  
Old 03-24-2020, 02:21 PM
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The big question is how the virus will mutate, as they all do. The so-called Spanish 'flu of 1918 came in several waves and the second in particular was more deadly. The weird thing about this epidemic was that it hit worldwide and it killed many of the young and healthy, so it is not a case of being a result of the war and culling the weak and the elderly. We can only hope that it does not happen again, and bear in mind as well that many of the victims were left with impaired health afterwards. This could occur with the current virus, as it goes for the lungs.
The reason the Spanish flu was worse for the young was that it turned your immune system against you, so those with better immune systems were hit harder.
The existence of the flu was considered a military secret at first, which is one of the reasons it spread so virulently. It was called the Spanish flu because Spain, which was neutral, had no reason not to report it. It did not start in Spain.

My source for the flu stuff is my wife, who wrote a book on the flu when we were worried about the avian flu. She got paid, but the book was never published because the flu was not as bad as expected, showing there is a dark lining to every silver cloud.
I'm at a loss about how herd immunity applies here. It works for vaccination because you can make people immune without a good chance of killing them. This is more like smallpox before Jenner. The "vaccine" for it during the Revolution was infecting people with smallpox, and hoping they didn't die. After that they were immune and you could control the spread. Not a great solution compared to vaccination, and I wouldn't call it herd immunity.
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Old 03-24-2020, 03:01 PM
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As for a vaccine, it will be a long wait, at least a year. And despite claims to the contrary, there is nothing that actually stops you falling ill if you are infected.
We're already testing a vaccine. The year-long wait would be for traditional medical trials. I would expect something to hit the market much sooner given the situation.
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Old 03-24-2020, 11:25 PM
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We're already testing a vaccine. The year-long wait would be for traditional medical trials. I would expect something to hit the market much sooner given the situation.
Traditional medical trials take longer than a year. A year is an extremely accelerated rollout. This is assuming the vaccine is safe and shows efficacy. 8 months from now they may be starting over. The very preliminary trials now may show a vaccine is safe enough after a few months, but it will take longer to show if it works at all. No point in gearing up to vaccinate the world with something that doesn't actually work, or has profound side effects. I know many groups are working on multiple different vaccines, so hopefully at least one of them will work out. Double hopefully one will work so well that trials can be halted early and it is put into immediate use.
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Old 03-25-2020, 12:00 AM
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Bears repeating. The year and a half estimate already IS the accelerated timeframe where things are pushed ahead faster because of the current situation. Faster than that would be ethically and medically dubious. We don't live in an episode of Star Trek.

That's not a "traditional" schedule by any stretch. Please, please, please don't spread bad information.
  #42  
Old 03-26-2020, 03:41 PM
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As I understand it if we let the virus set the pace of new infections we get a tall but narrow bell curve representing the rate of new infections. The economy would be only slightly affected and we would achieve herd immunity pretty quick. The downside of course is that mostly older people like me have a good chance of not having medical care available to them due to lack of available resources. That must be a hard thing for the rest of you to swallow.
There are problems with your assumptions. First is the apron that if we let things run there course quickly, the economy will only be slightly affected. You are basing this on the idea that most people would be working. This is absolutely unfounded. When people start dropping like flies, they will flood the hospitals, morgues, makeshift hospitals, veterinary clinics, tents in parking lots - you name it. Then all the medical personnel - doctors, nurses, nursing assistants, medical students - will all start coming down with it. This is because gowns and masks and face shields and gloves would be burned through in days. Next, all your first responders will be hit: EMTs, firefighters, police. Because they have to deal with the infected.

The ones who aren't in the ICU or hospital themselves would be in quarantine or self-isolation. So who would be carrying for all the sick and dying?

Then there's the problem that anyone needing any kind of medical care, be it emergency surgery, elective procedures, or cancer treatments or infections or any doctor visit, would be shit out of luck. Because all medical facilities and personnel will already be swamped.

What happens to the economy when everyone has several family members die in rapid succession?

And it's not just old people or those with underlying health conditionsthat are being severely hit. 40 percent of cases are between 18 and 40. Young people are ending up in the ICU in medically induced comas.

You think the stock market is going to be strong when CEOs and politicians start keeling over?

There's no easy to get out of this without the economy taking a huge hit. The question is are we going to blindly let people die because there are more than the system can handle, or are we going to try to spread the effects so as many as possible have a fighting chance?
  #43  
Old 03-26-2020, 04:15 PM
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In addition to a possible vaccine, slowing things down allows for more time to find treatments (which can potentially be made available much faster, since the medical and ethical standards for sparsely tested treatments on people who are about to die are much lower than for a vaccine that you have to give en masse to healthy people), to build more hospitals and ventilators and masks, and most importantly: to get the number of cases low enough that ramped up testing and contact tracing can be used to keep them from exploding again.

The graphic that shows a big spike compared to a longer lower curve is misleading. The goal is not to still have ~40-70% of people get it over the course of 6 months rather than two. The goal is to drive current cases down to handfuls with as severe a lockdown as we can manage, then use careful relaxation of constraints along with better testing to keep cases low. Basically, do what S. Korea did, and what we could have done starting in January if there hadn't been multiple fuckups.

This article, The Hammer and the Dance, describes the strategy well.
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Old 03-26-2020, 05:09 PM
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Traditional medical trials take longer than a year. A year is an extremely accelerated rollout. This is assuming the vaccine is safe and shows efficacy. 8 months from now they may be starting over. The very preliminary trials now may show a vaccine is safe enough after a few months, but it will take longer to show if it works at all. No point in gearing up to vaccinate the world with something that doesn't actually work, or has profound side effects. I know many groups are working on multiple different vaccines, so hopefully at least one of them will work out. Double hopefully one will work so well that trials can be halted early and it is put into immediate use.
"traditional" is something for a disease that kills thousands. There will be millions of dead from this so I would expect the time frame for vaccines and treatments to be accelerated.

And just looking at the numbers we are seeing the doubling of deaths in the US every 3 days. That would mean a total of close to 2 million by the end of April. That is why we're shutting everything down.
  #45  
Old 03-26-2020, 10:37 PM
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The appropriate way to deal with a contagious disease is to identify those who have it, and isolate them. At present, we cannot do this. Once tests finally, belatedly, become available, we can start easing the shutdown without killing millions of Americans. Until they are, though, the only two ways we can reduce the number of deaths is by shutdown, and increasing our capacity to treat.
2 thoughts for those thinking of the tradeoff maybe being not worth it:
-if you make a million a year, and assuming “savings” of not shutting down are distributed evenly (they wouldn’t) then your share of the savings is 0.000005 cents of every dollar saved.
-if we flatten the curve enough, and we have enough testing available to identify and isolate, you might not get this, ever.
  #46  
Old 03-27-2020, 04:39 PM
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The GOP plan funnels hundreds of billions of bucks to corporations who already sit on large cash reserves. I see no stimulus there except more campaign "contributions".
There is a phase out of the stimulus payments for individuals based on their 2018 incomes. Why don't they have a similar phaseout for corporations based on their 2018 income?
  #47  
Old 03-29-2020, 08:59 PM
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Here is an aspect to flattening the curve I have not heard discussed:

I am assuming that myself and nearly all of the people I work with at a large hospital will eventually contract the virus. I also assume that infections will spike sooner among hospital staff than the general population. There is no data to support these assumptions, but they seem reasonable. The data indicate that most of us will recover. When we recover, we will be immune to the virus, and available to care for new cases, without either contracting the virus themselves or carrying it to the uninfected. (biologically carrying, I mean...mechanical transmission is still something to worry about) From what I have read, the virus runs it's course in 2-3 weeks, or so.

If half the hospital staff is out sick, then the workers that are left are touching twice as many patients.

If the curve is rather flat, then not only will existing medical infrastructure stand a better chance of being adequate to deal with the case load, but the infection rate of caregivers will be lower, and there is a much better chance that enough can recover in time to be useful in treating new cases. If the spike in cases coincides with the infection of caregivers, then that will further limit the availability of healthcare for the infected. It will be really bad if the situation is so dire that healthcare workers are needed to work while infected. In that case, anything you need to be hospitalized for means you are extremely likely to contract COVID-19 in the hospital. So don't crash your car, or overdose on drugs or alcohol, or develop a heart condition, or have a stroke...because hospitals will likely not be there for you.

It seems to me that this is part of what happened (is happening) in Italy.
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Last edited by Kevbo; 03-29-2020 at 09:02 PM.
  #48  
Old 03-29-2020, 10:35 PM
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With a very tall bell, the people that may suffer most, and die most are health care workers. That causes a lack of care, and more importantly supply problems, and more deaths and more sick people that causes more sick health care workers that may die that makes the curve sharper. Rinse and Repeat.

Think of a battlefield medic. How many people can they save? Who is it gonna be? When your medics become overwhelmed and are getting shot at, it's a pretty bad situation. Flatten the curve, and more can be saved.
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  #49  
Old 03-29-2020, 10:59 PM
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"traditional" is something for a disease that kills thousands. There will be millions of dead from this so I would expect the time frame for vaccines and treatments to be accelerated.

And just looking at the numbers we are seeing the doubling of deaths in the US every 3 days. That would mean a total of close to 2 million by the end of April. That is why we're shutting everything down.
In the Bay Area we shut things down early, before California as a whole did. It seems to be working.
Here is a page with data.. Santa Clara county, which was hardest hit, is seeing a decline in new cases and deaths. So is the Bay Area as a whole. It's been about 2 weeks of lockdown which is when you'd expect to see an effect.
Cases can still spike, but at the moment it looks better. You can see the curve flattening in the graphs.
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