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  #201  
Old 05-12-2020, 07:42 AM
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Originally Posted by DSeid View Post
Don't know where you are getting that impression but here's the CDC site. Scroll down to "Outpatient Illness Surveillance. ILINet" and then to "Influenza-Associated Hospitalizations" and "Pneumonia and Influenza (P&I) Mortality Surveillance".

2019-20 was in no shape or form a mild flu season with an early stop. Possibly as bad as 2017-18 which was an exceptionally bad one. In lab confirmed influenza hospitalizations it was only behind that year. The issue mainly is if some later ILIs and pneumonia deaths were actually Covid-19, in retrospect. That lack of clarity is exactly the point that was being made.
Good post, DSeid. Said what I wanted to say.

I'm short on time and haven't looked at your link but I'm wondering if there's a breakdown of 'presumed' flu and confirmed flu. As with COVID and other tests, there's often a lag time between testing and confirming the results. And I would imagine that in really 'heavy' seasons, they may look at symptoms and lump 'presumed' cases into the category of confirmed cases. The danger of doing that is when you have a new disease that mimics the flu in some regards, which COVID-19 does. That's why I made reference to the 'heavy' flu season to begin with: I suspect that some cases that were contributing to the rough flu season were actually the beginnings of COVID-19, especially if the cases were in January and early February.
  #202  
Old 05-12-2020, 08:08 AM
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I'm short on time and haven't looked at your link but I'm wondering if there's a breakdown of 'presumed' flu and confirmed flu. As with COVID and other tests, there's often a lag time between testing and confirming the results. And I would imagine that in really 'heavy' seasons, they may look at symptoms and lump 'presumed' cases into the category of confirmed cases. The danger of doing that is when you have a new disease that mimics the flu in some regards, which COVID-19 does. That's why I made reference to the 'heavy' flu season to begin with: I suspect that some cases that were contributing to the rough flu season were actually the beginnings of COVID-19, especially if the cases were in January and early February.
I'm still not a doctor but I think I know the answer to that question.

Yes, there is a difference between 'presumed' flu and confirmed flu. No, they are not lumped together.

ICD-10 Influenza and pneumonia J09-J18

J09 and J10 are confirmed influenza virus infections. J11 is presumed flu.

Unfortunately they are "lumped together" (as J09-J11 or even J09-J18) in easily found public stats I can find.

I haven't seen a breakdown between J09, J10 and J11. I would be interested in seeing it (for whatever country). I believe J11 is FAR more used than those other two.
  #203  
Old 05-12-2020, 09:11 AM
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The rapid flu tests they give you at the doctor's office are really really inaccurate:

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The diagnostic accuracy of influenza swabs is often overestimated by clinicians. The CDC notes that rapid influenza testing has a sensitivity ranging from approximately 50% to 70% — meaning that in up to half of influenza cases, the flu swab results will still be negative. Another study in Turkey showed that the sensitivity of rapid influenza testing for H1N1 ranged from 31.7% to 50%, again depending on the brand of test. A 2012 metanalysis of the accuracy of rapid influenza testing showed an average sensitivity for detecting influenza in adults of only 54%. Sensitivity in children is somewhat higher since they tend to shed more virus. In most studies, the specificity of influenza testing is 90-95%, meaning that there is a much lower incidence of false positive results.
So while I don't doubt that there were cases of COVID misdiagnosed as flu, the reality is that the doctor's judgement is likely as good or better than the test. I am also not sure that flue is the most likely disease to conceal COVID. Severe COVID, sure, but for people with mild symptoms, people who go to their doctor or urgent care facility, it's really not flu-like at all. The most distinguishing feature of flu is the rapid onset: you go from "am I getting a cold?" to "I want to die" in a matter of hours. COVID seems to be the opposite: it comes on gradually, and you feel more and more crappy over several days, even a week. I don't think many doctors would think "flu" if a patient presented like that, and if they also had a negative flu test, it is even less likely. It is my understanding that you get the J11 diagnosis when you have a negative test but the mack-truck progression.

Last edited by Manda JO; 05-12-2020 at 09:11 AM.
  #204  
Old 05-12-2020, 01:29 PM
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Yeah I wouldn’t trust the codes used for much. But the CDC does break things out by different proxies.

One report is percent of our-patient visits that were for influenza like illnesses (ILI). That’s the one that shows a clear late third peak that was very unusual beginning around week 10.

Another is reports of positive tests by the public health labs. Dropping by week 10, like in many flu seasons.

Influenza associated hospitalizations- overall second only to 2017-18 in recent years but had flattened off by ... week 10.

Pneumonia and influenza mortality combined. Typical year until a huge spike ... beginning about week 10.

Put it together and it was a bad flu year that looked like it was falling off maybe just a bit late and testing fewer positives but then jumps in ILI and deaths from pneumonia beginning about week 10.

How to put that together?
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Old 05-12-2020, 01:31 PM
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Yeah I wouldn’t trust the codes used for much. But the CDC does break things out by different proxies.

One report is percent of our-patient visits that were for influenza like illnesses (ILI). That’s the one that shows a clear late third peak that was very unusual beginning around week 10.

Another is reports of positive tests by the public health labs. Dropping by week 10, like in many flu seasons.

Influenza associated hospitalizations- overall second only to 2017-18 in recent years but had flattened off by ... week 10.

Pneumonia and influenza mortality combined. Typical year until a huge spike ... beginning about week 10.

Put it together and it was a bad flu year that looked like it was falling off maybe just a bit late and testing fewer positives but then jumps in ILI and deaths from pneumonia beginning about week 10.

How to put that together?
  #206  
Old 05-12-2020, 01:36 PM
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Meanwhile Sweden is finally doing more for those in nursing homes.
https://www.google.com/amp/s/thehill...covid-19%3famp
  #207  
Old 05-12-2020, 03:01 PM
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That's why I made reference to the 'heavy' flu season to begin with: I suspect that some cases that were contributing to the rough flu season were actually the beginnings of COVID-19, especially if the cases were in January and early February.
It turns out most places aren't located in the United States. Shocking, but true. The fact is the flu season in Europe was unusually mild with a peak of only two weeks, which is what makes it seem impossible to me that any other disease could have been misdiagnosed as flu to any notable degree in Italy or pretty much anywhere else. That would require flu itself to have been virtually eradicated, which to the best of my knowledge it has not been.
  #208  
Old 05-12-2020, 04:00 PM
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It turns out most places aren't located in the United States. Shocking, but true. The fact is the flu season in Europe was unusually mild with a peak of only two weeks, which is what makes it seem impossible to me that any other disease could have been misdiagnosed as flu to any notable degree in Italy or pretty much anywhere else. That would require flu itself to have been virtually eradicated, which to the best of my knowledge it has not been.
What you linked to documents that influenza was peaking in Europe, Italy inclusive, end of January into early February. In Italy end of January was seeing nearly half a million cases diagnosed clinically as influenza in a week.

COVID-19 exploded as a diagnosis during February.

What seems impossible to you is pretty widely accepted by most experts. COVID-19 was there no later than mid January unnoticed and not diagnosed as COVID-19 anyway during Italy’s influenza peak and spreading.
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Old 05-12-2020, 04:09 PM
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What you linked to documents that influenza was peaking in Europe, Italy inclusive, end of January into early February. In Italy end of January was seeing nearly half a million cases diagnosed clinically as influenza in a week.

COVID-19 exploded as a diagnosis during February.

What seems impossible to you is pretty widely accepted by most experts. COVID-19 was there no later than mid January unnoticed and not diagnosed as COVID-19 anyway during Italy’s influenza peak and spreading.
So not only was there a significantly shorter flu peak than normal, but you also think it was a misdiagnosed different disease and nobody anywhere noticed? That's honestly completely absurd. If that were the case there should be thousands of samples that show CoViD-19 presence from earlier than February, and they've found what, one?
  #210  
Old 05-12-2020, 04:23 PM
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In January is widely accepted. The question is if earlier. https://www.google.com/amp/s/www.phy...-possible/amp/
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Old 05-12-2020, 04:30 PM
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In January is widely accepted.
Isolated cases, yes. Not the tens of thousands you claim.
  #212  
Old 05-12-2020, 04:54 PM
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Isolated cases, yes. Not the tens of thousands you claim.
Chill, nobody made such a claim.
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Old 05-12-2020, 05:07 PM
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Chill, nobody made such a claim.
It's right there in the link. If the "hundreds" who were hospitalized had CoViD-19 and we know only a small percentage of those infected with the virus are hospitalized, what does that tell you?
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Old 05-12-2020, 05:20 PM
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It's right there in the link. If the "hundreds" who were hospitalized had CoViD-19 and we know only a small percentage of those infected with the virus are hospitalized, what does that tell you?
I think the best, most accurate answer is I don't know - I wouldn't know how many cases were misdiagnosed. It could have been tens, hundreds, or more than that. I'm not suggesting that the heavy flu season in the US was exaggerated; I was just remarking (as has been documented already) that COVID-19 was circulating earlier than previously thought and that some of those early cases, including some deaths were missed.
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Old 05-12-2020, 06:47 PM
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Yah, not sure where you get tens of thousands.

My entry into this hijack was the claim that this an exceptionally light influenza season and that COVID-19 couldn't have been brewing unrecognized and unlabelled during it.

It had been a fairly typical influenza season in Europe reaching peak as COVID-19 was identified in Italy. Overall December through February together had been a slightly worse test positive influenza season that the previous year (see it presented graphically here). Visits for ILI were pretty lockstep with the year before in Italy. Not surprisingly across the world as populations (independent of and prior to mandates) populations began to socially distance, influenza dropped quickly, ending the season a bit earlier than usual. The short two weeks peak by the way refers to something different that you think it means and actually argues that something else WAS going on: it is two weeks of peak percent of the swabs sent of sick people being positive for influenza. It means that there was more of the time that the swabs sent of sick people suspected of having influenza were NEGATIVE for influenza, and thus the illness was being caused something else ...

Clearly, at peak of flu season, many individuals could have been infected with SARS-CoV-2, some significant number asymptomatic or mildly symptomatic, some much sicker, spreading COVID-19 in places like Italy, unnoticed, many weeks before any were diagnosed. How many? Dunno.

What does this aside have to do with Sweden again? Oh yeah. It is thought by many experts that NY and Italy had already had some significantly wide seeding, hidden in the fog of flu, before anyone even thought start changing their behaviors, let alone before there was governmental response; Sweden and its Nordic peer group likely not.
  #216  
Old 05-20-2020, 06:07 AM
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Sweden's neighboring countries are considering keeping borders closed to Sweden while opening the borders to other countries.

Sweden’s death toll unnerves its Nordic neighbours

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Denmark, Finland and Norway look at maintaining travel restrictions even as they prepare to open up to others
. . .
Denmark, Finland and Norway are debating whether to maintain travel restrictions on Sweden but ease them for other countries as they nervously eye their Nordic neighbour’s higher coronavirus death toll.

Sweden has the highest mortality rate per capita at this stage of the epidemic, according to a Financial Times tracker that uses a seven-day rolling average of new deaths. It has overtaken the UK, Italy and Belgium in recent days.
Sweden's 7 day rolling average for mortality as tracked in this publications tracker has been higher than the UK, Italy and Belgium. The recent rolling average is more astounding considering how high the deaths per million in these countries has been.

At this moment, in deaths per million per Worldometer:

Sweden 371
UK 521
Italy 532
Belgium 790

vs. Sweden's neighbors

Sweden 371
Denmark 95
Norway 43
Finland 54

Sweden allows people from other countries to go into their country, so people can go to Sweden from another country, but when they return to their own country, they're subject to a quarantine. Unless it's a long work project, that doesn't allow people to go back and forth for work.

In separate but related news dated May 19, 2020, Sweden is reported to be in very deep economic crisis despite not locking down as other countries have done.

Sweden in ‘Very Deep Economic Crisis’ Despite Soft Lockdown

Quote:
Scandinavia’s biggest economy will shrink 7% this year, Finance Minister Magdalena Andersson said on Tuesday. Shortly after she spoke, the debt office revealed an historic 30-fold spike in borrowing to cover emergency spending amid record job losses. A separate survey showed 40% of businesses in Sweden’s service sector now fear bankruptcy.
. . .
Andersson said her country is now seeing “a very deep economic crisis.” She also said the “deep downturn in the economy is happening faster than we expected.”

Marten Bjellerup, chief economist at the debt office in Stockholm, says he thinks Sweden will fare “somewhat better” than others, but acknowledged “the difference is marginal.”
Sweden is affected by the global economy like everyone else, maybe more so. Half of Sweden's GDP comes from exports, and demand for those exports have "dried up."

Although the article doesn't mention it, the lockdown of borders from other countries could impact the demand from people traveling from neighboring countries.

And again, Anders Tegnell claims that the strategy Sweden took wasn't to put the economy above lives. He says that the strategy was put into place because it's sustainable. ISTM record bankruptcies and high death rates aren't sustainable.

It also seems to me that the businesses like restaurants, gyms and personal services really can't go on indefinitely with a fraction of its customers. Most business like that that aren't at full capacity, at least some of the time, are losing money.

The Bloomberg article concludes.

Quote:
But for now, Sweden’s experiences suggest there might be few economic benefits to leaving an economy open during a pandemic.
So far, people have theorized that perhaps Sweden will achieve herd immunity, but Tegnell claims that's not the goal. Herd immunity has not been achieved. Then people have theorized that Sweden's approach will fare better economically. It doesn't appear so. Tegnell claims it wasn't meant to save the economy. One of the other claims is that the second wave for other countries will level out the amount of death. But what if it doesn't? The first wave of people can't come back from the dead for a do-over. The upside of this what-if seems small while the downside is already happening and can't be reversed.

I remain skeptical of Sweden's strategy. I might understand it a bit more if Sweden was in the position of the US where a deep recession might cause a number of deaths of despair, but Sweden has a strong social safety net with universal health care and guaranteed minimum income. Studies show that a strong social safety net can buffer the effects of a recession.

Quote:
Strong social safety nets, however, may have buffered some populations from negative health impacts of the economy.
It would also be helpful when people claim that recession kills would quantify how many people will be killed so that it can be measured against how many people are killed by covid-19 now.

As for the second wave argument, they might have asked those people dying if they'd rather die now or take a small chance that something would save them in the future. Those people might have picked the latter, but they weren't given much of a choice.
  #217  
Old 05-20-2020, 07:18 AM
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I have been wondering about the high death rate per million - versus the Swedish economy and had come around to thinking that although its a relatively high rate, the economy was still largely open compared to most other nations whose economies are shut down.

In terms of a strategy that would appear to have some sort of merit, especially given that we don't really know the final result, but the previous post appears to refute that possibility, if that's the case then Sweden does seem to have selected a poor option - but only time is going to prove it.

I had seen an article on the BBC that suggest that a large chunk of deaths are in elderly care homes - maybe Sweden has been ill prepared for this and that the rest of the country is actually does better than it appears.
  #218  
Old 05-20-2020, 08:08 AM
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I think the real surprise to the Swedes is the economic effects. But this is a global pandemic, and in a global economy it is impossible to avoid knock on-effects. A lot of the world has seen the major downturns in tourism and hospitality. Closed borders and lack of travel means that Sweden will be hit no matter what its internal policies are. But Swedes were also expected to avoid such activities as a matter of personal choice. So overall the economic impact was unavoidable. No matter what the implementation of policy was.

What will be interesting is their ability to bounce back. There is some evidence that an early hard lockdown leads to significantly faster recovery. But this time recovery is going to be driven by confidence and desire within the populace. Certainly there seems to be a lot of pent up demand for the chance to enjoy what has been denied for the last few months. So maybe tourism and hospitality will recover quickly once things are over. But until global restrictions are lifted it isn't going to be easy. Retail will be interesting. My observations here on the other side of the planet suggest it will recover. Some areas are moribund. Car sales are non-existent. But they were already in deep trouble.
  #219  
Old 05-20-2020, 08:44 AM
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What will be interesting is their ability to bounce back. There is some evidence that an early hard lockdown leads to significantly faster recovery. But this time recovery is going to be driven by confidence and desire within the populace. Certainly there seems to be a lot of pent up demand for the chance to enjoy what has been denied for the last few months. So maybe tourism and hospitality will recover quickly once things are over. But until global restrictions are lifted it isn't going to be easy. Retail will be interesting. My observations here on the other side of the planet suggest it will recover. Some areas are moribund. Car sales are non-existent. But they were already in deep trouble.

According to
Sweden's finance minister, they aren't projecting a quick bounce back.

Quote:
Asked whether Sweden might see a quick rebound, Andersson, the finance minister, said “that doesn’t seem very likely at present. We expect a more drawn out scenario.”
Seems unlikely to me too. With people from other countries avoiding them like the plague, literally, it's going to be hard to drive up demand.
  #220  
Old 05-21-2020, 05:03 AM
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A geriatrics professor in Sweden says that the elderly in care homes were given palliative care and not taken to hospitals with proper treatment when they were diagnosed with Covid-19. He claims that this was active euthanasia. [This is a link to a translated comment. The original article is in the post.]

Quote:
Geriatrics professor Yngve Gustafson believes that many elderly people are not treated for covid-19, but instead receive palliative medicine directly. "To routinely give older people with lung infection respiratory drugs, is active euthanasia, if not something worse", he says.
. . .
"The proportion of old people in respiratory care is lower than usual, despite the elderly being the worst affected by covid-19 and despite having talked about overcapacity", says Yngve Gustafson.

"This only indicates that we opted out of old people who could have had a chance of survival."

An anonymous doctor and researcher at Karolinska University Hospital describes to DN that the use of a "palliative cocktail" with sedative and analgesic, as he sees it, is used to a large extent on covid-19 patients both in hospitals and the elderly. He is fastidious about remaining anonymous.

"This is so sensitive. We do not talk to each other among our colleagues about this, but what I see now is that people increasingly practice euthanasia under the guise of palliative care."

According to the doctor, the standard mixture ("palliative cocktail") contains the drugs morphine, haldol and midazolam, which are also included in Socialstyrelsen's recommendations for end-of-life care.

"Many covid-19 patients are treated in this way.
An anonymous doctor claims that instead of oxygen treatment, elderly patients in care homes are given a "palliative cocktail" which includes morphine. The lack of oxygen treatment, combined with the morphine, according to these doctors, gives the elderly patients a lower chance of survival.

Another article is about a guy who has a father in an elderly care home who was prescribed this palliative care. He stepped in to stop the treatment to his father. He claims this is why his father survived. Google translate version. Reddit post.

According to the same geriatrics professor in the first article, he's received many calls from people who have relatives in elderly care homes who have been told that their care was prescribed by a doctor over the phone. The patients are left in the elderly care homes where the medical help is not trained for Covid-19 patients. They are also given palliative care which often leads to death.

Quote:
If you look at the proportion who have died from very old people: 70-80 percent of those cared for at geriatric clinics for covid-19 infection have been sent out live, either to the home or back to the elderly. In elderly homes, in principle, only palliative care has been prescribed, which means that you get morphine, midazolam and haldol to prevent being nauseated and vomited by morphine. It is a treatment that almost 100 per cent will surely lead to death. Giving both midazolam and morphine inhibits breathing. If you have trouble breathing, you quickly get such an oxygen deficiency that you die.
This might explain something I found very curious in Sweden's stats during the height of the hospitalization rates. On one day I'd check the stats and the number of patients in serious/critical condition would be roughly 500. The next day, it would be around 1,000. Then back down to 500 and back and forth like that for several days. It didn't make much sense because 500 people weren't dying every day and it seemed unlikely people were getting better and worse on a daily basis.

I'm surmising that when they got the call that some had Covid-19 at an elderly care home, they added them to the serious stats. But the next day, since they're not transferred to ICU, they're not in those stats. It also might be an explanation for why the hospitals were not overrun. Patients from elderly care homes weren't transferred to hospitals to be put on ventilators. They were given palliative care.

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Originally Posted by DSeid View Post
Their approach to nursing homes is a model in what not to do, albeit so far no one has provided a great model in what to do. That is clear.
California calls every elderly care home every day and has done so during the lockdown. They also transferred patients to hospitals and didn't leave them to be taken care of by the elderly care home. They tried doing that for a while but stopped when they got pushback. It isn't a perfect model, I'm sure but I'm liking it better than Sweden's model.

I think Sweden's model might point out why locking everyone down helps the elderly since there's not much of a way to protect them from the general population, and if the general population isn't spreading the virus in the peak, then the elderly might have more of a chance.

In other news, Denmark is still not seeing a second wave 4 weeks after reopening. Scientists are baffled. [Translated comment, original in the post]

Quote:
It is thus still unclear why increased infection activity is still not recorded 4-4.5 weeks after the first reopening of Denmark. We do not know whether this is due to high compliance with physical distance and hygiene advice, or whether it is possibly due to biological conditions, such as weakening of virulence (ie disease-causing by infection, ed.) Or infectiousness by virus, it sounds.
  #221  
Old 05-21-2020, 10:01 AM
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H and R a few brief comments,

First, given that about half of California's death's are nursing home related, about the same as in Sweden, they clearly are not the model to follow either.

Next, YMMV but I take anonymous 'someone says" reports with a big swig of doubt and lumpy reporting needs no nefarious explanations. 100% though their elder care plan was a fail. Many of their deaths would not have occurred if they had not failed in that critical part of the plan.

No question that Sweden does not exist in isolation to the world's economies, and that while their "orders" were a less heavy hand, behaviors were still altered. How fast they recover along with what happens during the next wave(s) are still questions to be answered by time.

Also I am sure you know that your "at this moment" metric is a bit silly at best if not disingenuous.

Finally, yes Denmark's lack of a new spike is very interesting. They opened schools (split classes moving from younger kids to older), daycares, and small businesses over a month ago. No mass testing or contact tracing (plans to do not implemented yet). No wide use of masks. Now going on two weeks with shopping malls open and restaurants/cafes/older kids in schools a few days back.

New cases still happening but still dropping (no eradication there), and very few new deaths reported. So why is this level of light mandated restrictions with kids in school (and without "testing testing testing") working when pretty much everything else is as it was at the start of their wave? Basically they are now doing mostly what Sweden did just time shifted. No the virus has not suddenly become less virulent or infectious only there. I cannot find anything about any specific approach to elder care facilities there but would be curious.
  #222  
Old 05-21-2020, 11:12 AM
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Originally Posted by DSeid View Post
Next, YMMV but I take anonymous 'someone says" reports with a big swig of doubt and lumpy reporting needs no nefarious explanations. 100% though their elder care plan was a fail. Many of their deaths would not have occurred if they had not failed in that critical part of the plan.
It's fair to say that the publication might not be reputable. I don't know the reputation of Swedish publications. But questioning the one anonymous source is like saying that any publication that reports on whistleblowers are completely without merit. There are two other sources who gave their names in those articles that basically said the same as the anonymous doctor. I just added the quote from the doctor because he or she was more specific about the drugs normally used.

Quote:
Originally Posted by DSeid View Post
Also I am sure you know that your "at this moment" metric is a bit silly at best if not disingenuous.
I have no idea what this means.

I added the words "at this moment" just to denote that the stats were current as I knew them and not from May 7-20 which was the time of the 7 day rolling average. Those stats were in reference to the 7 day rolling average for a week in May that had Sweden having the highest death rate of any country in the world.

Sweden becomes country with highest coronavirus death rate per capita
Sweden has 6.08 deaths per million inhabitants, higher than the UK, USA and Italy


Quote:
Sweden has now overtaken the UK, Italy and Belgium to have the highest coronavirus per capita death rate in the world, throwing its decision to avoid a strict lockdown into further doubt.

According to figures collated by the Our World in Data website, Sweden had 6.08 deaths per million inhabitants per day on a rolling seven-day average between May 13 and May 20.

This is the highest in the world, above the UK, Belgium and the US, which have 5.57, 4.28 and 4.11 respectively.
I added the death rate from Worldometer for the UK, Italy and Belgium as mentioned in the article above and another I reference in that post. I also added the death rate for Finland, Norway and Denmark since those were the countries in the other article that were considering closing the borders to Sweden.
  #223  
Old 05-21-2020, 02:43 PM
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Just 7.3% of Stockholm had Covid-19 antibodies by end of April, study shows

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The public health agency had previously said it expected about 25% to have been infected by 1 May and Tom Britton, a maths professor who helped develop its forecasting model, said the figure from the study was surprising.

“It means either the calculations made by the agency and myself are quite wrong, which is possible, but if that’s the case it’s surprising they are so wrong,” he told the newspaper Dagens Nyheter. “Or more people have been infected than developed antibodies.”

Björn Olsen, a professor of infectious medicine at Uppsala University, said herd immunity was a “dangerous and unrealistic” approach. “I think herd immunity is a long way off, if we ever reach it,” he said after the release of the antibody findings.

Tegnell has denied herd immunity is a goal in itself, saying Sweden aims instead to slow the spread of the virus enough for health services to cope. But he has also said countries that imposed strict lockdowns could be more vulnerable to a second wave of infections because a smaller percentage of their populations would be immune.

... so Sweden is not being protected against a second wave by not imposing a strict lockdown.
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Old 05-21-2020, 03:59 PM
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I think Sweden is proof that the persistent COVID optimists have been misguided. By no means am I saying we should be eternal pessimists, but I think that, particularly among Westernized societies that pride themselves for being "open" and mobile, coronavirus has presented them with an identity crisis: we wanted to believe that this was not really that scary, maybe a little worse than the flu, that we could figure out an antiviral cocktail, and whatever else. Sweden and the UK tried tinkering around with "herd immunity," and it has pretty evidently backfired. And the US really never figured out a strategy, and we still haven't come up with a coherent strategy nationwide, although some states have done a reasonably good job of implementing strategies at the local level.

Last edited by asahi; 05-21-2020 at 04:01 PM.
  #225  
Old 05-21-2020, 08:41 PM
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I have no idea what this means.

I added the words "at this moment" just to ...
You really do not understand why comparing a rate long after a country has had its peak and is now low enough that they are re-opening to a country still at its plateau is minimally silly? C'mon, really?

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Just 7.3% of Stockholm had Covid-19 antibodies by end of April, study shows




... so Sweden is not being protected against a second wave by not imposing a strict lockdown.
Out of curiosity, what do you think happens in a particular country/city at a particular time that causes a wave to peak and to begin to drop? My understanding is that there are too few susceptibles getting exposed so R drops below 1. The level that is "too few" is altered by degrees of social distance, behaviors, and other factors local to the place at that particular time. Do you think something else happens?


asahi, not really sure which approach is more consistent with unflagging optimism and which with a pessimistic realism or at least resignation. To me the idea that avoiding a significant surge now and forever seems to be the (likely unrealistic) optimistic position. Surely in a few months there will be that cocktail or vaccines coming over the hill! The Swedes seem to be anything but the optimists ... they are resigned to having at least one surge and understand the position of many modelers that a moderate surge now means less chance of having one that overwhelms the system in the Fall/Winter.

Judging whether the Swedes pessimistic approach is better or worse than an optimistic view is premature. I was, as noted in the beginning of this thread, of the doubtful mindset. But even with their complete fail in regards to elder care facilities they have not been a disaster to date, and the risk of a bigger surge happening in sync with influenza is to me the persistent biggest nightmare to be afraid of and to want to reduce the risk of. I'll continue to reserve judgement on their approach until next Spring hits.
  #226  
Old 05-22-2020, 08:50 AM
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But then there's Mongolia.

https://medium.com/@indica/covid-und...a-3b0c162427c2
  #227  
Old 05-22-2020, 09:26 AM
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UK - so our infection rate is appearing to increase, however this is likely to be the results of increased testing over the last week or so - the results will be starting to come in, there has been some delay in getting the returns from the labs.

I also expect our rate will appear to increase for at least a week and maybe more due to the backlog, along with more people being able to access testing.

What it is likely to reveal - especially as the antibody test program expands - is the true rate of infection as opposed to all the informed guesswork.

We are in for a long old slog though - 50 thousand deaths is entirely possible.
  #228  
Old 05-22-2020, 09:46 AM
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That was enjoyable.
Description: A short nicely-written story about how Mongolia did everything right, and has essentially no Covid-19 presence. They welcomed in WHO, and took their advice. They listened to the news from other countries and launched major preventative measures in January.
  #229  
Old 05-22-2020, 10:37 AM
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That was enjoyable.
Description: A short nicely-written story about how Mongolia did everything right, and has essentially no Covid-19 presence. They welcomed in WHO, and took their advice. They listened to the news from other countries and launched major preventative measures in January.
Indeed, a very enjoyable read. I don't have much say in anything, but I do talk to development aid politicians (in my small country) and I will be making the point that countries that have suffered economically from COVID 19 should not be deprioritized for economical aid just because the incidence of the disease was low. We should not be punishing them for electing to take the beating on the economy instead of their population.
  #230  
Old 05-22-2020, 02:04 PM
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Here's a good explanation of why Sweden is reacting the way it is.

Why Sweden is unlikely to make a U-turn on its controversial Covid-19 strategy

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This is where Sweden is unique, something that may be attributable to its history. The country has not experienced a national emergency or crisis for more than 100 years. Since around the Swedish general strike of 1909, it has not seen any profound social conflicts, for example the miners’ strike in Britain, or a civil war, as in Spain or Finland. Any foreigner who has lived in Sweden will know how conflict-adverse Swedish people seem to be. Furthermore, Sweden has not engaged in any armed disputes since the 1810s. This is in contrast to Denmark and Norway, which were occupied by Germany in the second world war, and Finland, invaded by the USSR in the same period. A rallying cry of unity in the face of national adversity isn’t part of the collective cultural fabric in Sweden.

This lack of experience with handling national crises goes some way to explaining why there is a technocratic and dispassionate outlook to Covid-19, as opposed to a sense of urgency. It is also why the public health agency in Sweden seems to have few qualms about “herd immunity”. Whereas other countries see it as a dangerous national experiment, Swedish health officials regard it more as a type of medical prescription. It might not be 100% effective and some deaths might occur, as in any medical situation. But in the long run, it could work in mitigating the negative effects of the virus, without mass social disruption.

It is for this reason that the denial by the Swedish government and health officials that it is actually pursuing “herd immunity” seem so halfhearted, a rebuttal to critical foreign press rather than its citizens. For a foreigner living in Sweden like me, it is not entirely reassuring. How long Sweden will continue with this policy is difficult to ascertain. But as long as Covid-19 is seen in this light, and it looks as if it will, a U-turn seems unlikely.
  #231  
Old 05-22-2020, 03:37 PM
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Here's a good explanation of why Sweden is reacting the way it is.

Why Sweden is unlikely to make a U-turn on its controversial Covid-19 strategy
Huh.
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Originally Posted by article
Perhaps another explanation is that Sweden has a very different way of perceiving the current crisis. Instead of seeing it as a national emergency or a fight against an “invisible enemy”, there seems to be a tendency to regard coronavirus just as a serious public health problem. It is viewed as something that requires the careful observance of rules set out by health experts, rather than an existential problem that calls for the state to suspend civil liberties for the sake of national security. Indeed, whenever a non-scientific expert such as me criticises the Swedish strategy, the response has often been that I am not an expert.
What a strange paragraph. That's precisely how we should be perceiving this even if you disagree with the Swedish health authorities. This pandemic should be a wake up call before an actual existential problem pandemic arrives but this isn't it.
  #232  
Old 05-24-2020, 12:50 PM
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Sweden 'wrong' not to shut down, says former state epidemiologist

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The predecessor of Sweden’s state epidemiologist has broken her silence on the country’s controversial coronavirus strategy, saying she now believes the authorities should have put in place tougher restrictions in the early stages of the pandemic to bring the virus under control.

Annika Linde, who oversaw Sweden’s response to swine flu and Sars as state epidemiologist from 2005 to 2013, had until now expressed support for her country’s approach under her successor, Anders Tegnell.

But she has now become the first member of the public health establishment to break ranks, saying she has changed her mind as a result of Sweden’s relatively high death toll compared with that of its neighbours, Denmark, Norway, and Finland.
  #233  
Old 05-24-2020, 03:24 PM
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I find it frustrating that countries are being judged by current death rates while the virus is still active and spreading. How long can people hide from this while the world economy continues to falter. Lives are not being saved only delayed. Many additional lives will be lost due to the damage we have allowed to control our lives an economies. Huge resources going into tracing that should be spent protecting those at risk.
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Old 05-24-2020, 03:42 PM
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I'm probably what might be called on the hawkish end of the cautious crowd. I am for targeted (but fairly quickly progressively wider) openings despite a lack of accurate testing, comprehensive contact tracing or a vaccine.

I think you have to realize that a significant part of this economic damage would have happened with or without government fiats on closures. Fear and a tonne of people getting actually sick from the disease would have done that. The US just had about two average flu seasons in two months.

Last edited by CarnalK; 05-24-2020 at 03:45 PM.
  #235  
Old 05-25-2020, 12:10 AM
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I find it frustrating that countries are being judged by current death rates while the virus is still active and spreading. How long can people hide from this while the world economy continues to falter. Lives are not being saved only delayed. Many additional lives will be lost due to the damage we have allowed to control our lives an economies. Huge resources going into tracing that should be spent protecting those at risk.
...hi HoneyBadgerDC. Let me show you a graph.

https://twitter.com/David_Cormack/st...08671336304641

Numbers sourced from "Our world in data."

What that graph shows is that New Zealand had the toughest lockdown of all of the countries mentioned.

What that graph also shows is that since when we dropped to Level 2 a couple of weeks ago New Zealand is currently imposing the least strict restrictive government policies. Schools are back. Shops are open. The economy is moving. My business has started taking bookings again.

We took a science-lead approach to Covid-19 that has resulted in both a re-opening of the local economy and prevention of massive loss of life. We have less restrictions than even Sweden has now. We protected those that are at risk. But we have also invested in tracing as well as testing because we know that doing both of these things will also protect those at risk.

The evidence strongly suggests that the approach you have advocated on these boards since we started this discussion just a few months ago is one that would both lead to significant excess deaths and leave no path to reopening the local economy properly.

And you don't have to look around for an example to prove this: this thread would surely suffice. I think judging the success of different strategies based on death rates while the virus is still active and spreading is a perfectly valid metric to determine which strategy is the best to pursue.

And the strategy we followed here in New Zealand is, in my opinion, far superior to the one that was followed in Sweden, and is far superior to anything that you have suggested here. We've only had 21 deaths: over half of those deaths from a single cluster. We've gone several days with no new cases and we are conducting (on average) 4000 tests per day. Lives are being saved here and we aren't delaying anything: if we do get a new outbreak we've already demonstrated that isolation, testing and tracing can work to save lives. By no metric is the approach you have consistently promoted on these boards a sensible approach to a global pandemic.
  #236  
Old 05-25-2020, 02:40 AM
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And the strategy we followed here in New Zealand is, in my opinion, far superior to the one that was followed in Sweden, and is far superior to anything that you have suggested here.
NZ has done a great job... for NZ. It is a small island nation with a small population. Do you think the same thing could have been implemented in, say, the US?

Also, NZ's current measures will only continue to work if it doesn't let anyone new in (or takes an *extremely* cautious approach to letting anyone in). Especially since no one there will have immunity, and it will be gasoline and a match all over again. That's the hell of this thing.
  #237  
Old 05-25-2020, 03:15 AM
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Sweden only has twice the population of the New Zealand. Here in Australia we are hoping to tread the same path as NZ. Where I live we are for all intents virus free. Australia has twice the population of Sweden. We are currently accelerating our opening up, not for political reasons, but because the science says we can.
No doubt at all that we have the advantage of isolation.
For the US. Well it depends. Isolation isn't just about physical distance. Australia has a massive tourism industry dependant upon overseas travellers, and also has a significant overseas student populace. The economic issues seem to be less a matter of distance, but more about interdependency. The US doesn't have a much of a different set of issues about sovereignty than Australia. Our states have all shut borders and instituted mandatory 14 day quarantine for all but specially exempt travellers (basically transport drivers and a few other special classes of workers.) Our constitution explicitly says:
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On the imposition of uniform duties of customs, trade, commerce, and intercourse among the States, whether by means of internal carriage or ocean navigation, shall be absolutely free.
There was the faintest murmur from the peanut gallery about the imposition of restrictions on intercourse, and now restrictions are in. Currently there is a bit of political shoush, with one state complaining, and the federal government muttering that they never actually suggested closures. But we did it without much issue. It isn't great. Our tourism industry is in free fall and one major airline has gone into administration. But we are now planing not on a second wave, but on being able to open up the internal economy to near full throttle with very possibly no repercussions.
Political will and the support of the populace makes these things possible. Not geography.
  #238  
Old 05-25-2020, 04:05 AM
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NZ has done a great job... for NZ. It is a small island nation with a small population. Do you think the same thing could have been implemented in, say, the US?
The same strategy seems to work in all the countries that implement it though, despite differences between them. Not everyone has managed complete extermination of the virus yet but getting it down to very low levels has been accomplished in many countries.

Is there any specific reason why the strategy would not work in the US, if implemented?

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Also, NZ's current measures will only continue to work if it doesn't let anyone new in (or takes an *extremely* cautious approach to letting anyone in). Especially since no one there will have immunity, and it will be gasoline and a match all over again. That's the hell of this thing.
Nations with similar epidemiological profiles are in the process of opening to one another. It seems that it is the nations that cannot get their infection under control that will be shut out.
  #239  
Old 05-25-2020, 05:18 AM
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NZ has done a great job... for NZ. It is a small island nation with a small population. Do you think the same thing could have been implemented in, say, the US?
...our size and status weren't at issue: the coronavirus was here, it ripped through one rest-home and if it had have gotten a foothold here our statistics would be looking just like everywhere else.

What we did was follow the science. Are people in the US capable of following the science? If they are not then you have the answer to that question.

Quote:
Also, NZ's current measures will only continue to work if it doesn't let anyone new in (or takes an *extremely* cautious approach to letting anyone in). Especially since no one there will have immunity, and it will be gasoline and a match all over again. That's the hell of this thing.
We had a choice of either closing the borders or letting thousands of people die an unnecessary death. We chose the former. That gave us the opportunity to reopen the local economy now while most of the rest of the world will continue in semi-lockdown with excess deaths continuing at a constant rate probably for the next couple of years. Most of us aren't wearing masks here. I went and got a haircut today. People are out and about. Shutting down hard and shutting down early has paid off.

Yeah, that's a hell of a thing to deal with all right. We've bought ourselves time and with time that gives us the opportunity to take be able to "figure things out" without people dying. Some economic sectors have been hit hard: but those same sectors would have been hit even worse if we hadn't taken the measures that we did.

And if we did get a new outbreak it wouldn't be like "gasoline and a match" all over again. We are significantly better prepared for an outbreak than we were just a couple of months ago. On top of testing everyone who feels sick and wants a test we are doing random surveillance testing nationwide to look for community spread and we are testing on average 30,000 people a week. And we have set up the infrastructure so we can rapidly isolate a region with a localised alert level to give us time to track and trace contacts.

Would the New Zealand plan work for the USA? Well the first thing we did was "lockdown before community spread" so obviously its too late for that to happen. But this ProPublica thread lays out a straightforward 7-point strategy that mimics almost everything we did. 1) Build an army of contact tracers. 2) Test. Constantly. 3) Isolate people with suspected infection. 4) Protect health care workers. 5) Don't try to go back to normal 6) Watch out for the second wave. 7) Comunicate. Clearly. Constantly.

There were a couple of things that encouraged buy-in from the NZ public. The first was the focus on the concept of "bubbles." When we locked down (to level 4) the people that we locked down with were "in our bubble." You were fine to interact with anyone in your bubble but you had to keep 2 meters away from any every other bubble. Families would walk down the street and when they saw another family would yell "BUBBLE FORMATION!" and the family would reform in a way to maintain distancing. When we dropped to level 3 the rules allowed two bubbles to merge, so families that had been separated could then start visiting each other. It was a very simple concept that was easily understood.

The second was having a timeline. When we went into lockdown we were given both a goal and an exit strategy. We've all heard about "flattening the curve." But we had a secondary goal, one that isn't talked about nearly enough and that was to "break the chain of transmission." To do that we were given timelines. Remain at Level 4 for at least 2 incubation periods (we ended up staying at Level 4 for 2.5 periods). Stay at level 3 for an additional incubation period (we were there for 1.5 periods). Then at level 2 (where we are at now) for an indefinite amount of time, which still mandates social distancing but allows groups up to 10 people to meet (this amount to be reassessed periodically), and essentially every store to reopen.

Having that timeline: and watching what was happening around the world while we kept to that timeline was both horrific and convinced us we were doing the right thing. The government told us that what we saw "right now" would be based on our actions 2 weeks prior. And, as if on cue, two weeks into the lockdown we saw our first wave of deaths. In Italy and in the UK and in America the death toll is so big its almost to hard to comprehend. But here it was almost the opposite: it was a slow trickle of deaths, mainly from a single rest home, that firmed our resolve. If we had locked down a week later: how many more rest-homes would have been hit? If our lockdown hadn't been so strict, how many more would have died?

Our remoteness and our population size made our particular strategy of elimination a strategy with a good chance of success. But at least we had a strategy. The UK, America, Sweden, Brazil, there is no strategy. No plan. And these countries with no clear strategy and no plan basing policy on "bad science" are trying to "open up." With the greatest of respects: I'd much rather be "here" right now than "there", even if our airports remain closed for the immediate future.
  #240  
Old 05-25-2020, 08:58 AM
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I find it frustrating that countries are being judged by current death rates while the virus is still active and spreading. How long can people hide from this while the world economy continues to falter. Lives are not being saved only delayed. Many additional lives will be lost due to the damage we have allowed to control our lives an economies. Huge resources going into tracing that should be spent protecting those at risk.
This is sheer nonsense. Lives can indeed be saved. Staying in place slows the pace of spread, as the evidence clearly shows virtually every place on the planet. Such measures buy us all time, and it allows healthcare workers to do their job while simultaneously reducing the risk to critical front-line workers.

Not trying to be overtly partisan or political, but the reason it has failed so badly in the US is that we were simply not prepared. We've fumbled around for literally months trying to come up with things like PPE, contact tracing, and testing - and we're still fumbling. And we have a cultural problem as well as a political problem: far too many people are viewing this crisis in terms of their own individual desires and 'freedom' to wear a mask or not, to congregate or not, to listen to science or not. And the longer we do this, the longer the virus will last.

About 2/3 of people want to stay in place anyway. The danger is that this patchwork response will have some states opening while others are closing, and we will be spinning wheels. And the danger of that is that we all reach the conclusion that it doesn't matter what we do because death is inevitable -- which is wrong. Other countries have clearly shown how we can actually kinda, sorta live with this virus even as some of the more vulnerable may die from time to time.
  #241  
Old 05-25-2020, 09:00 AM
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NZ has done a great job... for NZ. It is a small island nation with a small population. Do you think the same thing could have been implemented in, say, the US?

Also, NZ's current measures will only continue to work if it doesn't let anyone new in (or takes an *extremely* cautious approach to letting anyone in). Especially since no one there will have immunity, and it will be gasoline and a match all over again. That's the hell of this thing.
NZ's policies and responses would have dramatically lowered the case load and number of fatalities had we adopted them here. Germany, South Korea, and Singapore all have also managed well, and while nobody's mentioning it, there are actually a number of success stories (for now anyway) in Africa and SE Asia. Really, we should be absolutely embarrassed at how badly a supposedly first world nation has responded to this crisis, and again I'm not being strictly political - the issue is as much cultural as anything.
  #242  
Old 05-25-2020, 09:05 AM
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In 2019, how many international flights a day landed in New Zealand? How many landed in the US?
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Old 05-25-2020, 09:06 AM
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I'm probably what might be called on the hawkish end of the cautious crowd. I am for targeted (but fairly quickly progressively wider) openings despite a lack of accurate testing, comprehensive contact tracing or a vaccine.

I think you have to realize that a significant part of this economic damage would have happened with or without government fiats on closures. Fear and a tonne of people getting actually sick from the disease would have done that.
Not necessarily. Businesses would have been tempted to remain open and to have their workforce come out until business got so bad that they had to close during slow periods. People still would have gone out ,virus be damned, out of sheer ignorance. Customer ignorance combined with the owners' desire to keep businesses going would have exposed workers to unnecessary hazards. Ordinary working class people should not be forced to pay for their government's abysmal failures to do its basic functions. I look at the stimulus program as a form of compensation for this failure.

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The US just had about two average flu seasons in two months.
Not sure what you mean here: there's typically one flu season that lasts several months. Are you suggesting that corona was simply another flu season?
  #244  
Old 05-25-2020, 09:07 AM
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In 2019, how many international flights a day landed in New Zealand? How many landed in the US?
A lot more in the US and the US has a lot more ports. That doesn't change the fact that the US could have been far more aggressive than it was in dealing with this situation. Yes, NZ is smaller, is an island, has fewer international flights - so what?
  #245  
Old 05-25-2020, 09:19 AM
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The UK, America, Sweden, Brazil, there is no strategy. No plan. And these countries with no clear strategy and no plan basing policy on "bad science" are trying to "open up." With the greatest of respects: I'd much rather be "here" right now than "there", even if our airports remain closed for the immediate future.
I don't think it is fair to say that Sweden had "no plan", "no strategy" or that they were basing it on bad science.

They absolutely have a plan, and its quite a challenging one to keep up. They also have a strategy and its based in the best science provided by the governments epidemics man.

Is it is a good strategy? That is a different issue. Personally I think it is at least reckless. Are they actually managing to carry out their strategy in practice? They have admitted that they failed in relation to the nursing home. So at best it is a partial success.

But they did have a science-based plan and they have stuck to it through hell and high water.
  #246  
Old 05-25-2020, 10:04 AM
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Lives are not being saved only delayed.
This is a super fatalistic and stupid belief. And unfortunately quite prevalent.

Let's be optimistic and assume that an effective treatment for this thing is right around the corner. If you take this drug as soon as you start showing symptoms, your chances of needing hospitalization decreases by 50%. For high-risk groups, the drug decreases the likelihood of going into the ICU by 50%. For the highest-risk groups, the likelihood of death decreases by 50%.

Would you rather contract the virus after this treatment goes on the market? Or would you rather contract the virus right now? How do you think the 100,000 folks killed by this thing would have voted, if they had been given a chance?

Another reason why this is dumb logic:

Everything we do is about delaying death. We spend umpty-ump trillions of dollars on military spending to delay our collective deaths, presumably. Think about all the happy, healthy, well-educated lives we could create if we diverted half of that on social welfare spending and education. But we've decided that killing and scaring people all around the world for the purposes of delaying our deaths somehow makes more sense. If this makes sense to you, then it should make sense to you why people want to temporarily sacrifice a booming economy for the same reason.
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Old 05-25-2020, 10:18 AM
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You can flip that logic and decide we need to keep the lockdowns indefinitely until there is a total cure. How long can we base things on the possibility of a cure being around the corner?

What will probably appen is that we'll develop better protocols and better understanding of when/why this goes bad in some people. That will reduce mortality rates from this disease. But planning based around some miracle breakthrough isn't smart.
  #248  
Old 05-25-2020, 10:28 AM
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You can flip that logic and decide we need to keep the lockdowns indefinitely until there is a total cure. How long can we base things on the possibility of a cure being around the corner?

What will probably appen is that we'll develop better protocols and better understanding of when/why this goes bad in some people. That will reduce mortality rates from this disease. But planning based around some miracle breakthrough isn't smart.
Planning around some conditions on the ground is smart, though.

The administration's guidelines for reopening laid out some key conditions. It doesn't seem like a lot of jurisdictions have been following those guidelines, which is sad, but who can blame them when the administration never took them seriously.

I agree that an indefinite lockdown planned around "what ifs" can't be justified. But lots of people don't even want to have a gradual reopening. They just want the virus to wash over the land and let the chips (bodies) fall where they may, since in their mind doing anything short of a complete return to normalcy is "not saving lives, just delaying deaths." The middle ground is rapidly disappearing in the discourse.
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Old 05-25-2020, 10:46 AM
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Yes, NZ is smaller, is an island, has fewer international flights - so what?
It means you can't make a good comparison when every single factor differs. Stockholm has three international airports and is the biggest city in northern Europe, with ten times the population density of Wellington. You'd expect Stockholm to be hit harder by the pandemic simply because that is the exact same pattern we have seen around the entire world.
  #250  
Old 05-25-2020, 10:57 AM
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You can flip that logic and decide we need to keep the lockdowns indefinitely until there is a total cure. How long can we base things on the possibility of a cure being around the corner?

What will probably appen is that we'll develop better protocols and better understanding of when/why this goes bad in some people. That will reduce mortality rates from this disease. But planning based around some miracle breakthrough isn't smart.
Developing better protocols and better understandings of when/why this goes bad in some people is one of the 'miracle breakthroughs' we're counting/working on.

CMC fnord!

Last edited by crowmanyclouds; 05-25-2020 at 10:58 AM.
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