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Old 05-18-2020, 12:53 PM
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The curve is flattened enough


The "flatten the curve" idea became well-known a couple of months ago, and we in the US have responded better than I could have imagined.

The whole point of that was not to reduce the number of people who eventually get infected, but to keep them from being infected all at the same time, to keep the hospitals from being overwhelmed. Because when enough of the population is infected that it overwhelms the hospitals, that's when people die in excess of the mortality rate you'd see if the hospitals can adequately treat those who are hard-hit.

Isn't that right?

I expected the rates to keep increasing along an exponential curve longer that they did, which means that we've done a better job at quarantining than I would have thought.

But it seems that hospitals in most of the country are far from being overwhelmed. Where do we go from here? A vaccine is a long way off - too far away to sustain the quarantine while waiting. Herd immunity is way way way off: something like 0.5% of the US has been infected, and at 30,000 new cases a day, it will take a decade or more to achieve herd immunity.

Should we just accept that most people are going to get it, that a percentage of those will die, and dial back the quarantine just enough to keep the health care system from hitting its capacity? People have to work to feed their families, and if most people are going to get it anyway, should we just move along as much as we can, short of hitting infection rates that cause a higher percentage to die?

Or is there some other goal? Are we hoping that testing and contact tracing will help us isolate the pockets of infection to stamp it out that way? We just need to wait for more and better tests?

I'm asking a lot of questions, sincerely not knowing the best answer, but it seems at this point that we just need to relax the quarantine and let the infection spread more. I realize that a lot of people will die (millions in the US alone), but if they're going to get killed by it anyway, is it doing us any good to delay the inevitable and cause more suffering due to unemployment and economic damage?
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Old 05-18-2020, 01:17 PM
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I am not an expert or anything, but if the goal is to "stamp out" the virus I think that is an unrealistic goal, and I agree waiting it out until a vaccine emerges is also unrealistic. That does not mean we should just let it fly, of course, but if the infection rate is such that hospitals are able to keep up while also delivering on other non-COVID community needs, then perhaps relaxing some of the restrictions should be considered while maintaining caution and vigilance (social distancing, masks, workplace measures to limit spread, hand washing, etc.).

The complimentary goals should be both slowing the spread while allowing gradual re-opening of our economy and reducing the unemployment rate. If there is a setback in a specific area (measured by hospital capacity issues) then restrictions are restored for a while. I think it is unrealistic to have a goal of "preventing" spread, illness, hospitalizations, and death from the virus - but we should implement measures to slow it down, as we have done.
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Old 05-18-2020, 01:28 PM
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For myself, I've been working with the assumption that as some point I will get COVID-19, but I'm doing what I can to delay that as long as possible.
Delay to give scientists a better chance to collect data and to learn (can we get reinfected for example), time for manufacturing to turn around and make what we are short on (masks and other PPE, ventilators), time for treatments to be devised and tested.
And time for the overworked and stressed health care workers to rest and recover.
The longer I personally can delay getting COVID, the better I feel my chances of recovering are.

So I won't be dining in any time soon, or going to bars, or attending large gatherings. These are luxuries, not necessities. I'd rather revamp the economy than sacrifice peoples' lives to "save the economy".
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Old 05-18-2020, 01:52 PM
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Originally Posted by CurtC View Post
Should we just accept that most people are going to get it, that a percentage of those will die, and dial back the quarantine just enough to keep the health care system from hitting its capacity?
The issue seems to be that a significant minority of the U.S. population isn't interested in "dialing it back just a bit" -- as states have been opening things back up, some people are acting like everything can and should be back to normal now. They refuse to wear masks, they're crowding into bars and restaurants, etc.

If, as a result of that sort of behavior, we *don't* see the curve head back upwards in those areas in the next few weeks, I'll be stunned. And, if/when that happens, I fear that we can expect to see angry protests if those areas attempt to reinstate shelter-in-place orders.
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Old 05-18-2020, 01:53 PM
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something like 0.5% of the US has been infected, and at 30,000 new cases a day
This is the only really weak part of your post. God only knows what the real numbers are because for the most part Americans can only get tested if their physician/ER feels they have it. That demands symptoms strong enough to send someone to the doc or ER. So mild cases, and family members of confirmed cases may have it, get over it, and stay off the statistic charts (my situation). On top of that, Doc/ER may not test you anyway because 1) It's clear you've got it, or 2) they don't have the means to do the testing anyway. And on top of THAT, the COVID tests are wildly inaccurate, yielding false negatives even fairly early on in the affliction.

Otherwise, I'd be inclined to agree that as long as the local hospitals have the capacity then it's appropriate to take measures that will increase the number of cases they see--with an aim of meeting but not beating their capacity. Because we're not going to get rid of this thing any time soon.

However, given the chaos surrounding this administration's handling of the outbreak, it's suppression of CDC studies, and any number of corporations claiming to have the necessary snake oil to beat it...who will be the first to try any proposed vaccine or medicine? Not me or mine, seems wiser to let someone else take that chance.

Personally I think America will handle it the same way as it has handled any frontier: lots of trial and error, astounding ingenuity, and copious rolls of the dice. We will go back to a slightly modified 'normal' way too soon, we will lose way more people than we would have had we behaved like better-favored countries, and we will emerge with the strongest economy in the world for our 'sacrifices'. And although this is not the moral path, it is the only path that will land us the respect of whomever is left and the power to maintain control of our national destiny; because at the end of all things, he who has the gold will still be making the rules.
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Old 05-18-2020, 02:30 PM
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The issue seems to be that a significant minority of the U.S. population isn't interested in "dialing it back just a bit" -- as states have been opening things back up, some people are acting like everything can and should be back to normal now. They refuse to wear masks, they're crowding into bars and restaurants, etc.
....
I find this characterization a little problematic.

IMO, the restrictions imposed were not tailored to address the greatest risks. Nor is it clear to me that the loosening of those restrictions is entirely sensible. The terminology used (essential) is problematic in itself.

One local example involved churches (something I have ZERO use or sympathy for.) In CHicago, a number of churches wanted to hold services. They were denied, despite what impressed me as detailed plans including social distancing/masks, disinfectant/door openers/etc. I could not understand why the city wanted to deny responsible behavior - in effect, lumping well-intentioned behavior in with the irresponsible.

Given the irrational aspects of the regs and reopening plans, it does not strike me as unreasonable that some people rebel.

I certainly agree with you that folk who say, "Open everything up immediately" are off base - and dangerous.
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Old 05-18-2020, 02:36 PM
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I hope I don't contract COVID-19 because I have several serious risk factors, and I'm not ready to die yet. Therefore, my personal behavior is for my benefit not the economy's. I will continue to self-isolate until at least there is a proven vaccine. When the majority of people in my area stop wearing masks, I will switch to a mask that protects me instead of one that protects other people, and i will wear it everywhere outside of home. I will urge my husband to do the same, but if he does he will be doing it for me more than for himself, because he doesn't have most of the risk factors I have.

So go ahead, open all the movie theaters and restaurants and bars you want, I won't be going to them for a while.
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Old 05-18-2020, 02:37 PM
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The issue seems to be that a significant minority of the U.S. population isn't interested in "dialing it back just a bit" -- as states have been opening things back up, some people are acting like everything can and should be back to normal now. They refuse to wear masks, they're crowding into bars and restaurants, etc.

If, as a result of that sort of behavior, we *don't* see the curve head back upwards in those areas in the next few weeks, I'll be stunned. And, if/when that happens, I fear that we can expect to see angry protests if those areas attempt to reinstate shelter-in-place orders.
Yep.

My family and I went to a strawberry picking farm this morning- it's about 50 miles north of Dallas, and there were about 200-250 people there, in a small field, and about 1 in 20 were wearing masks, and virtually none of them were actually paying attention to social distancing.

It was like their lizard brains interpreted "limited lifting of restrictions" to mean "back to normal". We were pretty astounded, annoyed and not a little bit frightened.


The hope was that after we've flattened the curve and kept the spread from becoming exponential, that we'd follow that up with really vigorous testing and contact tracing combined with social distancing, mask-wearing and other precautionary measures to keep the virus cases at a relatively low, manageable level until a vaccine is found.

But with these imbeciles doing what they were doing at the strawberry farm, and what I'm sure they're doing in hundreds of other places, we just delayed the exponential outbreak and probably guaranteed ourselves another round of total lockdown later in the summer.
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Old 05-18-2020, 02:39 PM
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Should we just accept that most people are going to get it, that a percentage of those will die, and dial back the quarantine just enough to keep the health care system from hitting its capacity? People have to work to feed their families, and if most people are going to get it anyway, should we just move along as much as we can, short of hitting infection rates that cause a higher percentage to die?

Or is there some other goal? Are we hoping that testing and contact tracing will help us isolate the pockets of infection to stamp it out that way? We just need to wait for more and better tests?

I'm asking a lot of questions, sincerely not knowing the best answer, but it seems at this point that we just need to relax the quarantine and let the infection spread more. I realize that a lot of people will die (millions in the US alone), but if they're going to get killed by it anyway, is it doing us any good to delay the inevitable and cause more suffering due to unemployment and economic damage?
So, we definitely cannot eradicate the SARS-CoV-2 virus in the population without a vaccine (and an aggressive global vaccination campaign) because even if we could eliminated it in the human population of industrial nations it will likely become endemic in both developing nations and in other mammals in which it has been shown to infect. (How much of an actual reservoir and how much spillback can occur is uncertain but given the infectiousness of the virus any propensity for spillback will ensure persistence of the contagion.)

So, we need to have a plan for dealing with the spread of the virus and resulting COVID-19 outbreaks that allows it to advance through the population at a controlled non-epidemic rate while identifying the particular conditions or factors that make certain people (not all of them older or having evident co-morbidities; the serious and critical presentations of COVID-19 are now known to affect some proportion of young and health individuals including a small minority of children) while developing therapeutic treatments and working on vaccine development and trials. If we could identify the people who are not prone to severe reactions we could actually expose them to the virus in a controlled fashion (variolation) thus driving toward a herd immunity threshold.

However, this doesn’t just mean that “the curve has flattened enough” and we should just open everything up and let the contagion takes its natural course. Doing so would simply result in a delayed epidemic that would look like what Iran or Russia is experiencing now. Instead, what is needed is a controlled loosening of isolation guidelines that allows for essential services to be expanded combined with tracking and trending the spread of contagion to prevent it from getting out of control and overwhelming health services. This does mean faster and more accurate testing (both antigen and antibody) so that these trends can be monitored and models can be corrected with reliable data.

There has been a lot of discussion about tracking and tracing of individual exposures and outbreaks but after looking at a lot of the most recent data I’m dubious that at the current low level of exposure (estimated somewhere between 5% and 10% in North America but heavily weighted toward urban populations) and the latency period of the infection that track & trace of individual contacts even via automated smartphone tracking is really going to provide useful information that will let health authorities isolation outbreaks. The smarter thing to do is to look at predictive models (with the knowledge that they are going to provide a very broad range of different values) and select isolation measures to be relaxed based upon infecting specific groups both with an eye to controlled infection limiting contact to known severely affected cohorts AND to what are the most essential services for society as a whole. To that end, reopening primary and secondary schools to all children who don’t have any underlying conditions and whose parents are willing probably makes sense both from a practical point of view of controlled infection while also ensuring that children are getting both the education and social interaction that they need for development.

Reopening bars, beaches, churches, and concert venues however, is just asking for mass outbreak, and particularly among people who are more likely to have severe consequences. What is really needed is both a public education campaign combined with modeling from political leaders on appropriate levels of interaction, and in that we have seen numerous failures with potentially catastrophic consequences in terms of both overwhelming health systems and political stability.

BTW, there has been a lot of discussion here and elsewhere about the need to achieve “herd immunity” as fast as possible so we can “reopen the economy”. First of all, it should be understood that herd immunity is not, in and of itself, a strategy; it is an exposure threshold above which the contagion drops below epidemic proportions, i.e. the virus can not longer infect enough people to grow at geometric rates. Provided that the immunity conveyed by exposure lasts for a significant duration (years, hopefully decades) we will achieve that herd immunity threshold one way or another, but rushing toward it just ensures maximum mortality. The other consideration is that due to the infectiousness of the virus (with an estimated R0 of now between 3.8 and 8.9) the herd immunity threshold falls between 74% and 89% of the population being exposed and developing and effective immune response. That is very high, and if the effective immune response only lasts for a few months or the spike protein mutates between variants such that the immune response does not cover all circulating virus, there may be no herd immunity. We never achieved herd immunity with varicella zoster despite the fact that nearly every person on the planet was infected as a child and attained effective lifelong immunity, and so it is possible we may have to live with regular (if less severe) outbreaks of SARS-CoV-2 indefinitely until an effective virus is developed, and even that may require periodic inoculation similar to influenza although the mutation rate of this virus appears to be about a quarter compared to the influenza viruses, so you might need an inoculation only once every few years.

The result is that we probably need to consider some long term modifications to both our socioeconomic institutions as well as more vigorous surveillance for infectious pathogens rather than to just assume that we can achieve some herd immunity threshold and everything goes back to normal. We need that, anyway, because this is neither the last nor most virulent infectious pathogen we are going to have to deal with as a civilization, and the next one that comes along might have a mortality that is an order of magnitude greater than this or worse.

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Old 05-18-2020, 02:43 PM
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I think one issue is that the promises/plans to preserve social distancing are either intentionally disingenuous or pipe dreams. Businesses can't enforce social distancing rules on their customers--they just can't. The whole "customer is always right" culture makes it impossible for a clerk or a cashier to tell someone or a group to leave a store, or even remind them forcefully to observe the rules. And in many cases, businesses just can't follow the rules if they want to stay in business. You can't afford to run a restaurant if you never go about 25% capacity, and probably not if you never go above 50%. And everyone knows this. So gradual reopening is, at least here in TX, pretty openly being practiced with a wink and a nod, a common understanding that businesses will do the "best they can'.

What we need, desperately, is some actual science about how this shit spreads and what is actually effective to stop it. There doesn't seem to be any consensus. I am happy to believe that it's half security theater, but I don't know WHICH half. I don't know if it's surfaces or enclosed spaces or hugs or what that does the damage.

We are about to have a huge set of "socially distant" but in-person graduation ceremonies around here. I truly don't know if 1) the precautions as written are reasonable and prudent and 2) if it's actually logistically possible to follow those precautions. And I don't think anyone else knows, either.
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Old 05-18-2020, 02:43 PM
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Because when enough of the population is infected that it overwhelms the hospitals, that's when people die in excess of the mortality rate you'd see if the hospitals can adequately treat those who are hard-hit.

Isn't that right?
One question I haven't seen answered is just how much can hospiutals effectively do to treat Covid-19?

I know that a lot of people who get infected never need hospitalization. And I know that a substantial number of people who do get hospitalized or put on ventilators end up dying anyway. What I wonder about is how many people survive because they got hospital treatment who would have died if they hadn't—how much does medical treatment improve a person's chance of survival?
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Old 05-18-2020, 02:50 PM
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What we need, desperately, is some actual science about how this shit spreads and what is actually effective to stop it. There doesn't seem to be any consensus.
Right, although my impression is that we are making some progress and we do know more than we did a month or two ago.

And, depending on what the "actual science about how this shit spreads and what is actually effective to stop it" turns out to be, there might, or might not, be effective steps we as a society can take to stop the spread, even in the absence of a vaccine. If we had a good way to tell who's infectious and who isn't, and how to keep those who are infectious from infecting others, we'd be a long way toward having this thing licked.
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Old 05-18-2020, 02:56 PM
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I think we have a lot more data than we did, and a lot of studies, but I don't know that any sort of consensus is emerging.
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Old 05-18-2020, 03:05 PM
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It was like their lizard brains interpreted "limited lifting of restrictions" to mean "back to normal". We were pretty astounded, annoyed and not a little bit frightened.

Very well put.

Said lizard brains say, "WooHOO, we flattened the curve, let's party! They don't want to understand that the best behavior to insure survival is to EXTEND that flattened curve.

It's frightening.

The same people are saying that the only ones to die are the old ones with compromised health, and everyone would be better off if they were dead, anyhow. Since I fall in that miserable category, I'm not happy.

I have many rude comments on the whole mess.


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Old 05-18-2020, 03:06 PM
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My family and I went to a strawberry picking farm this morning- it's about 50 miles north of Dallas, and there were about 200-250 people there, in a small field, and about 1 in 20 were wearing masks, and virtually none of them were actually paying attention to social distancing.

It was like their lizard brains interpreted "limited lifting of restrictions" to mean "back to normal". We were pretty astounded, annoyed and not a little bit frightened.
I'm from Dallas, but have been quarantining in east Texas, south of Tyler, since March 12.

What you saw with people being sloppy with masks and social distancing - is that different from what it's been for the last two months? That's what I've seen as a universal rule, but even with that sloppiness we've managed to flatten the curve to well below the level that it stresses hospitals. My family and I actually dined in at a restaurant in Tyler on Saturday.

I don't want to get it - my wife and I are approaching 60, so it is concerning (we're both healthy so the concern is not dire). But I can't see society keep up the severe restrictions for even six more months, even sloppily following restrictions, so I'm wondering what is the best plan for the next three months to two years.
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Old 05-18-2020, 03:51 PM
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One question I haven't seen answered is just how much can hospiutals effectively do to treat Covid-19?

I know that a lot of people who get infected never need hospitalization. And I know that a substantial number of people who do get hospitalized or put on ventilators end up dying anyway. What I wonder about is how many people survive because they got hospital treatment who would have died if they hadn't—how much does medical treatment improve a person's chance of survival?
The survival rate on mechanical ventilation has gone up a bit but the statistics are still rather dire, and it is possible that in many cases ventilation my actually be exacerbating the coagulation problems. However, there have been a number of revelations on therapeutic treatments to prevent people from being put on mechanical ventilation that have made significant improvements. More early detection testing and an effective anti-viral treatment combined with prophylaxis (specific anti-viral immune system factors, inhibition peptides) may significantly reduce the potential for infection or progression of the COVID-19 disease.

Because this has now been determined to be more than a respiratory infection, and specifically the propensity to cause blood clotting, physicians know the signs and symptoms to look for and can apply treatments to reduce coagulation and prevent strokes due to blood clots. And of course supplemental oxygen is quite necessary for anyone suffering low oxygen perfusion, and hospitals and medical gas suppliers have limits to how much medical grade oxygen they can produce and store at a given time. Without that support, people will become hypoxic and suffer brain and nervous system damage, and eventually death.

So, there is a lot that general hospital and ICU support can do to help many patients provided these facilities are not overwhelmed. But if they are, we can’t just conjure up beds, anti-coagulant and steroidal treatments, or supplemental oxygen out of thin air, and people who need that support now will not receive it.

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Old 05-18-2020, 03:58 PM
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I have diabetes and hypertension. So getting it would NOT be good. I'd likely need a hospital. So I'm waiting, hoping for medication that can help fight it off. I would think that finding medication will be easier than the vaccine, so maybe that Remedivir or whatever else can be discovered quickly/
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Old 05-18-2020, 04:08 PM
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Texas reports massive jump in COVID-19 cases in single day
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The surge in positive cases comes at the same time Texas has seen a spike in deaths over the last three days. The state reported 33 more deaths on Saturday, bringing the three-day total to 147 — the worst three days since the pandemic began. On Thursday the state reported 58 deaths — the highest single-day increase in deaths in one day in Texas during the fight against COVID-19.
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Old 05-18-2020, 04:14 PM
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A huge part of the reason that we cannot reopen things is becuase we do not have the testing in place necesary.

We cannot just base things on hospital emmisions, we have to know ahead of time what hospital emissions are going to be.

The fun thing about exponential growth is that it tends to go up faster than you'd expect.

Let say we start with 5 people a day are being admitted to a hospital that can handle 30 a day.

Now, with robust testing, we see a spike in infections. We know that the number of hospitalizations will be going up over the next week. So, a week from now, we will have 15. You prepare for the increase, and then the next week it starts going back down, as social distancing measures start to take effect.

Without robust testing, you have 5 people a day coming into the hospital. Next week, it's 15 a day, and you are starting to get nervous, so you start pushing for social distancing and business shut downs. By the end of the next week, you have 45 a day coming in, and your hospital is overwhelmed, and you hope that you did enough that next week you are back down to 15 a day.

As I was talking to a client just today, "He asked, when will we get back to normal?" My reply, "When we accept this as the new normal."



Maybe I played Trimps too much back in the day, but exponential growth seems to be pretty obvious to me, but for whatever reason, many don't seem to see it that way. You really can't "ride the line" of picking a hospital utilization threshold and trying to stay there. You really need to overdo things, because there really is not much wiggle room in there, not when you are dealing with exponents.
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Old 05-18-2020, 04:14 PM
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So Greg Abbott decided this would be a good time to announce additional easing of restrictions including allowing bars to open on Friday.
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Old 05-18-2020, 04:38 PM
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.

The longer I personally can delay getting COVID, the better I feel my chances of recovering are.
Do you, though? Right now in my state the hospitalization rate is 10%. It makes me wonder if I'm doing myself a disservice by continuing to stay home (other than bringing my garbage to the dump once, which is a contactless activity, I have been home since March 22) given I'm mildly asthmatic because aren't my chances better if I get it soon and get it over with while hospitals are in decent shape rather than during the almost inevitable second wave this fall/winter?

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Old 05-18-2020, 04:49 PM
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...Instead, what is needed is a controlled loosening of isolation guidelines that allows for essential services to be expanded combined with tracking and trending the spread of contagion to prevent it from getting out of control and overwhelming health services. ...
I always welcome your posts.

Just one small point - how do you feel about the term "essential" as it is being used WRT jobs/businesses/etc. I know it is the commonly used term, but I find it quite problematic.
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Old 05-18-2020, 05:06 PM
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A number of nations in Europe and Southeast Asia are currently engaged in the ticklish and tricky business of reopening and returnig to normal, while watching that R number like hawks. What they have in common is that the did not just "flatten" the curve, but rode that slope down all the way on the other side.

This is an article from almost a month ago on nations reopening. To the best of my knowledge none of them are finished and they are all still doing baby steps.
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Old 05-18-2020, 05:40 PM
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The issue seems to be that a significant minority of the U.S. population isn't interested in "dialing it back just a bit" -- as states have been opening things back up, some people are acting like everything can and should be back to normal now. They refuse to wear masks, they're crowding into bars and restaurants, etc.

If, as a result of that sort of behavior, we *don't* see the curve head back upwards in those areas in the next few weeks, I'll be stunned. And, if/when that happens, I fear that we can expect to see angry protests if those areas attempt to reinstate shelter-in-place orders.
Yep. That's happening here in NYC, which has not started to reopen yet. But people are sick of it all and are (irresponsibly) not wearing masks, not distancing, and bars and restaurants that cater to younger groups are re-opening (semi-clandestinely, but they're open, no doubt about it).

I'd be surprised if we don't see an uptick in rates of infection (and death) soon.
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Old 05-18-2020, 06:04 PM
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Yep. That's happening here in NYC, which has not started to reopen yet. But people are sick of it all and are (irresponsibly) not wearing masks, not distancing, and bars and restaurants that cater to younger groups are re-opening (semi-clandestinely, but they're open, no doubt about it).

I'd be surprised if we don't see an uptick in rates of infection (and death) soon.
That's the thing, tho. *Any* relaxing of restrictions is likely to result in an increase in infection and possibly deaths. I think we need to accept a certain amount of risk here, with the capacity at hospitals being the primary constraint, and higher-risk individuals continuing precautions. Otherwise, we are going to have to stay locked in our homes until a vaccine appears.
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Old 05-18-2020, 06:19 PM
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Just one small point - how do you feel about the term "essential" as it is being used WRT jobs/businesses/etc. I know it is the commonly used term, but I find it quite problematic.
The term is certainly being thrown about with little regard for the literal meaning; golf courses, bars, hair and nail salons are not “essential” by any definition. On the other hand, I am sympathetic to the fact that many of these are small businesses that cannot modify their practices to align with “social distancing” measures in any conceivable way to be able to operate and make any kind of revenue. Nor, frankly, can sit down restaurants, fitness studios, coffeeshops, et cetera, and we are collectively doing little figure out ways of assuring that these businesses do not fail hard even though they cannot possibly pay expenses like rent or payroll much less participate in the economic infrastructure of purchasing supplies.

I’m particularly concerned about restaurants because many of the people who work in restaurants and hospitality do not have college degrees or experience that could be applied to other industries, many are part time or gig workers who already lacked any job stability or significant savings, and the industry as a whole simply cannot survive with any kind of “social distancing” measures as most restaurants are marginally profitable even when they are doing strong business (and without alcohol sales many upscale restaurants would be totally underwater). These businesses are the end point of many other industries supplying meat, fresh produce, baked goods, dishware, linens, equipment, advertising, et cetera so what is already a significant industry upon itself is just the tip of the iceberg from an economic standpoint which is already rippling through the meat, cheese, and beer/wine/liquor suppliers and will affect others in turn. I would like to find a way for these businesses to reopen in a sustainable fashion but am at a loss for how to do so in the foreseeable future.

So, I think some plan for staged reopening has to be considered and implemented both for the economic reality and so we can have a managed approach to getting enough immunity that the contagion doesn’t spread like wildfire. And businesses that are actually essential to the economy, and businesses that are essential for health and welfare, including non-contagion-related medical practices, dentists, physical and occupational therapists, et cetera, also need some plan to return to service, as do less-than-essential-but-still-necessary services like barbers and hair salons, clothing stores, et cetera. But just opening everything up for business, giving the notion that physical distancing and mask wearing are optional, and hoping for the best is not a plan.

And without a plan, that “flattened curve” (which, in the United States even few states have actually achieved) is rapidly going to return to aggressively positive, and the longer that goes on the harder it will be to drive it flat again until maximal exposure levels are achieved. Which, if you are okay with writing off a few million people, is a plan of sorts. It just isn’t the kind of plan I think any rational person who actually understands anything about epidemiology or has concerns for other people should advocate.

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Old 05-18-2020, 08:28 PM
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So, we definitely cannot eradicate the SARS-CoV-2 virus in the population without ...

<snip>

... To that end, reopening primary and secondary schools to all children who don’t have any underlying conditions and whose parents are willing probably makes sense both from a practical point of view of controlled infection while also ensuring that children are getting both the education and social interaction that they need for development.

Reopening bars, beaches, churches, and concert venues however, is just asking for mass outbreak, and particularly among people who are more likely to have severe consequences. ...
We have covered this ground enough by now that I am sure my broad agreement with your take in that post is no surprise, so I've only included a portion that includes something deserves special emphasis and something that I think is not as clearcut as you state it.

The schools portion I, as a pediatrician, completely concur on. Keeping schools closed is imposing a huge cost on children and their futures while the risks to them from this disease are a small fraction of the risk they must deal with every influenza season. This from a letter in JAMA Pediatrics
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The risks posed by delaying school openings are real and sizeable, particularly for students from low-income families.1,2 The phenomenon of summer learning loss has been well established, with children losing a mean of 1 to 3 months in varying subjects. Some estimate that there will be a 9-month to 12-month loss when children return to school in the fall, and this will only be compounded if distance learning continues. No credible scientist, learning expert, teacher, or parent believes that children aged 5 to 10 years can meaningfully engage in online learning without considerable parental involvement, which many families with low incomes are unable to provide because parents must work outside the home.
The degree to which spread is slowed to others by school closures is unknown but by the evidence to date remains is fractional compared to influenza as well.


Bars? Concerts? No question. Tightly packed enclosed space, yelling and singing even, big risk. Benefits to quality of life and the economy non-zero but not as vital. I can imagine socially spaced concerts but hard to imagine them being worthwhile financially ... or very fun.

Beaches? Now we get into some question. Open air is much less risk than enclosed spaces and while some are beaches are very crowded they are not in general tightly packed spaces. Even fairly busy beaches usually have families setting up their umbrellas and chairs at least six feet away from each other. Stating that as a more clear guideline seems to be not so difficult and the violations that will occur of a low risk sort.

Houses of worship, such as churches. I am not so religiously observant myself but the importance of in person services is huge to many. The quality of life reduction by none for this group is massive. Are there ways to allow services in ways that minimize the risks? And yes there are. Reduced capacity services with every other row seating spaced six feet apart, possibly with several services in shifts, and more attending on line, or perhaps alternating cohorts that attend in person on different weeks. Crowded services with lots of singing though? No. Late stage only.


These are though the sorts of disagreements and discussions to have, over what is actually the most benefit change for the least risk to make, and how to decide how to stage. Yes some will be by the natural experiments going on as different places relax in different ways. The results will need to be interpreted with caution: The U.S. is not Sweden and Texas is not Michigan. They are not controlled studies methodically designed. Still we will learn what we can by watching other nations and individual state results from their approaches. The lack of strong and effective national level leadership (I hope that does not cross the political line) has left us with this patchwork of experiments (I don't presume the results of any of them), and some will very likely have flares that minimally test the limits of their systems as they make it up on the fly. Yes it does seem like some are rushing in where angels fear to tread. But spinning this the best way possible - summer is the time to learn these lessons, when capacity is not already strained with influenza, and the lessons learned may help prevent worse problems in the Fall.
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Old 05-18-2020, 08:54 PM
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I hope I don't contract COVID-19 because I have several serious risk factors, and I'm not ready to die yet. Therefore, my personal behavior is for my benefit not the economy's. I will continue to self-isolate until at least there is a proven vaccine. When the majority of people in my area stop wearing masks, I will switch to a mask that protects me instead of one that protects other people, and i will wear it everywhere outside of home. I will urge my husband to do the same, but if he does he will be doing it for me more than for himself, because he doesn't have most of the risk factors I have.

So go ahead, open all the movie theaters and restaurants and bars you want, I won't be going to them for a while.
I could have written this. Some of us continue to self-isolate for our own benefit, not for any "community" benefit. And the economy is other people's concern, not mine. My only concern is my life and that of my husband. I already see some people without masks, and I stay as far away from them as possible. This will continue until there is a vaccine.
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Old 05-18-2020, 09:00 PM
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I could have written this. Some of us continue to self-isolate for our own benefit, not for any "community" benefit. And the economy is other people's concern, not mine. My only concern is my life and that of my husband. I already see some people without masks, and I stay as far away from them as possible. This will continue until there is a vaccine.

Sounds like Mr VOW and me. He's 70, recent heart attack. I'm 67, Type 2 Diabetes, high blood pressure, etc etc. Neither one of us is ready to die. Hell, these are our Golden Years!


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Old 05-18-2020, 09:02 PM
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Beaches? Now we get into some question. Open air is much less risk than enclosed spaces and while some are beaches are very crowded they are not in general tightly packed spaces. Even fairly busy beaches usually have families setting up their umbrellas and chairs at least six feet away from each other. Stating that as a more clear guideline seems to be not so difficult and the violations that will occur of a low risk sort.

Houses of worship, such as churches. I am not so religiously observant myself but the importance of in person services is huge to many. The quality of life reduction by none for this group is massive. Are there ways to allow services in ways that minimize the risks? And yes there are. Reduced capacity services with every other row seating spaced six feet apart, possibly with several services in shifts, and more attending on line, or perhaps alternating cohorts that attend in person on different weeks. Crowded services with lots of singing though? No. Late stage only.
Your arguments on both points are valid, although I would note that getting actual compliance from the general public on following guidance is a different issue. But that gets to another salient issue, which is that if you don't open up at least some venues for public interaction people are eventually going to start violating the prohibitions en masse anyway, which will also further erode any confidence or respect people have for government. So while I would argue that beaches are not essential (I'll grant the benefits of houses of worship for those who are pious though I doubt many are going to follow strict guidelines) but that when you get to the point that people are going to go to them regardless, you may as well at least give some allowance and try strongly recommended guidance because the other alternative is mass disobedience. And frankly, a resultant wave of infections that could be traced back to people on beaches ignoring distancing measures may serve to reinforce the need for such measures pour encourager les autres, as awful as that sounds.

I'm not unsympathetic to the need for people to be able to get out and do things to relieve the pressure of being stuck at home; I've been personally frustrated by the inability to go out camping or hiking (even though the trails are generally pretty sparse, the potential for infection in open air is much lower, and the ability to maintain distance is pretty easy) and when the local wilderness trail opened up last week, their strictures were so ridiculous and in some ways counterproductive (everybody has to be counted and go through a gate, which led to people just bunching up) that I gave up on it. But I also see a thundering herd of people walking around and interacting in apparently complete ignorance of distancing guidelines, and even the occasional expression of contempt for maintaining distance or wearing a face mask, which means even the marginal effectiveness of basic distancing measures is probably overstated. And this is in a state where the government has actually taken the threat of widespread epidemic seriously.

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Old 05-18-2020, 09:14 PM
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I'm from Dallas, but have been quarantining in east Texas, south of Tyler, since March 12.

What you saw with people being sloppy with masks and social distancing - is that different from what it's been for the last two months? That's what I've seen as a universal rule, but even with that sloppiness we've managed to flatten the curve to well below the level that it stresses hospitals. My family and I actually dined in at a restaurant in Tyler on Saturday.
I don't know if it's any different than it's been for the past couple of months; with the exception of going to grocery curbside pickup, and to get my younger son stitches in his chin (tree climbing accident), I haven't gone anywhere.

But the thing was, this wasn't sloppy, this was *just* like it would have been this time last year, except that maybe 5% of people were wearing masks.

Had one person actually been contagious, there could have been a huge number of people who ended up infected.
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Old 05-18-2020, 09:44 PM
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I realize that a lot of people will die (millions in the US alone), but if they're going to get killed by it anyway, is it doing us any good to delay the inevitable and cause more suffering due to unemployment and economic damage?
Yes, we've flattened the curve to some degree, but we've done that not by producing tests or by tracing, tracing, and quarantining people. We've largely achieved flattening the curve by shutting everything down for 6-10 weeks. Even weeks and weeks after the lock-downs began, we had 2000 deaths per day until fairly recently.

We're right to be concerned about the economy. People don't want to accept that millions of lost jobs is inevitable, but at the same time, people don't want to just accept that their lives are inevitably going to end 10-20 years early. People don't want to accept that they have to end up in the ICU for 3 weeks and bankrupt after they leave the hospital (speaking of economics).

Right now probably no more than 5% of the country's population's been exposed to the virus. What happens when start letting our guard down and workers start dropping like flies? Look at what's happening at meat packing and industrial facilities.
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Old 05-18-2020, 11:35 PM
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I think one issue is that the promises/plans to preserve social distancing are either intentionally disingenuous or pipe dreams. Businesses can't enforce social distancing rules on their customers--they just can't. The whole "customer is always right" culture makes it impossible for a clerk or a cashier to tell someone or a group to leave a store, or even remind them forcefully to observe the rules. And in many cases, businesses just can't follow the rules if they want to stay in business. You can't afford to run a restaurant if you never go about 25% capacity, and probably not if you never go above 50%. And everyone knows this. So gradual reopening is, at least here in TX, pretty openly being practiced with a wink and a nod, a common understanding that businesses will do the "best they can'.

What we need, desperately, is some actual science about how this shit spreads and what is actually effective to stop it. There doesn't seem to be any consensus. I am happy to believe that it's half security theater, but I don't know WHICH half. I don't know if it's surfaces or enclosed spaces or hugs or what that does the damage.

We are about to have a huge set of "socially distant" but in-person graduation ceremonies around here. I truly don't know if 1) the precautions as written are reasonable and prudent and 2) if it's actually logistically possible to follow those precautions. And I don't think anyone else knows, either.
I agree with this and I think we are all getting a lesson in human psychology. We are higher level beings, but at the core we are animals. I think it is unrealistic to tell people for more than the two months we have been doing this that they cannot interact with others, that they can keep in touch online, and not hug, slap each other on the back, shake hands, congregate in bars and churches (some people do both) etc. People start getting a little squirrely and will rationalize why they can go back to that. It is the vast minority of people who are okay with being socially distant for extended periods of time.

Any plan must take that into account and it seems that at least publicly, none of the plans have admitted this very basic fact. People did what was asked for two months, but preach all you like, they will not do it for six to eighteen months.

Further, I am not in the restaurant business, but I know people who are, and you simply cannot, in that business or any, operate at 25 or 50 percent capacity. Your rent or mortgage is not at 25 or 50 percent. The electric bill is not at 25 or 50 percent. Although you can lay off some staff, it is nowhere near linear. If you had 10 people at full capacity, you cannot have 5 or 2.5 at reduced capacity, more like 8. Your personal expenses are not at 25 or 50 percent.

So you either continue the slow slide into bankruptcy or close now and take a financial hit that is merely terrible instead of catastrophic.



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That's the thing, tho. *Any* relaxing of restrictions is likely to result in an increase in infection and possibly deaths. I think we need to accept a certain amount of risk here, with the capacity at hospitals being the primary constraint, and higher-risk individuals continuing precautions. Otherwise, we are going to have to stay locked in our homes until a vaccine appears.
Right. I think it is terribly irresponsible for some in the media to be reporting as if TX is failing here. It was always about flattening the curve, then relaxing restrictions, and once they were relaxed, of course we would see an increase in cases. That doesn't mean it failed or it was too early, it was exactly as predicted.

It is bait and switch to say that restrictions cannot be relaxed until we are sure that there will not be an increase in new cases. That will never happen without a cure or a vaccine and nobody (at least when this started) said that we were locking down that long.
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Old 05-19-2020, 04:20 AM
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I find it interesting that drive in theaters, before most were closed or going down, are now having record business. The ones open here in Kansas City are showing old movies but to sell out crowds. Musicians are starting to do drive in concerts. A high school is holding their graduation at one.

One local drive in has gotten record bookings.

So the new normal may be the re-opening of the drive in.
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Old 05-19-2020, 05:23 AM
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The "flatten the curve" idea became well-known a couple of months ago, and we in the US have responded better than I could have imagined.

The whole point of that was not to reduce the number of people who eventually get infected, but to keep them from being infected all at the same time, to keep the hospitals from being overwhelmed. Because when enough of the population is infected that it overwhelms the hospitals, that's when people die in excess of the mortality rate you'd see if the hospitals can adequately treat those who are hard-hit.

Isn't that right?
Yes, that is correct.

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I expected the rates to keep increasing along an exponential curve longer that they did, which means that we've done a better job at quarantining than I would have thought.
Yes, oddly enough most people have some smarts and self-interest. Also, while in isolation some things - such as the 6 foot distance and wearing a cloth mask - might not be super-effective in combination there's an additive effect that has helped.

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I'm asking a lot of questions, sincerely not knowing the best answer, but it seems at this point that we just need to relax the quarantine and let the infection spread more. I realize that a lot of people will die (millions in the US alone), but if they're going to get killed by it anyway, is it doing us any good to delay the inevitable and cause more suffering due to unemployment and economic damage?
You have asked the million dollar question here.

The goal going forward is to balance between keeping the medical system functional while opening as much of the economy as possible while still keeping infection rates manageable. As others have noted, a certain number of people can't distinguish between "easing some restrictions" and "anything goes".

Going forward we WILL need to continue distancing, mask wearing, hand washing, and so forth. That is absolutely vital. We will NOT be going back to life-as-normal last year.

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I think one issue is that the promises/plans to preserve social distancing are either intentionally disingenuous or pipe dreams. Businesses can't enforce social distancing rules on their customers--they just can't. The whole "customer is always right" culture makes it impossible for a clerk or a cashier to tell someone or a group to leave a store, or even remind them forcefully to observe the rules.
That's why we clerks and cashiers don't do that at my store - we call a manager or store director to do it for us.

What we struggle with, at least at my store, is enforcing item limits. You know, telling people that no, you can't roll out of here with a cart full of meat, you get only two pork, two beef, two chicken. (Yes, there are some people with large families - they can get two "family packs" which are 7-10 pounds of meat each, available in all of the above categories. That's 15-20 pounds each of chicken, beef, and pork or 45-60 pounds of meat. In addition to sausage, turkey, lamb, etc.)

But even there, we can call in a manager or director. And those folks can call the police (and have in a few instances). Sure, some people threaten to never come back (which, to be honest, won't break our hearts) but we really are an essential service. We are where the food is.

It's more problematic for other businesses.

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And in many cases, businesses just can't follow the rules if they want to stay in business. You can't afford to run a restaurant if you never go about 25% capacity, and probably not if you never go above 50%. And everyone knows this.
You are correct on this.

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What we need, desperately, is some actual science about how this shit spreads and what is actually effective to stop it. There doesn't seem to be any consensus. I am happy to believe that it's half security theater, but I don't know WHICH half. I don't know if it's surfaces or enclosed spaces or hugs or what that does the damage.
The problem here is that this is a new disease. There hasn't been enough time to really learn the things you mention, and that the research is having to be done while also dealing with the ill doesn't help.

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We are about to have a huge set of "socially distant" but in-person graduation ceremonies around here. I truly don't know if 1) the precautions as written are reasonable and prudent and 2) if it's actually logistically possible to follow those precautions. And I don't think anyone else knows, either.
Well, we do know that the curve has flattened. So we're doing something right.

The precautions suggested by various organizations like the CDC and WHO were not pulled out of someone's nether regions, it's based on how a lot of diseases spread.

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Do you, though? Right now in my state the hospitalization rate is 10%. It makes me wonder if I'm doing myself a disservice by continuing to stay home (other than bringing my garbage to the dump once, which is a contactless activity, I have been home since March 22) given I'm mildly asthmatic because aren't my chances better if I get it soon and get it over with while hospitals are in decent shape rather than during the almost inevitable second wave this fall/winter?
The good news:

As someone with mild, intermittent asthma I had a lot of concerns about increased risk myself but it seems that asthma, particularly the mild sort, is NOT a risk factor in severe reactions. link, link, link. You can, of course, still have a bad reaction as seen in people with no known additional risky conditions, but apparently being slightly asthmatic is not a huge red flag.

At this time (subject to change with more information) based on what I've been able to find on line the "viral load" has an effect on how severe subsequent illness might become. Which means if you get sick after picking up only a few viral particles you'll likely have mild illness, but if you pick up a LOT of viral particles all at once you are more likely to have severe illness. So washing hands, wearing a mask, keeping your distance from others not only mean you're less likely to catch covid at any one time, but if you do, you might have a more mild case of it. So even if we decide folks might as well catch it and get it over with there is STILL a benefit to keeping up with all that other, bothersome stuff because it makes it more likely those people will have a mild as opposed to a severe illness.

All of our chances will be best if we keep cases within levels that our health systems can manage. The trickly part is finding out the least restrictive way to do that.
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Old 05-19-2020, 06:39 AM
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This is the only really weak part of your post. God only knows what the real numbers are because for the most part Americans can only get tested if their physician/ER feels they have it. That demands symptoms strong enough to send someone to the doc or ER. So mild cases, and family members of confirmed cases may have it, get over it, and stay off the statistic charts (my situation). On top of that, Doc/ER may not test you anyway because 1) It's clear you've got it, or 2) they don't have the means to do the testing anyway. And on top of THAT, the COVID tests are wildly inaccurate, yielding false negatives even fairly early on in the affliction.

Otherwise, I'd be inclined to agree that as long as the local hospitals have the capacity then it's appropriate to take measures that will increase the number of cases they see--with an aim of meeting but not beating their capacity. Because we're not going to get rid of this thing any time soon.
The weakness in quoting known infection rate isn't that the real infection rate is higher, as everyone realizes it is (I tested positive for antibodies on a test claiming 100% specificity, I was never tested for active infection), it's that it isn't the relevant number to overwhelming the health care system. That would be hospitalization rate, which as long as hospitals aren't near capacity (and lots of people who should get hospital care are turned away) is a pretty accurate stat. And in more parts of the US now hospitals are in more immediate danger of layoffs or even shut downs because other care has been reduced by 'lock downs', than they are of being overwhelmed by COVID cases.

Not everywhere though, and hospitalization rate could rise a lot in various places depending the effect of 'reopening' measures.

In short, OP's suggestion is being carried out now in many places, to a degree possibly enough to overwhelm hospitals in those areas. We don't know. Certain statements about this tend to be from politicized people IME.

But OP's basic logic is correct. If you can't sustain a 'lock down' till there's a vaccine/highly effective treatment (non starter as actual plan, see below) and you can't 'stamp it out' first then 'reopen' (doesn't seem possible in the US at this point), then you have to find the combination of economic restriction and load on the healthcare system which *is* sustainable. Like a lot of other COVID questions though that's a lot more complicated than the politicized binary which it tends toward.

There are myriad economic activities and differing risk levels inherent to them, not just 'on/off'. There's wide variability in compliance with precautions...but if people won't stick to somewhat relaxed measures what makes anyone think the same people would stick to them if they weren't relaxed? OTOH the medical system is learning how to treat people better without any single headline grabbing breakthrough. A vulnerable person might have a significantly better chance of avoiding death or extreme suffering if they get it 3 or 6 months later just because hospitals are better at it. Nor is vaccine or highly effective treatment certain to be anywhere near the standard '18 months from whenever we're speaking'. There still might never be either, or there could be one or both in quantity before the end of 2020.

I don't see any way to find an answer to this without some degree of trial and error in various places, which is what is happening.
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Old 05-19-2020, 08:05 AM
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I don't see any way to find an answer to this without some degree of trial and error in various places, which is what is happening.
I would agree with much of what you said, Corry El, and I agree here that there will be some degree of trial and error.

But it seems that we in the US are applying a trial and error approach while being willfully ignorant of what has worked in other countries, and even when we acknowledge that other countries have been more successful, we shrug and say that "that won't work here."

Why did it take so long for us to accept that masks were a thing? It's common damn sense, really.

Why has it taken so long for us to accept that we were woefully under-prepared in terms of testing?

When will it dawn on us that our system of employer-sponsored healthcare is very likely playing a HUGE role in why people are getting subpar care or waiting until it's too late. I say likely because I can't prove it without an actual study, but based on what I've read, other countries like Germany and Korea have done well not only at tracing but also separating and treating those who have become infected. We have not.

I think the problem I have with reopening America isn't so much that I disagree that we need to reopen - we absolutely need to get our economy going again. Rather, my problem is that we're just accepting the outcome that we're seeing now (and will likely see again in the fall) as inevitable - like we just have to accept the death and the medical bankruptcies. That's what irked me a little about the OP.

I absolutely disagree that we have to accept this outcome. This was not inevitable. This is a result of a society that doesn't want to learn from science, doesn't want to learn from others, and has a hard time accepting the idea that sometimes scientific reality confounds individual liberty. This "Let's reopen now" is, I think, a deliberate attempt to get people conditioned to accept death and financial ruin.

It's completely unfair to wage earners or even middle class salary earners - not to mention their families - to force them to come to work just because we don't want to change how we live and work. It's grossly unjust - and on some level, dishonest - to claim that we've done all we can and we're just gonna have to live with this. It's not right that we have to use our working class as pawns in a chess game against a virus and its economic collateral damage. I don't accept this, and I think if we reading this accept it, we're participating in our own decline as a society. We should demand better than this.

I'm sorry, I'm trying not to make this a political rant, but the question of reopening now is a policy debate. It's inevitably political. I know this is not supposed to be political, and I'm trying to avoid singling out parties or individuals. FWIW, it's a societal problem as much as a political one, IMO.
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Old 05-19-2020, 08:59 AM
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The curve is flattened enough


If COVID-19 could talk, it might very well say, "I'll be the judge of that."

My dad, who could talk, used to say, "We shall see what we shall see."
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Old 05-19-2020, 09:02 AM
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I think the problem I have with reopening America isn't so much that I disagree that we need to reopen - we absolutely need to get our economy going again. Rather, my problem is that we're just accepting the outcome that we're seeing now (and will likely see again in the fall) as inevitable - like we just have to accept the death and the medical bankruptcies. That's what irked me a little about the OP.
What I fear is that the number and severity of infections will go down over the summer (as other corona-virus infections do naturally), and because of that the urgency goes down, scientific investigations go down, and people stop doing the necessary precautions like social distancing and face masks. Hell, it bugs me that people already won't do those simple and (quite frankly) minimally intrusive things. Come fall, more inside things, and the second wave will be worse than expected.

As I've been typing this, an even worse thought. RIGHT NOW, we're talking about IF schools open in the fall with in-person attendance that masks would be required, and that maybe pre-school, kindergarten, and first grade would not attend because it would be impossible to get them to stay distant. As the summer comes and cases decline, will these measures be left behind and schools open up fully with disastrous results?


Oh, and in regards to
Quote:
Originally Posted by asahi View Post
When will it dawn on us that our system of employer-sponsored healthcare is very likely playing a HUGE role in why people are getting subpar care or waiting until it's too late.
The treatment of COVID19 in the US is a symptom of this; it's a much bigger problem, and aint' gonna be fixed any time soon. COVID19 won't jar people into an epiphany.
  #40  
Old 05-19-2020, 10:04 AM
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I think some businesses can enforce social distancing. It's just not profitable for many of them like bars and restaurants that typically run on a slim margin.

There is a VERY small 'grocery' store about 4 miles from me. So small that they now only let one person in the store at a time. You tell them what you want, and they shop for you. I think they probably need two employees in the store at a time now, but they are enforcing social distancing very strictly (you can stand in the entrance to the store). I think they will be fine, it was rare that more that one customer at a time was in there anyway, but last time I went, I had to wait a few minutes before being allowed in.

What might actually help some of this is the people working from home now. I'm one of them. I can shop pretty much whenever I want. Don't have to shop in the evening, or wait until the weekend. That may spread out the crowds a little bit. I'm really not an optimistic person, but that may help a tiny bit.
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  #41  
Old 05-19-2020, 10:23 AM
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Quote:
Originally Posted by Jasmine View Post

If COVID-19 could talk, it might very well say, "I'll be the judge of that."

My dad, who could talk, used to say, "We shall see what we shall see."
Well, yeah. But you have to go with your best guess. What the hell else can you do?

Of course, what really matters is how fast, and precisely in what order, reopening happens. Throwing open the doors of every business is probably not the right approach.
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  #42  
Old 05-19-2020, 10:48 AM
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In any respect is the irresponsible desire to reopen that we are currently seeing, a predictable response to the ill-advised and excessive closings? I'm thinking about the limited success of programs like DARE or "Just say no", especially when kids realize that a hit on a joint DOESN'T kill them or make them crazy. Or ill-advised abstinence education, as opposed to teaching safe, responsible sex.

IMO, it is unfortunate that TPTB didn't enact tailored restrictions from the get go, aimed at protecting the most vulnerable populations and eliminating the greatest potential risks.
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  #43  
Old 05-19-2020, 10:57 AM
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Quote:
Originally Posted by Dinsdale View Post
In any respect is the irresponsible desire to reopen that we are currently seeing, a predictable response to the ill-advised and excessive closings? I'm thinking about the limited success of programs like DARE or "Just say no", especially when kids realize that a hit on a joint DOESN'T kill them or make them crazy. Or ill-advised abstinence education, as opposed to teaching safe, responsible sex.
So, you're actually saying that taking steps to stop what is perhaps the most deadly virus on the planet is as "ill-advised and excessive" as telling kids that smoking a joint is dangerous? THAT is what you are basing your argument on? Seriously?

If it is that "ill-advised and excessive", why is a Georgia church closing again after being reopened for only 2 weeks because "families" (notice the plural) in the congregation have contracted the disease?
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  #44  
Old 05-19-2020, 11:09 AM
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Originally Posted by Dinsdale View Post
In any respect is the irresponsible desire to reopen that we are currently seeing, a predictable response to the ill-advised and excessive closings?
You can argue that some of the closings at the statewide level were excessive, but that's more of a retrospective judgment. State governors had absolutely no idea where the virus was 10-12 weeks ago when they began ordering the closures statewide. That was a rational decision.

That said, now that we have a better (though far from perfect) understanding of the virus's scale, it's not unreasonable to ask how we can start at least trying to resume life as normally as we can live it. That's not unreasonable.

Now that the curve has gradually stabilized, we have a precious commodity right now: a little bit of time. We have time to ramp up testing, ramp up production of masks and PPE, and we can print money to help people and businesses avoid suffering the worst financial consequences of the shut-down. But if we don't test and if we start acting in defiance of common sense, we'll be back where we started, and it'll be right in the middle of flu season.
  #45  
Old 05-19-2020, 11:32 AM
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So, you're actually saying that taking steps to stop what is perhaps the most deadly virus on the planet is as "ill-advised and excessive" as telling kids that smoking a joint is dangerous? THAT is what you are basing your argument on? Seriously?
The virus is not appearing to be among the most deadly on the planet, tho. Granted, data is not well-established yet, but at this point COVID-19 is about as contagious as the cold, and about as deadly as West Nile:

Infectious Diseases in Context

It's worth noting that the media is focused almost solely on COVID-19 death counts, which distorts, IMHO, what is really happening. It makes it seem like this virus is the only thing killing people in the world right now, which it is not.
  #46  
Old 05-19-2020, 11:47 AM
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Originally Posted by Urbanredneck View Post
So the new normal may be the re-opening of the drive in.
I've talked to restaurant owners who are thinking of moving to drive in service. It's going to be at least a year before they are allowed to reopen at full capacity, and Covid-20 will be out by then anyway.

We should expect to start seeing dining rooms demolished to make way for larger car park areas. Every fast food restaurant is going to go to Sonic's model.


Quote:
Originally Posted by Corry El View Post
The weakness in quoting known infection rate isn't that the real infection rate is higher, as everyone realizes it is (I tested positive for antibodies on a test claiming 100% specificity, I was never tested for active infection), it's that it isn't the relevant number to overwhelming the health care system. That would be hospitalization rate, which as long as hospitals aren't near capacity (and lots of people who should get hospital care are turned away) is a pretty accurate stat.
The point of testing is that you know what the hospitalization rate will be in the next week or so. If you do not have adequate testing, and are just basing everything on the number of people going to the hospital, then it's like trying to drive down the interstate while only using your rear view mirror.

Quote:
Originally Posted by Dr. Winston OBoogie View Post
What I fear is that the number and severity of infections will go down over the summer (as other corona-virus infections do naturally), and because of that the urgency goes down, scientific investigations go down, and people stop doing the necessary precautions like social distancing and face masks. Hell, it bugs me that people already won't do those simple and (quite frankly) minimally intrusive things. Come fall, more inside things, and the second wave will be worse than expected.
The public will probably become complacent, but I do not think that scientific investigations will.
  #47  
Old 05-19-2020, 12:02 PM
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"Flatten the curve" was in response to an immediate and dire need -- to prevent hospitals from becoming war zones. There was no expiration date on that, it was just hitting a giant red button to shut shit down because we completely failed to prevent the virus from entering the country and spreading nationally.

I'm not sure how things have been communicated in other states, but like others here have suggested, things here pretty quickly transitioned from "flatten the curve" to "prepare for an exit." That meant producing or acquiring tests, putting an infrastructure in place to tamp down hot spots, stockpiling PPE, figuring out how to operate businesses safely, etc. Ohio is now opening back up, having done a decent job (if you trust our leadership) at building up a public health infrastructure and developing guidelines for businesses, but still short on PPE and woefully short on tests.

So what now? To me, saying we've flattened the curve so we can open back up is silly, because we're actually in a worse position now than we were on March 9th in terms of viral spread. It seems very likely that things can get out of hand and overwhelm the hospitals again. The problem is that as a state, we're out of money. Our unemployment system is strained, the federal response has been fucking awful, and so people just straight up need to go back to work. Even though we're clearly not really ready for wave #2.

It sucks. There SHOULD have been a plan in place to pay people to stay home for multiple months, while states got their shit together in terms of PPE and testing. There SHOULD have been a nationalized effort to produce PPE and tests starting back in January. There's no reason we should be in this awful situation, where we've got to send people back to work even though we know it's going to lead to another spike. But it's where we are.
  #48  
Old 05-19-2020, 12:08 PM
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Quote:
Originally Posted by snowthx View Post
The virus is not appearing to be among the most deadly on the planet, tho. Granted, data is not well-established yet, but at this point COVID-19 is about as contagious as the cold, and about as deadly as West Nile:

Infectious Diseases in Context

It's worth noting that the media is focused almost solely on COVID-19 death counts, which distorts, IMHO, what is really happening. It makes it seem like this virus is the only thing killing people in the world right now, which it is not.
I just took a look at that site and the data is HORRIBLY out of date. The COVID-19 data was updated on March 20 with stats of 130 000 cases per year and 4 700 deaths. Visualizations are great for understanding the data, but the data has to be valid.

Last edited by FinsToTheLeft; 05-19-2020 at 12:08 PM.
  #49  
Old 05-19-2020, 12:19 PM
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Originally Posted by FinsToTheLeft View Post
I just took a look at that site and the data is HORRIBLY out of date. The COVID-19 data was updated on March 20 with stats of 130 000 cases per year and 4 700 deaths. Visualizations are great for understanding the data, but the data has to be valid.
Yeah I see that as well. They have another, more current, page with more visualizations here including the deadliness/contagiousness graph. The take-away is about the same, tho.
  #50  
Old 05-19-2020, 12:21 PM
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Quote:
Originally Posted by steronz View Post
"Flatten the curve" was in response to an immediate and dire need -- to prevent hospitals from becoming war zones. There was no expiration date on that, it was just hitting a giant red button to shut shit down because we completely failed to prevent the virus from entering the country and spreading nationally.

I'm not sure how things have been communicated in other states, but like others here have suggested, things here pretty quickly transitioned from "flatten the curve" to "prepare for an exit." That meant producing or acquiring tests, putting an infrastructure in place to tamp down hot spots, stockpiling PPE, figuring out how to operate businesses safely, etc. Ohio is now opening back up, having done a decent job (if you trust our leadership) at building up a public health infrastructure and developing guidelines for businesses, but still short on PPE and woefully short on tests.

So what now? To me, saying we've flattened the curve so we can open back up is silly, because we're actually in a worse position now than we were on March 9th in terms of viral spread. It seems very likely that things can get out of hand and overwhelm the hospitals again. The problem is that as a state, we're out of money. Our unemployment system is strained, the federal response has been fucking awful, and so people just straight up need to go back to work. Even though we're clearly not really ready for wave #2.

It sucks. There SHOULD have been a plan in place to pay people to stay home for multiple months, while states got their shit together in terms of PPE and testing. There SHOULD have been a nationalized effort to produce PPE and tests starting back in January. There's no reason we should be in this awful situation, where we've got to send people back to work even though we know it's going to lead to another spike. But it's where we are.
What does actually worry me more than being shut down again is if we should get shut down again, but aren't.
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