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  #51  
Old 05-19-2020, 12:26 PM
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Originally Posted by k9bfriender View Post
What does actually worry me more than being shut down again is if we should get shut down again, but aren't.
I'll tell you right now, Ohio cannot afford a 2nd shutdown. When the next wave hits, and it will hit, we're just going to have to plow through it.

That fact has really got me not knowing what to do. Do we start seeing friends again? Letting the kids have playdates? It feels like we shouldn't be socializing yet, since the virus is still out there, and worse than before the shutdown, but at the same time, the damage is done. We lost. Is there any point in continuing to quarantine?
  #52  
Old 05-19-2020, 12:28 PM
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Broomstick, thanks for your long posted reply. I did notice, however, that many of the quotes you attributed to me (the OP) were not mine. Not that I really disagreed with them.
  #53  
Old 05-19-2020, 01:36 PM
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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.
I think that's an example of the over-politicization of 'more testing' as the answer. It's entirely impractical to fine tune the policy response every week based on what 'testing' (supposedly) could tell you about next week's hospital admissions. At some point you have to make a decision to change restrictions with the knowledge you can't micro adjust that on anything like a weekly basis.

Anyway it's beside the point I was making, which is that what you care about in the end with a 'flatten the curve' goal is hospitalizations. You don't directly care whether X hospitalizations is from 1% of the population being 'confirmed cases' or 5% actually having been exposed in the same time frame. The difference in confirmed and actual exposures only really matters when the higher number gets toward some kind of 'herd immunity' level which is much higher.

In this part of NJ at least anybody can get a test any time, walk in, free. I walked in for an antibody test a couple of weeks ago (positive). This is good, but hasn't actually fundamentally changed the situation here, in the highest per capita COVID death rate state. The numbers are going down now, but that's because aspect(s) of the stay home, social distancing mask etc. must be working (though important to keep in mind nobody knows which specific measures in which situations account for how much of the improvement, some, 'we highly recommend you wear a mask outdoors' are quite likely nearly useless 'feel goods'). It's not because of 'testing', which would only make a big difference if the disease were contained, to keep it contained. That's water under the bridge here.

Again I think the politics blame game tends to result in routine overstatement of what testing can really do for you, though it is important.
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Old 05-19-2020, 03:28 PM
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I think that's an example of the over-politicization of 'more testing' as the answer. It's entirely impractical to fine tune the policy response every week based on what 'testing' (supposedly) could tell you about next week's hospital admissions. At some point you have to make a decision to change restrictions with the knowledge you can't micro adjust that on anything like a weekly basis.
No, that would be an example of science and evidence based decisions.

What you are describing is politicization of the crisis. That it is inconvenient to respond to the data, and so you won't.

I didn't say anything about fine tuning. Do we "fine tune" our houses when the smoke detector goes off? No, we realize that there is an emergency and take care of it.

At the very least, even if you refuse to make any changes to policy or public announcements, it gives the hospitals a heads up about what they should be expecting over the next week or so.

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Anyway it's beside the point I was making, which is that what you care about in the end with a 'flatten the curve' goal is hospitalizations. You don't directly care whether X hospitalizations is from 1% of the population being 'confirmed cases' or 5% actually having been exposed in the same time frame. The difference in confirmed and actual exposures only really matters when the higher number gets toward some kind of 'herd immunity' level which is much higher.
Right, and if you are not testing, then you have no idea what number to expect in hospitalizations. Exponential growth's not something to mess with.

You don't want to have any policy changes, but you want to "fine tune" your number of hospitalizations, without even testing to know what they will be ahead of time.
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In this part of NJ at least anybody can get a test any time, walk in, free. I walked in for an antibody test a couple of weeks ago (positive). This is good, but hasn't actually fundamentally changed the situation here, in the highest per capita COVID death rate state. The numbers are going down now, but that's because aspect(s) of the stay home, social distancing mask etc. must be working (though important to keep in mind nobody knows which specific measures in which situations account for how much of the improvement, some, 'we highly recommend you wear a mask outdoors' are quite likely nearly useless 'feel goods'). It's not because of 'testing', which would only make a big difference if the disease were contained, to keep it contained. That's water under the bridge here.
Testing is not a cure, and no one has said it was. Testing is a tool. It has two important aspects. The first is individual, that a person knows whether or not they are infected, which I would argue is a good thing, YMMV. The second is that it gives public health officials a tool to monitor the progress of the disease, because as has been repeated, it takes a week for it to go from infection to sending someone to the hospital (if they get it that badly), so without testing, your data is a week out of date. When you are talking about something that can easily double every 3 days, that's not soon enough.
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Again I think the politics blame game tends to result in routine overstatement of what testing can really do for you, though it is important.
I think that politics is undermining the need for testing, because as you said, responding to the information that testing gives you may be politically inconvenient. We'd have to have a hell of a spike here in Ohio for DeWine to shut us down again. It may be in the best interests of public health to do so, but it would not be in his interests politically, so it is easier to pretend that testing doesn't matter than to use it as a tool to protect public health.
  #55  
Old 05-19-2020, 07:19 PM
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Not sure the arguments for or against testing are necessarily political. (Even if some decide their beliefs based on partisan signaling.) Both do though require accepting or not accepting certain assumptions as being more likely valid.

To me, as much as I believe a strong surveillance system is a key part of needed data inputs, it seems that there is little evidence to support a belief that results of more global testing have very strong predictive value for the hospitalization rate next week, at least in a context in which the disease is already moderately widespread. There's just too much noise from many sources in who gets tested and why. It is a very very very poor measure of the true rate of infection and an even poorer measure of how much risk those who are infected are at of being hospitalized or ending up in the ICU. Using it as a primary indicator risks lots of chasing your tail, and impacting the behaviors of the vast majority of the population would be poorly accomplished with frequent adjustments up and down even on the basis of data that had good short term predictive value. Really any adjustments on restrictions back up at all will be hard to accomplish, and likely will need to be done at some point. Considering compliance of the public in response to "orders" may be "political" in that it is "the art of the possible", but ignoring it, thinking that all will just comply, would be dangerously naive.

If the item of concern is hospitalization rates (both as its own primary concern and as a proxy of next week's ICU rates and the following week's death rates) then look at it directly rather than at a proxy of dubious and at best limited predictive value. I am not married to any specific parameter but it seems to me that continued rolling average drop for three weeks after entering a stage, or staying below a much lower certain level and within a very limited rate of rise, would be reasonable to require before progression into a next stage. And alternatively some specific rate of rise or crossing of some absolute threshold reason to pull back a level. (Along with other criteria like having enough capacity available otherwise, no huge outlier increase in surveillance testing results, so on ...)

Now from the POV of politicians' self-interests ... they should be aware that the biggest harm would not come from opening up a bit slower than was possible, but from either having to reimpose restrictions once removed, or having a flare that overwhelms systems. Their informed self-interests should be conscious that sometimes shortcuts take much longer and want to err to the slower side in order to avoid risk of either of those politically most devastating outcomes.
  #56  
Old 05-19-2020, 08:57 PM
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I actually think there is a very strong argument that aiming for herd immunity is the best strategy in this situation. We know that we can risk stratify coronavirus deaths by age, and that those under 45 have a much lower risk of death than older people (https://www.cdc.gov/nchs/nvss/vsrr/c...#Race_Hispanic), and that the risk of death increases exponentially with age. I'm not sure where the 74-89% of population immunity required for the herd immunity benefit comes from--mostly I hear somewhere around 70%. https://hub.jhu.edu/2020/04/30/herd-...9-coronavirus/. I think that the suggestion that the lower-risk population start entering society again is well worth considering

I think the major benefit of opening slowly is simply to continue to not overwhelm the healthcare system, and to protect the most vulnerable from actually getting ill (now does the population of "most vulnerable" count as <30% of the population? That's a complicated question which requires further, more nuanced risk stratification). A vaccine could be years off, and we cannot keep suppressing the economy for that long. I think the question of the capacity of the health care system and how to know when to "clamp down" again is tricky--if we open up restaurants, and see a small surge, do we close them again? When do we then reopen? And what if we see another small surge after re-reopening?

I agree that testing is useful for larger-scale epidemiological purposes (like anticipating an outbreak and preparing appropriately), but I question the ability of our public health infrastructure to contact major contacts of a known case to recommend testing and disease suppression in that way. My understanding is that our testing capacity now exceeds our testing demand: https://www.washingtonpost.com/healt...b7a_story.html

IOW, I think the benefits of opening slowly and aggressive testing are to avoid overwhelming the healthcare system, and possibly waiting for other treatment options. I don't think continuous restrictions are necessary or optimal while waiting for a vaccine. I don't think I need to elaborate on the economic toll this has on the American population; suffice it to say it is substantial.
  #57  
Old 05-19-2020, 11:08 PM
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I think that the suggestion that the lower-risk population start entering society again is well worth considering
How is this supposed to work, though? For example, we hear that kids are very very low risk, so sending them back to school would be one place to start. However, schools aren't operated by the kids, and a fair chunk of teachers (and janitors and bus drivers and lunch ladies and so forth) are older or have health conditions that put them in the "not lower-risk" category. The last statistics I've seen (admittedly from 2011-2011) are that 30%+ of US teachers are over 50. If they stay home, how do the schools operate? or do we make them come to work anyway?

How do you make it possible financially for workers over the age of 45 (or 55, or whatever your cut-off is) to stay home to minimize their risk, while still encouraging people who are presumed to be lower-risk to go back to work? How do you do this WITHOUT breeding resentment and age discrimination and ageist feuding?
  #58  
Old 05-19-2020, 11:16 PM
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I actually think there is a very strong argument that aiming for herd immunity is the best strategy in this situation. We know that we can risk stratify coronavirus deaths by age, and that those under 45 have a much lower risk of death than older people (https://www.cdc.gov/nchs/nvss/vsrr/c...#Race_Hispanic), and that the risk of death increases exponentially with age. I'm not sure where the 74-89% of population immunity required for the herd immunity benefit comes from--mostly I hear somewhere around 70%.
Again, herd immunity is not a strategy; it is an end result of whatever strategy (or lack thereof) that is applied to deal with contagion. And while it is true that “ those under 45 have a much lower risk of death than older people”, the deaths that occur are horrific, as are the long term consequences for many that contract a severe case of COVID-19. Writing the susceptible cohort of the population (who we still cannot reliably identify) off in service of some hypothetical return-to-normality is not a good strategy.

The estimate of 74% to 89% threshold for herd immunity comes from the simple calculation for that threshold (TH=1-1/R0), which assumes that exposure results in long-lasting (many years) long resistance based on the most current estimates of R0 of 3.8 to 8.9 (which are much higher than the original estimates provided by the WHO but are actually remarkably consistent with early tracking models of the rate of contagion). If it turns out that immunity is not long-lived or the SARS-CoV-2 virus mutates sufficiently in its antigen properties that it can reinfect previously exposed people, there may not be any effective herd immunity without a periodic vaccine, which itself is years in the offing. Thus, we need to start thinking beyond the simplistic solutions like “expose everyone now to achieve herd immunity” or “a vaccine will be here by January”, neither of which are realistic strategies that both minimize mortality and morbidity nor return us to a stable economic environment.

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  #59  
Old 05-19-2020, 11:19 PM
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If it turns out that immunity is not long-lived or the SARS-CoV-2 virus mutates sufficiently in its antigen properties that it can reinfect previously exposed people, there may not be any effective herd immunity without a periodic vaccine, which itself is years in the offing. Thus, we need to start thinking beyond the simplistic solutions like “expose everyone now to achieve herd immunity” or “a vaccine will be here by January”, neither of which are realistic strategies that both minimize mortality and morbidity nor return us to a stable economic environment.
If we cannot develop immunity to SARS-CoV-2, we're fucked. There's really no strategy except to prepare more hospital bed space and start training nurses.
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  #60  
Old 05-19-2020, 11:34 PM
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If we cannot develop immunity to SARS-CoV-2, we're fucked. There's really no strategy except to prepare more hospital bed space and start training nurses.
Did you miss the "without a vaccine" part?
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Old 05-20-2020, 03:54 AM
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Looking at the charts, cased around the world have generally stopped increasing exponentially and now range from decreasing to increasing, but at a steady linear rate. I.e cases in the USA increase rapidly until around mid April to about 30,000 day, and have slowly decreased since. The virus hasn't gone away. But the charts would suggest that even in places like New York or Italy, the worst is well over. Normalized by population, most states are around 200 cases per million people or less with no signs of the massive peaks previously seen around the greater NYC area.

So I guess my question is this. Can we assume that this flattening is due to the strict(ish) "social distancing" practices, or is there something else in play here? I'm not an epidemiologist, but it seems to me that baring some other factor, these charts should continue to rise, even with social distancing, given that quarantine isn't perfect. Especially in places like NYC or where I live in Hoboken, NJ. I mean I'm not so naïve to believe some silly mask provides total protection against the virus when I live in a building of 1000 people, pass people on the street, in the take-out line, etc.

Georgia has been reopened for 3 weeks and doesn't appear to have seen an increase.


Referencing these charts here
http://91-divoc.com/pages/covid-visualization/




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I actually think there is a very strong argument that aiming for herd immunity is the best strategy in this situation. We know that we can risk stratify coronavirus deaths by age, and that those under 45 have a much lower risk of death than older people (https://www.cdc.gov/nchs/nvss/vsrr/c...#Race_Hispanic), and that the risk of death increases exponentially with age. I'm not sure where the 74-89% of population immunity required for the herd immunity benefit comes from--mostly I hear somewhere around 70%. https://hub.jhu.edu/2020/04/30/herd-...9-coronavirus/. I think that the suggestion that the lower-risk population start entering society again is well worth considering
.
I don't know why "herd immunity" has gained such traction as a possible solution. Other than it is a fancy way of saying "do nothing". As Stranger On A Train pointed out, that isn't a "strategy". Let's assume 50% is required. That's still 160 million Americans, which presumes somewhere between 1 to 6 million will die.
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Old 05-20-2020, 04:29 AM
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I don't know why "herd immunity" has gained such traction as a possible solution. Other than it is a fancy way of saying "do nothing". As Stranger On A Train pointed out, that isn't a "strategy". Let's assume 50% is required. That's still 160 million Americans, which presumes somewhere between 1 to 6 million will die.
Not to be cruel, but I think I just have to say it. This is a pandemic. A metric shit ton of people will die. It is certainly tragic and every loss is someone's family member. But death is a part of life and until very recently, young deaths were a real part of life.

A lot of comparisons are made to the 1918 pandemic. I looked up my family tree again and was struck by something. My great-great grandparents had 10 children, and a full 6 of them died from some childhood illness. My great-great grandfather died at age 35 in 1908 from typhoid fever, and his wife died at age 44 in 1917 from the measles. And this was not untypical.

This was the reality that people in 1918 were dealing with. We have grown up pretty spoiled. We all expect to live into old age. Sure, we hear about people getting cancer or having heart attacks and dying at a young age, but that won't be us or anyone we know. We will all live a long time.

We are simply not prepared for the reality that for as much progress we have made, landing men on the moon and so forth, there are some things that can kill a whole bunch of us. And this thing will kill a whole bunch of us, and my understanding was that we were simply "flattening the curve" so that the hospitals were not overwhelmed and giving more of us a chance, not that we were going to be locked up so that nobody or very few people died.

And we have further advantages. Vulnerable people can continue to stay at home no matter what restrictions are being lifted in the community. Unlike my great great grandfather who had to go to town for supplies when typhoid fever was ripping through the town, people today can get their groceries via Instacart or get delivery of food and even alcohol through Uber Eats or other methods and get almost anything in the world shipped to them by Amazon.

Again, I'm not trying to be dire or insensitive, but a lot of people will die no matter what. But we just cannot bear to hear politicians say that so we have what is, IMHO, false comfort being put out there that if we only did this, if we had more testing, if we only did that, if we only would cripple the economy further that everything would be unicorns and rainbows. This is a pandemic. That is bad shit.
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Old 05-20-2020, 04:44 AM
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I actually think there is a very strong argument that aiming for herd immunity is the best strategy in this situation. We know that we can risk stratify coronavirus deaths by age, and that those under 45 have a much lower risk of death than older people (https://www.cdc.gov/nchs/nvss/vsrr/c...#Race_Hispanic), and that the risk of death increases exponentially with age. I'm not sure where the 74-89% of population immunity required for the herd immunity benefit comes from--mostly I hear somewhere around 70%.
I don't think anyone knows what percentage of the population needs to be immune to covid for true herd immunity, and I think, based on so many other diseases requiring 85-95% immunity to achieve that, a figure of 70% is wishful thinking at best.

Meanwhile, we don't really know - aside from advanced age - how to really determine who is at high risk and who isn't, except in the most broad of terms (do you realize how many people in the US have diabetes, high blood pressure, COPD, and so forth?) and even then, the lives of "at risk" people should not be considered less worthy than the lives of those at low risk. So very many of the high risk and the dead were NOT debilitated, already-dying people but folks who were able bodied for most purposes and probably with years of life ahead of them if the virus hadn't taken them.
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Old 05-20-2020, 04:54 AM
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Looking at the charts, cased around the world have generally stopped increasing exponentially and now range from decreasing to increasing, but at a steady linear rate. I.e cases in the USA increase rapidly until around mid April to about 30,000 day, and have slowly decreased since. The virus hasn't gone away. But the charts would suggest that even in places like New York or Italy, the worst is well over. Normalized by population, most states are around 200 cases per million people or less with no signs of the massive peaks previously seen around the greater NYC area.

So I guess my question is this. Can we assume that this flattening is due to the strict(ish) "social distancing" practices, or is there something else in play here?
Social distancing, better hygiene, masks, etc. Sure, the new cases are decreasing - because nearly the entire planet is sheltering in place. The "worst is over" ONLY because of the lockdowns. If we throw off the facemasks, forget about social distancing, and go back to the way things were before cases will spike. As has been demonstrated in various areas that tried just that and turned into mini-hotspots in 1-2 weeks after that.

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I'm not an epidemiologist, but it seems to me that baring some other factor, these charts should continue to rise, even with social distancing, given that quarantine isn't perfect. Especially in places like NYC or where I live in Hoboken, NJ. I mean I'm not so naïve to believe some silly mask provides total protection against the virus when I live in a building of 1000 people, pass people on the street, in the take-out line, etc.
No, you're not an epidemiologist. Neither am I, to be fair, but honestly, quarantine doesn't have to be perfect to reduce the number of new cases. If it was perfect new cases would be zero, but they aren't.

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Georgia has been reopened for 3 weeks and doesn't appear to have seen an increase.
How does "manipulating the numbers" strike you?

Quote:
In Georgia, one of the earliest states to ease up on lockdowns and assure the public it was safe to go out again, the Department of Public Health published a graph around May 11 that purportedly showed new COVID-19 cases declining over time in the most severely affected counties. The entries, however, were not arranged in chronological order but in descending order.

Georgia state Rep. Jasmine Clark, a Democrat with a doctorate in microbiology, called the graph a "prime example of malfeasance," adding: "Science matters, and data manipulation is not only dangerous, but leads to distrust in our institutions." Democratic state Rep. Scott Holcomb likewise called the department's presentations "purposely misleading."
Here's another link on Georgia cooking the books

There's more out there if you look for it.

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I don't know why "herd immunity" has gained such traction as a possible solution. Other than it is a fancy way of saying "do nothing". As Stranger On A Train pointed out, that isn't a "strategy". Let's assume 50% is required. That's still 160 million Americans, which presumes somewhere between 1 to 6 million will die.
"Doing nothing" is cheap. The rich and powerful can go hide in bunkers until the disaster is over and screw the peasants.
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Old 05-20-2020, 04:57 AM
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We are simply not prepared for the reality that for as much progress we have made, landing men on the moon and so forth, there are some things that can kill a whole bunch of us. And this thing will kill a whole bunch of us, and my understanding was that we were simply "flattening the curve" so that the hospitals were not overwhelmed and giving more of us a chance, not that we were going to be locked up so that nobody or very few people died.

And we have further advantages. Vulnerable people can continue to stay at home no matter what restrictions are being lifted in the community. Unlike my great great grandfather who had to go to town for supplies when typhoid fever was ripping through the town, people today can get their groceries via Instacart or get delivery of food and even alcohol through Uber Eats or other methods and get almost anything in the world shipped to them by Amazon.

Again, I'm not trying to be dire or insensitive, but a lot of people will die no matter what. But we just cannot bear to hear politicians say that so we have what is, IMHO, false comfort being put out there that if we only did this, if we had more testing, if we only did that, if we only would cripple the economy further that everything would be unicorns and rainbows. This is a pandemic. That is bad shit.
While I may quibble on the details, this is one of the few times I agree with UltraVires. No one wants to hear the truth. This is a world-wide disaster, even if it's sort of in slow motion. There are no good answers. Our choices here are between one sort of bad and another sort of bad. We can do some damage control and/or mitigation, but this is not fixable.

The arguments should be about how we're going to limit damage and what trade-offs are tolerable. But instead we get bullshit.

I am so tired of it already but best case I think we're only about 5 months into a 24-36 month marathon.
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Old 05-20-2020, 05:52 AM
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I am so tired of it already but best case I think we're only about 5 months into a 24-36 month marathon.

Yep. That's been my thinking since lockdowns started.
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Old 05-20-2020, 07:25 AM
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... The estimate of 74% to 89% threshold for herd immunity comes from the simple calculation for that threshold (TH=1-1/R0), which assumes that ...

<snip>

... Thus, we need to start thinking beyond the simplistic solutions like “expose everyone now to achieve herd immunity” or “a vaccine will be here by January”, neither of which are realistic strategies that both minimize mortality and morbidity nor return us to a stable economic environment.
100% agreed with the conclusion but the "simple calculation" and "assumes that" needs much emphasis. Simple fact: NO ONE KNOWS at what point in which particular society with which particular set of circumstances there would be enough in the "Recovered" bucket to slow transmission. The expert consensus quoted has usually gone with extrapolating from 1918 and predicted 40 to 60% but that has been just one way to guess.

It may be much higher ... or much lower. No matter how simple or complex the calculations and modeling the actual facts needed to do more than make it up remain unknown.

How lasting and complete or incomplete is immunity after infection? What is the true infection rate? How contagious are those who never get symptomatic? What is the range of contagiousness inclusive of the fraction who are super-spreaders and those who functional dead-ends to further transmissibility? How much cross-immunity occurs from infections with the other common cold causing coronaviruses? Does that cross-immunity prevent infection, modify severity, modify transmissibility, all, or least likely, none? What is the magnitude of seasonal forcing on this specific virus? Are kids in fact only relatively fractionally contagious when they get it? What fraction?

ALL OF THOSE are necessary things to know for the experts to run models that actually mean shit about predicting where/when herd immunity becomes a factor in slowing spread in specific circumstances. Different answers to ANY of them could alter calculation results dramatically.

That though only supports your conclusion. We are walking in darkness tapping a stick ahead of us. Sitting still until the lights turn on at some unknown if ever future time is not an option. Literally not possible as in it won't happen, compliance with that is not possible. Rushing headlong into the darkness would be idiotic. Our only choice is to feel our way through it.
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Old 05-20-2020, 08:08 AM
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Not to be cruel, but I think I just have to say it. This is a pandemic. A metric shit ton of people will die. It is certainly tragic and every loss is someone's family member. But death is a part of life and until very recently, young deaths were a real part of life.

...
I also am surprised to agree w/ UV.

I have heard insufficient discussion of how this pandemic relates to our modern attitude towards death, or expectations of modern medicine, and our willingness to fund whatever efforts we feel necessary.

Instead, we've seen our willingness as a species to fail to plan, while expecting last minute "Hail Mary" solutions, at whatever the cost. Maybe part of that cost ought to be that a lot of people die, who might not have had to had we invested previously.
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Old 05-20-2020, 08:52 AM
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If we cannot develop immunity to SARS-CoV-2, we're fucked. There's really no strategy except to prepare more hospital bed space and start training nurses.
Although many people appear to have forgotten, we have been in the middle of a pandemic for nearly four decades. The AIDS epidemic was first recognized in July 1981 and has been going strong ever since. It took the better part of of a decade to characterize the basic pathogenesis of the human immunodeficiency virus
and we’re still learning new things about it (as we are all viruses). We’ve yet to trial an effective vaccine but public awareness campaigns and therapeutics have reduced the incidence in developed countries below the epidemic threshold and allowed infected persons to lead long and productive lives (not so good in developing nations, unfortunately, due to lack of education and basic medical services, prejudice, and superstition), and we’ll never have herd immunity for HIV without a vaccine because an infected patient continues to shed the virus for their lifetime to greater or lesser degree.

Now, it is true that HIV is less contagious than SARS-CoV-2 by nature of transmission, but there are measures that we can take short of full lockdown to limit the spread of the latter, and with development of rapid testing an early intervention with effective therapeutics under development we may be able to drive severe morbidity and mortality down to levels of seasonal influenza. This is not a situation of herd immunity or apocalypse, especially if it remains that most people only experience mild or no symptoms, although that is obviously not good for those who are vulnerable.

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So I guess my question is this. Can we assume that this flattening is due to the strict(ish) "social distancing" practices, or is there something else in play here? I'm not an epidemiologist, but it seems to me that baring some other factor, these charts should continue to rise, even with social distancing, given that quarantine isn't perfect. Especially in places like NYC or where I live in Hoboken, NJ. I mean I'm not so naïve to believe some silly mask provides total protection against the virus when I live in a building of 1000 people, pass people on the street, in the take-out line, etc.

Georgia has been reopened for 3 weeks and doesn't appear to have seen an increase.
CNN.com: “Florida and Georgia facing scrutiny for their Covid-19 data reporting” It seems that the governments of China and Russia are not the only ones to misrepresent or alter data relating to COVID-19 outbreaks.

The “social distancing” can help flatten the curve even if they are not comprehensively followed just because there are segments of the population that are limiting contact. If you broke down the population by behavioral demographics that would probably be clear. Of course, there could be other factors such as weather that play a part (though we’ve seen no clear reduction in tropical and subtropical countries) and no other changes in the pathology of virus variants that would suggest a reduction in virulence, so the null hypothesis is that the distancing and isolation measures in play are the primary driver but with states in various phases and degrees of reopening we will have pretty clear evidence to falsify that hypothesis (again, provided that the data being reported is accurate).

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That though only supports your conclusion. We are walking in darkness tapping a stick ahead of us. Sitting still until the lights turn on at some unknown if ever future time is not an option. Literally not possible as in it won't happen, compliance with that is not possible. Rushing headlong into the darkness would be idiotic. Our only choice is to feel our way through it.
Yeah, the simple model is at least inaccurate, and I’ve been surprised that the belated and often-indifferently imposed distancing measures have been as effective as they have been, but that also means we ought to tread lightly on releasing them lest we simply return to a potential wide scale epidemic outbreak.

Ideally, only a few states, or areas of states, would open up first and all preparations would be made to support those states with medical services and protective equipment on reserve, but apparently we’ve decided to just open everything up with only a handful of states taking significant measures to phase openings and very few people actually following recommended handling practices with mask-wearing and distancing if they are bothering at all, but I guess that will tell us things, too, albeit maybe answers we don’t like.

In any case, there are some long term changes we are going to have to make to restructure our economy and alter workplaces and social spaces, and a dose of cold reality may be what is necessary to drive home that necessity. We can just hope that governments will be more honest than not, and political leaders will respond to guidance from public health authorities rather than to push their own agendas.

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Old 05-20-2020, 11:12 AM
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... Now, it is true that HIV is less contagious than SARS-CoV-2 by nature of transmission, but there are measures that we can take short of full lockdown to limit the spread of the latter...
Talk about understating the case.

It is relatively easy for a person to reduce the possibility of their getting AIDS to truly miniscule levels. The R factor can be kept very low without shutting down parts of the economy. That cannot be done with SARS-CoV-2. If we cannot become immune, we will all get it eventually, and, worse, keep getting it. As it stands, it's really quite likely most of us will get it anyway.

Could we come up with effective therapeutic approaches? Maybe. One hopes so because if we cannot become immune and there's no therapy beyond drinking a lot of fluids and hoping for the best, we're boned, pal.
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Old 05-20-2020, 11:20 AM
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Unlike my great great grandfather who had to go to town for supplies when typhoid fever was ripping through the town, people today can get their groceries via Instacart or get delivery of food and even alcohol through Uber Eats or other methods and get almost anything in the world shipped to them by Amazon.
Which still means that people get their groceries and booze from other people.

Not saying you're doing this, but I've seen way too much of this "out of sight, out of mind" stuff here in my own city. In my neighborhood, people by and large don't give a shit anymore, and aren't even trying. The same is true, as far as I can tell, in all of brownstone and hipster Brooklyn.

In the neighborhoods where all those invisible delivery people live, they're still dropping like flies. https://gothamist.com/news/new-map-s...-most-affected

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  #72  
Old 05-20-2020, 11:31 AM
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{...} Could we come up with effective therapeutic approaches? {...}
It appalls me that we're being forced to accept a false dichotomy, everything goes back to 'normal' or forced total quarantine.
Doesn't seem like anyone wants to talk about limiting the number of cases (if only because there is no guaranty that you will survive an infection unscathed) and using the time bought to come up with increasingly more effective treatment protocols (while working 'our' asses off on a vaccine).

AIUI we've already realized that vents are not a particularly good treatment choice compared to sufficiently high levels of oxygen and NIPPVs.

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Old 05-20-2020, 11:35 AM
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If we cannot become immune, we will all get it eventually, and, worse, keep getting it. As it stands, it's really quite likely most of us will get it anyway.
Isn't that how it works for most respiratory diseases anyway, before COVID19? While not yet proven, not gaining immunity to something we are exposed to is not how we understand how our immune system works. It's likely we will all get it just like we all get a cold; since this is new, we are dealing with the virus burning thru virgin territory, with a high level of unpredictability with higher impacts on some vulnerable populations. This is about as contagious as the cold and more deadly than the flu. A vaccine will certainly accelerate getting it into the background, so until then caution is warranted, but it is here now and it will be difficult for most of us to avoid it entirely. IMHO.
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Old 05-20-2020, 11:35 AM
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It appalls me that we're being forced to accept a false dichotomy, everything goes back to 'normal' or forced total quarantine.
Doesn't seem like anyone wants to talk about limiting the number of cases (if only because there is no guaranty that you will survive an infection unscathed) and using the time bought to come up with increasingly more effective treatment protocols (while working 'our' asses off on a vaccine).
I certainly hope they're working on vaccines and medicines. Again, I was speaking to a hypothetical, not a certainty.

The number of cases needs to be limited to below the capacity of the health care system to treat people with serious conditions. That's the objective whether or not there's a vaccine, in part because we must proceed on the assumption there will never be a vaccine.
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Old 05-20-2020, 11:46 AM
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CNN.com: “Florida and Georgia facing scrutiny for their Covid-19 data reporting” It seems that the governments of China and Russia are not the only ones to misrepresent or alter data relating to COVID-19 outbreaks.
One misleading graph does not invalidate the general argument. The moving average number of deaths per day attributed to COVID 19 in Georgia has not increased since the April 24th reopening:

https://www.washingtonpost.com/graph...ge%2Fstory-ans
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Old 05-20-2020, 12:04 PM
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One misleading graph does not invalidate the general argument. The moving average number of deaths per day attributed to COVID 19 in Georgia has not increased since the April 24th reopening:

https://www.washingtonpost.com/graph...ge%2Fstory-ans
Business Insider is skeptical:

Quote:
The state's Department of Public Health has recently released graphs showing a decline in both confirmed cases and deaths. But independent evaluations, including the Atlanta Journal Constitution's analysis of Georgia's data, has shown more of a plateau in new coronavirus cases in the state, rather than a decline.

Further complicating the issue is the amount of time it takes to get accurate data and determine a trend. As experts have explained, current coronavirus case counts are not representations of how severe the outbreaks are in that very moment — rather, the case counts show how severe the outbreaks were roughly two weeks earlier.

Therefore, Georgia's optimistic-looking data from recent weeks may be reflecting the success of the state's lockdown measures, rather than reflecting the success of lifting those measures.

Georgia public health officials have acknowledged a lag in the data — specifically the amount of time between when a person is tested, and when their positive test result is actually reported to public health officials for tracking.

So, in many cases, there could be a roughly two-week delay — or even longer — between a person contracting the virus, and their positive test result getting reported to state health authorities.
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Old 05-20-2020, 12:10 PM
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Again, I'm not trying to be dire or insensitive, but a lot of people will die no matter what. But we just cannot bear to hear politicians say that so we have what is, IMHO, false comfort being put out there that if we only did this, if we had more testing, if we only did that, if we only would cripple the economy further that everything would be unicorns and rainbows. This is a pandemic. That is bad shit.
I get what you're saying, but given the timeline this also sounds a bit like "We've tried nothing, and we're all out of ideas."

Based on the IFR numbers NY released a few weeks back, which are still barely more than a blind guess, something like 1.5 million Americans will eventually die of COVID-19 if we just let it run its course. That's a sufficiently large number that I think any time we spend delaying the "inevitable" while looking for better options is probably worth it.

The problem is that we've sorta rushed through 2 Coronavirus relief bills and then left the states to run out of money on their own. That's a far cry from the national 4 year effort to defeat fascism that we saw during WWII, or the lengths we went to as a nation to stop the red menace, or even the trillions we've spent trying to prevent another terrorist attack on US soil. It wasn't even 2 weeks into most lockdowns when the "we can't stay locked down forever" crowd took over the national conversation.

Two months is all America is willing to tolerate in terms of sacrifice before throwing its collective hands up in the air and saying, "Well, I guess we just need to let this happen." That's pretty pathetic.

Last edited by steronz; 05-20-2020 at 12:11 PM.
  #78  
Old 05-20-2020, 12:34 PM
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Not to be cruel, but I think I just have to say it. This is a pandemic. A metric shit ton of people will die. It is certainly tragic and every loss is someone's family member. But death is a part of life and until very recently, young deaths were a real part of life.

A lot of comparisons are made to the 1918 pandemic. I looked up my family tree again and was struck by something. My great-great grandparents had 10 children, and a full 6 of them died from some childhood illness. My great-great grandfather died at age 35 in 1908 from typhoid fever, and his wife died at age 44 in 1917 from the measles. And this was not untypical....

Again, I'm not trying to be dire or insensitive, but a lot of people will die no matter what. But we just cannot bear to hear politicians say that so we have what is, IMHO, false comfort being put out there that if we only did this, if we had more testing, if we only did that, if we only would cripple the economy further that everything would be unicorns and rainbows. This is a pandemic. That is bad shit.
This is also not 1918. I like to think that we have the ability to a more proactive approach than simply let the healthcare system collapse so we have patients in FEMA tents in the street and have to bury bodies in giant lime pits.

It's also a mistake to decouple the economic issue from the health issue. If cases start to spread and workers start to get sick, states won't need to shut stuff down. People will stop going to work and frequenting businesses on their own and the economy will tank anyway. The more testing we have, the more we know who is safe and who needs to be isolated. That way we don't have to shut everything down because everyone thinks they will get sick and die as soon as they step out of their yard.
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Old 05-20-2020, 12:58 PM
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The problem with easing restrictions is that if a further wave occurs then a significant part of the population will restrict their economic activities - which means they won't go out and spend on leisure which knocks on to a whole load of other consumer items.

The Western economies all rely heavily on consumer confidence, and that confidence needs to be right across the population - if there is a loss of faith in just 20% of a population because they consider themselves vulnerable it will be a disaster - it will lead to deep rooted unemployment in service industries which in turn will knock confidence for larger purchases such as cars and other finance related items such as housing.

If any state is massaging or out and out lying then it will bite them so very hard indeed - better to take a hit now than an ongoing depression that might last for years due to Covid being endemic. This will all eventually come out and the finger pointing will not be merciful - woe betide the incumbents of political office.

Should this occur then the political elites are going to have a very tough time indeed - mass unemployment, low economic activity, little prospect of a recovery and a population that will find a readjustment away from addictive consumerism extremely difficult indeed.
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Old 05-20-2020, 01:28 PM
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Which still means that people get their groceries and booze from other people.

Not saying you're doing this, but I've seen way too much of this "out of sight, out of mind" stuff here in my own city. In my neighborhood, people by and large don't give a shit anymore, and aren't even trying. The same is true, as far as I can tell, in all of brownstone and hipster Brooklyn.

In the neighborhoods where all those invisible delivery people live, they're still dropping like flies. https://gothamist.com/news/new-map-s...-most-affected
Sure. I agree 100%. That is also another uncomfortable truth. If my great-great grandfather was a rich man he could have hired a servant to go to town in the middle of a typhoid epidemic. There will always be an "us" and a "them." Many of us are able to do our jobs from home on Zoom while others have to be out working in grocery stores or meat packing plants.

If you have ideas to change that, then I am all ears, but even the most zealous lockdown proponents have not said that we should cut all food production, even though that puts people in harm's way. I'm not trying to be a "Let them eat cake" sort of guy, but at least the modern system allows more people to stay safe.
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Old 05-20-2020, 01:32 PM
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Looking for resource. (Think of this as an old school classified ad).

I would love to see a list of what relaxation measures different states and countries have taken when, and for each what has happened to their case rates, percent positive rates, hospitalization and then ICU rates over the following two to four weeks, as it’s been that long. Which ones reimposed quickly and which ones stayed without major new flares? Yes careful interpretation for specifics will be needed but maybe some patterns can emerge.

Anyone have a resource?
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Old 05-20-2020, 02:02 PM
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Looking for resource. (Think of this as an old school classified ad).

I would love to see a list of what relaxation measures different states and countries have taken when, and for each what has happened to their case rates, percent positive rates, hospitalization and then ICU rates over the following two to four weeks, as it’s been that long. Which ones reimposed quickly and which ones stayed without major new flares? Yes careful interpretation for specifics will be needed but maybe some patterns can emerge.

Anyone have a resource?
https://coronavirusbellcurve.com/#curves

Appears to have some of what you're looking for. I haven't spent much time on the site and make no claims on reliability of data, but it appears OK.
  #83  
Old 05-20-2020, 02:10 PM
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Talk about understating the case.

It is relatively easy for a person to reduce the possibility of their getting AIDS to truly miniscule levels. The R factor can be kept very low without shutting down parts of the economy. That cannot be done with SARS-CoV-2. If we cannot become immune, we will all get it eventually, and, worse, keep getting it. As it stands, it's really quite likely most of us will get it anyway.
i wasn't suggesting that the specific measures that worked to control HIV would be applicable to SARS-CoV-2; rather that there are options besides either waiting for a working vaccine (which, despite recent optimism, may be years in the offing) or just giving in and letting the infection take course without remit. Even if immunity fades quickly and reinfection can occur, it is clear that for a large majority of people this is a survivable illness without treatment or hospitalization, and with better testing and surveillance we may be able to control outbreaks such that they do not reach epidemic proportions. This would require modification to how we conduct business and social activities, but as has been discussed previously, we should be doing so anyway because the next pandemic may be far more virulent than this one, and it is out there in our globally connected future.

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I would love to see a list of what relaxation measures different states and countries have taken when, and for each what has happened to their case rates, percent positive rates, hospitalization and then ICU rates over the following two to four weeks, as it’s been that long. Which ones reimposed quickly and which ones stayed without major new flares? Yes careful interpretation for specifics will be needed but maybe some patterns can emerge.

Anyone have a resource?
I don't have a single unified resource but there is the Johns Hopkins Coronavirus Resource Center (which seems to be the most up-to-date resource on COVID-19 epidemiological data), the Wall Street Journal "A Guide to State Coronavirus Reopenings and Lockdowns" (which has an accessible summary of state lockdown and relaxation orders), and The Council of State Governments "COVID-19 Resources for State Leaders" (which has an extensive listing of executive orders, state reopening plans, and links to the major predictive modeling efforts).

I also find it instructive to listen to the This Week in Virology podcast (which is obviously all about SARS-CoV-2 recently) because although while they are more focused on pathogenesis than epidemiology they often cover some very salient issues, such as the fact that a positive RT-PCR test only indicates the presence of viral RNA fragments (which can remain residual in a previously infected person for weeks or months) but not necessarily active virus, so all of these supposed positive retests are not definitive unless researchers run a plaque assay. Be warned, TWiV is a long form podcast (often in excess of two hours) with a lot of technical jabber, but at least on Apple there is some timestamping that lets you jump to sections of interest.

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Old 05-20-2020, 02:31 PM
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https://coronavirusbellcurve.com/#curves

Appears to have some of what you're looking for. I haven't spent much time on the site and make no claims on reliability of data, but it appears OK.
This is a pretty good visualization of what is happening on a state-by-state level, if the data is accurate. It's interesting scrolling thru the states - the graphs show when Shelter-In-Place orders were issued (if they were issued), when reopening, as well as recent 14-day trend lines for cases and deaths.

You can see some states have flattened the curve pretty well, others are still climbing, but even if cases are still climbing (as expected) deaths are generally trending down.

Last edited by snowthx; 05-20-2020 at 02:33 PM.
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Old 05-20-2020, 03:29 PM
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I followed Trom's link, and I can't help but feel sad about Virginia.
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Old 05-20-2020, 04:51 PM
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I don't think anyone knows what percentage of the population needs to be immune to covid for true herd immunity, and I think, based on so many other diseases requiring 85-95% immunity to achieve that, a figure of 70% is wishful thinking at best.
70% is an assessment based on a presumption predicated on presumptions. With some extrapolation from similar viruses.
Less contagious viruses can mean here immunity at 10-15%. More contagious ones reach immunity at 90% and some are so contagious (chicken pox, measles) that herd immunity is functionally impossible to reach.
Spanish flu of 1918 saw herd immunity kick in at about 50%.

And it’s not like that you go from fucked to fine as we increase from 69%- 70%. As the number of immune people grow, it has a harder time spreading.

The current numbers presumes the population has no immunity or resistance, which is unlikely to be the case, one paper suggest that exposure to certain strains of cold causing coronaviruses provides some immunity and resistance to COVID-19.

https://www.cell.com/cell/fulltext/S...674(20)30610-3

Which might go someways to explain the vastly different Death and morbidity rates amongst similarly positioned countries.

Last edited by AK84; 05-20-2020 at 04:53 PM.
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Old 05-20-2020, 04:52 PM
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I thought the flattened curve really meant effectively, that now, they have room for you at the hospital.
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Old 05-20-2020, 04:54 PM
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The goal is also to flatten to buy time for there to be effective therapeutics. Someone who gets the virus six months from now likely has more options than someone who gets it today.
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Old 05-20-2020, 04:57 PM
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I thought the flattened curve really meant effectively, that now, they have room for you at the hospital.
Not necessarily. It literally means the curve has been suppressed to some extent.

Hopefully it has been suppressed to the extent that our hospitals aren't overwhelmed but that's something that's very location dependent.

There tends a lot less slack in rural areas than urban because of the relative lack of hospital beds per capita, so even within the same state the same flattened state-level curve may be good for some people but not enough for others. Hopefully somebody is looking at those numbers as well.
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Old 05-20-2020, 06:07 PM
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"No way to prevent this says only country where this happens regularly"

Before you decide that there is no way to avoid the virus blasting through the population, maybe take a look at the curves of other nations. See what they have achieved without vaccines or antivirals, and in many cases with very weak healthcare systems and poor testing and tracking capacity.

Just with lockdowns and social distancing.

(I don't know what criteria that site uses, or why Bhutan is "winning" while south Korea is not. But it is a good collection of graphs, and they are the information I wanted to convey.)
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Old 05-20-2020, 06:36 PM
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America is 'different'. Nothing that works in any other part of the world can possibly work here for ... reasons.

CMC fnord!
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Old 05-20-2020, 07:13 PM
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https://coronavirusbellcurve.com/#curves

Appears to have some of what you're looking for. I haven't spent much time on the site and make no claims on reliability of data, but it appears OK.
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Originally Posted by Stranger On A Train View Post
i wasn't suggesting that the specific measures that worked to control HIV would be applicable to SARS-CoV-2; rather that there are options besides either waiting for a working vaccine (which, despite recent optimism, may be years in the offing) or just giving in and letting the infection take course without remit. Even if immunity fades quickly and reinfection can occur, it is clear that for a large majority of people this is a survivable illness without treatment or hospitalization, and with better testing and surveillance we may be able to control outbreaks such that they do not reach epidemic proportions. This would require modification to how we conduct business and social activities, but as has been discussed previously, we should be doing so anyway because the next pandemic may be far more virulent than this one, and it is out there in our globally connected future.

I don't have a single unified resource but there is the Johns Hopkins Coronavirus Resource Center (which seems to be the most up-to-date resource on COVID-19 epidemiological data), the Wall Street Journal "A Guide to State Coronavirus Reopenings and Lockdowns" (which has an accessible summary of state lockdown and relaxation orders), and The Council of State Governments "COVID-19 Resources for State Leaders" (which has an extensive listing of executive orders, state reopening plans, and links to the major predictive modeling efforts). ...
Links appreciated but unfortunately none seem to my first looks to be what I am hoping for, albeit they are decent resources to contribute to creating it if I have the energy. Which I clearly don’t have today. But if I want it I may need to at some point I guess.

All these states and countries are relaxing measures in different ways. I’m looking for a one site resource that compares and contrasts the different approaches and their results on meaningful metrics at meaningful intervals to the changes. Not just “new cases”.

It seems like something important enough for someone else to have already done.
  #93  
Old 05-20-2020, 07:59 PM
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All these states and countries are relaxing measures in different ways. I’m looking for a one site resource that compares and contrasts the different approaches and their results on meaningful metrics at meaningful intervals to the changes. Not just “new cases”.

It seems like something important enough for someone else to have already done.
That sounds like a good idea on the face of it but in order to actually have "meaningful metrics" or what I would term figures of merit you would have to have both a way of characterizing relaxation measures in a discrete fashion, and have some way to calibrate the relative efficacy which includes things like variance for socioeconomic factors, social and commercial compliance with isolation orders, access to healthcare, the effect of political leaders reinforcing or undermining directives, et cetera, lest all of this 'noise' overwhelm the actual trends of effectiveness that you are looking for.

I don't think this is impossible but it would take a lot of skilled understanding of these factors to really tease out actual effects from common measures from the individual variance between states (similar to what epidemiologists and social researchers do for studies on nutrition, education, et cetera) and notwithstanding that there are a lot of problems with testing and data reporting which means that in some places there are certainly underreporting both actual infections and deaths (not attributed to COVID-19 because the occur at home or the patient has a significant pre-existing condition). At this point, I think the best that can be done is lump together states by region and then make comparisons between individual states. A single "lockdown protest" by a few thousand people that results in a flurry of new infections because nobody was isolating (and which shows up two or three weeks afterward) and people returned to their communities and spread contagion from there is enough to significantly skew results, and that is something that no model is going to predict or account for. What would really be useful from a data analysis standpoint would be individual tracking data so you could have a big bag of data in the aggregate that would directly show how much compliance was achieved and where people went, but that has obvious severe privacy implications even if the data were stripped of identifying metadata.

Stranger

Last edited by Stranger On A Train; 05-20-2020 at 08:02 PM.
  #94  
Old 05-20-2020, 09:43 PM
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Stranger - no question the interpretations would be tentative, because in fact it is not only America that is different, every place has its quirks. But still useful to look for patterns that emerge, and minimally some experience if certain items that some claim are absolute pan out.

Just starting a wee little bit I began with Austria since they started sooner. Total deaths plateaued at under 71/million. Probably would be best to scan psychonaut's posts, but went with Googling:

May 1, almost 3 weeks ago, opened up to letting people outside without masks keeping 3 feet away, facemasks in enclosed public spaces, gatherings up to 10 people, funerals up to 30, shops open, restaurants 5/15 c 3 ft between tables of 4 and servers with mask, churches with distancing and masks, schools were scheduled to open 5/18 in split shifts but I see no reports of whether or not they did.

A contact tracing app is available but not used too much. Currently about the same number of tests/million run as the United States. But therefore a much lower percent positives.

Definitely lots of chomping at the compliance bit even with loosening. Yes protests and a narrow majority saying they would be against new restrictions in the case of another wave. Still most wear masks often even where not legally required to do so, even though most there doubt they do much.

A few blips as reported by [b]psychonaut[/b, the disease is not gone, but the moving average of daily new cases has not jumped up and the new deaths rolling average is staying below 1. Long enough for the initial opening to be having impacts, not long enough to see about restaurants, churches, and schools.


What I am hoping someone else has done is that for all the early opening countries and any state that has opened for at least 2 weeks. But just doing Austria took me enough time for now!

I know Italy has kept rates dropping with some opening since mid April and much more since 5/3 including parks and manufacturing. And Denmark has had schools open over a month. But for each we'd need to know the whole package, where deaths were when they opened, and what key metrics have done since.

Which went too far too fast for their specifics and had to pull back? Korea, but they opened bars! China has had to reimpose some restrictions in some locations. Lebanon after some of their citizens returned from abroad. Just today Saudi Arabia. Iran one province.

Put them all together and you have a bit more to base a guess of how much flattening allows you how much opening with how much bounce back.
  #95  
Old 05-20-2020, 10:23 PM
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I thought the flattened curve really meant effectively, that now, they have room for you at the hospital.
Not necessarily. You want the curve of hospitalizations to be both flat and significantly below capacity such that both you aren't running up against resource limits (e.g. you aren't going to run out of PPE, or use up needed pharmaceuticals, or burn through skilled medical personnel) and you have reserve capacity to deal with a surge. Ideally you are managing infections so the curve is always below the threshold and slightly downward, anticipating that some change will force the slope to positive but with enough lag that you can detect it.

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The goal is also to flatten to buy time for there to be effective therapeutics. Someone who gets the virus six months from now likely has more options than someone who gets it today.
Absolutely. We need to buy time to figure out what works, and also to replenish supplies, train new medical personnel, and generally give people on the front lines a break because while they are being venerated as "heroes", they are people with their own families, fears and limits of endurance and stress tolerance. If researchers can come up with some therapeutics that keep people from having to go weeks on oxygen support or ventilation, the number of patients that can be treated is much greater and especially in rural areas with only moderately equipped regional hospitals that were already stretched financially and resource-wise even before this pandemic.

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Put them all together and you have a bit more to base a guess of how much flattening allows you how much opening with how much bounce back.
You can certainly use them to refine general guidelines; I'm just dubious that you can actually make predictive trends that are significantly better than the more generic models that are currently in use. If I were going go to into data scientist mode, I'd pick certain measures like restricting large gatherings, closing certain types of business, closing schools, et cetera, ascribe a kernel density estimate (KDE) to each of them (and maybe a scale factor based upon the relative restrictiveness) and then use them as weighting values on an assumed nominal distribution of R0 and then look at how the resulting replication number changes based upon the data and go back and modify the KDEs accordingly. By looking at the posterior values you can figure out what the relative significance of different measures are and what the most likely value actually is for the modified R0, and then try to adjust the measures to keep the replication number below unity but high enough that you are getting progressive exposure and inoculation such that as time goes on you can open up more and more but still keep contagion to sub-epidemic levels.

However, the latency of contagion, the errors and delays in data reporting, variation in compliance, and just the speed at which this virus can spread are all going to make it challenging to really dial in any response. Erring toward "just enough to keep the economy moving" is probably as good as can be managed, and likely not enough to satisfy the desire of the public to get back to a more normal society, so we are almost certainly going to be seeing epidemic-scale outbreaks even in states that are applying more cautious opening plans.

Stranger
  #96  
Old 05-20-2020, 11:47 PM
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Before you decide that there is no way to avoid the virus blasting through the population, maybe take a look at the curves of other nations. See what they have achieved without vaccines or antivirals, and in many cases with very weak healthcare systems and poor testing and tracking capacity.

Just with lockdowns and social distancing.
Given how similar all those curves look, maybe it's not 'just lockdowns and social distancing'.
  #97  
Old 05-21-2020, 12:27 AM
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Given how similar all those curves look, maybe it's not 'just lockdowns and social distancing'.
Did you actually go to the link? Do Sweden and Taiwan look similar?
  #98  
Old 05-21-2020, 10:19 AM
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... If I were going go to into data scientist mode, I'd pick certain measures like restricting large gatherings, closing certain types of business, closing schools, et cetera, ascribe a kernel density estimate (KDE) to each of them (and maybe a scale factor based upon the relative restrictiveness) and then use them as weighting values on an assumed nominal distribution of R0 and then look at how the resulting replication number changes based upon the data and go back and modify the KDEs accordingly. ...
Not being a data scientist I'd be not so fancy!

I'd just pick a hypothesis and see if the data supports it or not.

To pick one at not so random, the hypothesis that keeping schools closed is a critical part of keeping rates low. If several re-openings have included re-opening schools and daycares without seeing any resurgence in new case numbers, increased percent positive cases, hospitalization rates, ICU utilization rates, or death rates, at appropriate time lags, and the places that have had flares and had to reimpose restrictions did not mostly share that they re-opened schools, then the hypothesis begins to become falsified. A big deal thing. Of course you need to look at each case to see what else might be correlated with it but it still informs.

Alternatively pick the hypothesis that keeping bars closed matters: South Korea's experience supports that strongly.

As powerful as your approach? Maybe not. But still useful.
  #99  
Old 05-21-2020, 10:42 AM
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Business Insider is skeptical:
Skepticism is good, but the central point is still valid - Nearly a month after Georgia began reopening, there is no evidence of the widely anticipated 'spike' in new cases.
  #100  
Old 05-21-2020, 11:13 AM
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Did you actually go to the link? Do Sweden and Taiwan look similar?
Yes, I did. That's how I was able to observe that they all looked similar.
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