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Old 03-13-2020, 01:15 PM
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How do I counter the the flu v COVID-19 argument?


I have to admit when someone posts over and over and over again on Facebook that the Flu kills 12,000-61,000 people a year and this COVID-19 thing is overblown by the media and we are all needlessly panicking, I have trouble disagreeing with those numbers. Often the argument is coupled with the "media is trying to discredit Trump" charge which makes my back bristle even more.

Here are the arguments I have made so far, is there a better one?

-The infection rate appears to be higher
-So far the death rate is higher
-Its possible way more than 40,000 people will die

I have a feeling there is a better argument out there that these people are missing. Is there one?
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Old 03-13-2020, 01:16 PM
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"Why would the President declare a National Emergency if this is just the media trying to discredit him?"
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Old 03-13-2020, 01:25 PM
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I heard an infectious disease doc on the radio this morning saying the flu usually kills about 1 in 1000 while COVID-19 is more like 1 in 50.
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Old 03-13-2020, 01:34 PM
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Originally Posted by manson1972 View Post
"Why would the President declare a National Emergency if this is just the media trying to discredit him?"
I have been able to get people thinking by asking them why they think China and Italy have chosen to cripple their own economies and imprison their own people. What insane leader would go to such extremes just to discredit Trump? It makes no sense.

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Old 03-13-2020, 02:24 PM
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Originally Posted by russian heel View Post
I have to admit when someone posts over and over and over again on Facebook that the Flu kills 12,000-61,000 people a year and this COVID-19 thing is overblown by the media and we are all needlessly panicking, I have trouble disagreeing with those numbers. Often the argument is coupled with the "media is trying to discredit Trump" charge which makes my back bristle even more.

Here are the arguments I have made so far, is there a better one?

-The infection rate appears to be higher
-So far the death rate is higher
-Its possible way more than 40,000 people will die

I have a feeling there is a better argument out there that these people are missing. Is there one?
"When was the last time you saw multiple first-world countries shut their borders because of 'the flu'?"
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Old 03-13-2020, 02:29 PM
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"When was the last time you saw multiple first-world countries shut their borders because of 'the flu'?"
This sounds circular. We shut down our borders because of the severity of the disease and the reason why it's severe is that we have shut down our borders.
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Old 03-13-2020, 02:33 PM
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I was about to say what KK Fusion just said - any argument of "The fact that people and nations are reacting so strongly proves that it's serious" smacks of circular logic. People who say "The flu kills more" are asking why it is necessary for society and governments to react so strongly, and to reply "Because they are reacting strongly" provides no useful response reply at all.
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Old 03-13-2020, 02:45 PM
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Guys, we're not talking about good SDMB debates, but things to say to a group of Facebook righties. Think they're going to call out "circular logic!"?
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Old 03-13-2020, 02:46 PM
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Originally Posted by russian heel View Post
I have to admit when someone posts over and over and over again on Facebook that the Flu kills 12,000-61,000 people a year and this COVID-19 thing is overblown by the media and we are all needlessly panicking, I have trouble disagreeing with those numbers. Often the argument is coupled with the "media is trying to discredit Trump" charge which makes my back bristle even more.

Here are the arguments I have made so far, is there a better one?

-The infection rate appears to be higher
-So far the death rate is higher
-Its possible way more than 40,000 people will die

I have a feeling there is a better argument out there that these people are missing. Is there one?
There are more influenza disease vectors, mainly because flu has had a pretty big head start.

There is no immunity to COVID-19. No vaccine and no natural antibodies to it unless you actually get it. You might win the genetic lottery and have an immmune system that thwarts it or fights it and wins that fight early, but the infection rate is high in part because it's a new virus. It's also one that allows people to shed virus before noticeable symptoms appear.
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Old 03-13-2020, 02:46 PM
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Originally Posted by russian heel View Post
I have to admit when someone posts over and over and over again on Facebook that the Flu kills 12,000-61,000 people a year and this COVID-19 thing is overblown by the media and we are all needlessly panicking, I have trouble disagreeing with those numbers. Often the argument is coupled with the "media is trying to discredit Trump" charge which makes my back bristle even more.

Here are the arguments I have made so far, is there a better one?

-The infection rate appears to be higher
-So far the death rate is higher
-Its possible way more than 40,000 people will die

I have a feeling there is a better argument out there that these people are missing. Is there one?
Well, it's all about relative risk. It is true that the seasonal flu kills a hell of a lot of people, and people tend to hand wave it away thinking it's no big deal. The real flaw in the argument is that the flu IS deadly, and people should take it much more seriously than they do. They should get their seasonal flu shots (and I've heard that getting a flu shot might help to mitigate some of the Covid-19 virus, or at least make the case if you get it less bad). But that brings up something...we don't HAVE a vaccine for this thing. Yet. We also have no idea how it might mutate now that it's out in the wild, so to speak. That, alone, should make people pay attention.

The arguments you are giving seem right. The infectious rate is higher with Covid-19. In some respects it's a lot more communicable. It also does have a higher absolute mortality rate, though it targets similar demographic groups. That said, flu CAN be MUCH higher as well and can target different demographic groups depending on the strain.

As to the last, the thing is, no one knows. For one thing, we don't know how many people have actually died in China...or, really, how many have it. We have the CCPs numbers on that, and, frankly, I wouldn't trust them. At all. But no one really knows how wide spread this thing is, or how out of control it will be. I seriously doubt that in the US if more people will die from Covid-19 than a bad outbreak of the flu, but we don't really know at this point as we have lost containment and are behind the curve on testing. That said, major steps are being taken by the government, especially local government, to mitigate the spread. My state is one of those who have already canceled school for 3-4 week and state employees who are non-essential have been put on a telecommuting policy, major public gatherings have been canceled, etc etc. This is definitely going to mitigate the spread, somewhat...but since we don't know how pervasive it is right now there is no way to tell how bad it will be. Then you have the fact that we are likely to have a slowdown in the next few months, only to have it sweep back in come fall.

So, how do you counter the arguments in your OP? With the truth. I'd also toss in that our President is an idiot who has no clue what he's talking about, and often says contradictory things, both contradicting his own administration, officials, experts and everyone else, but also himself.
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Old 03-13-2020, 02:47 PM
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Guys, we're not talking about good SDMB debates, but things to say to a group of Facebook righties. Think they're going to call out "circular logic!"?
It's not just Facebook righties though. There are a substantial number of lefties who also argue "flu kills more."


(The ideal argument would probably be to point out that the reason Covid-19 hasn't killed as many as flu is that it hasn't infected as many as flu yet. If it had the same number of infected, it would have a higher death toll.)
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Old 03-13-2020, 02:51 PM
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I heard an infectious disease doc on the radio this morning saying the flu usually kills about 1 in 1000 while COVID-19 is more like 1 in 50.
It's probably more like 1 in 100 across the general population, but for some people, it could be 1 in 50 or even 1 in 10. If you're living in a country that offers reliable access to quality modern healthcare and one that also tests instantly and on a large scale, your chances of survival are at least 1 in 100 if you're under the age of 50 and without underlying health concerns, and it's possible your odds could be even better than that.

If, on the other hand, you're living in a country without widespread testing, with a government that seems to be having a hard time reckoning with people about the seriousness of the disease, and has a healthcare system that's a complicated patchwork that doesn't offer affordable access to quality healthcare, then you're living in a situation that's a ticking time bomb.

Guess which country I'm talking about?
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Old 03-13-2020, 02:55 PM
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I heard an infectious disease doc on the radio this morning saying the flu usually kills about 1 in 1000 while COVID-19 is more like 1 in 50.
It's more like 1 in 200 in places like Korea with better screening.
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Old 03-13-2020, 03:40 PM
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It's more like 1 in 200 in places like Korea with better screening.
Korea shows why there is a need to test more; however, the death rate I have seen reported is still higher than the flu.

https://www.scmp.com/week-asia/healt...-testing-gives
Quote:
Yet in South Korea, where the country’s Centres for Disease Control and Prevention on Thursday reported 6,088 cases and 40 deaths, the mortality rate appears to be hovering around 0.65 per cent.

While this is still several times more lethal than seasonal influenza, which kills about 0.1 per cent of the people it infects – 30,000-40,000 people in the US alone each year – South Korea’s rate is far lower than that seen elsewhere.
And then there are doubts about that low (still higher than the flu) death rate. It may be higher:

https://medium.com/@newapollo/south-...te-5f8374bcb1a
Quote:
Others have claimed that South Korea’s lower fatality rate is a result of good surveillance detecting mild cases. I offered the alternative explanation that South Korea’s confirmed cases are more recent, thus patients have not reached an outcome yet.

Why does Italy have a higher case-fatality rate of 3.8% then?
Quote:
It is true that in general, proactive testing plays a part in lower fatality rates. It seems like Italy is not detecting the true number of cases, thus inflating the fatality rate.

However, I still think it is an error to say that proactive testing in South Korea has revealed the “true” fatality rate. For the moment, it has lowered the fatality rate, as it uncovered the cases around the Shincheonji super-spreader event, which would have otherwise been hidden by their secretive members. However, we don’t know if these cases are truly mild, or if these cases will be more severe but have simply not reached their outcomes yet.

We will get a better idea in the coming days.
On a related note, the reported sampling time to get a reading on Corona in Korea is about 10 minutes, with results available in a few days. We may eventually get perhaps enough test kits available in the US... in the next or two weeks.
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Old 03-13-2020, 03:46 PM
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https://www.google.com/amp/s/www.nyt...imate.amp.html

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Officials at the U.S. Centers for Disease Control and Prevention and epidemic experts from universities around the world conferred last month about what might happen if the new coronavirus gained a foothold in the United States. How many people might die? How many would be infected and need hospitalization? ....

Between 160 million and 214 million people in the U.S. could be infected over the course of the epidemic, according to one projection.... As many as 200,000 to 1.7 million people could die....

Even severe flu seasons stress the nation’s hospitals to the point of setting up tents in parking lots and keeping people for days in emergency rooms. Coronavirus is likely to cause five to 10 times that burden of disease, said Dr. James Lawler, an infectious diseases specialist and public health expert at the University of Nebraska Medical Center.
All of this may not come to pass, if people start changing their behavior, like washing hands, staying away from crowds, and so on.

But if this is Facebook, maybe the best response is: “Where shall I send the flowers when your elderly friends/family are buried?”
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Old 03-13-2020, 03:54 PM
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A good question would be... why is Trump cancelling all his rallies due to Covid-19? Is it because he's more afraid of the press than he admits, or is it because he's more afraid of the virus than he admits?

Look at what they do, not what they say. I don't see any groups of boomer Trump supporters staging large demonstrations to show they're not afraid of the virus.
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Old 03-13-2020, 03:59 PM
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Originally Posted by russian heel View Post
...I have a feeling there is a better argument out there that these people are missing. Is there one?
Two reasons:
  • The mortality rate for COVID-19 is at least an order of magnitude greater than that of influenza.
  • The number of cases of COVID-19 are increasing exponentially.
Note that "exponentially" is not a synonym for "a lot." It's a mathematical term.

When a danger is growing exponentially, everything looks fine until it doesn’t

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There’s an old brain teaser that goes like this: You have a pond of a certain size, and upon that pond, a single lilypad. This particular species of lily pad reproduces once a day, so that on day two, you have two lily pads. On day three, you have four, and so on.

Now the teaser. “If it takes the lily pads 48 days to cover the pond completely, how long will it take for the pond to be covered halfway?”

The answer is 47 days. Moreover, at day 40, you’ll barely know the lily pads are there.
The problem isn't the current number of cases. It's how many cases we will have in a few weeks or months.

More detail here:
Coronavirus: Why You Must Act Now

Last edited by robby; 03-13-2020 at 04:02 PM.
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Old 03-13-2020, 04:30 PM
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(The ideal argument would probably be to point out that the reason Covid-19 hasn't killed as many as flu is that it hasn't infected as many as flu yet. If it had the same number of infected, it would have a higher death toll.)
The true mortality rate of Covid-19 is not known.

And part of the issue in this regard seems to be that there are many people who contract the virus in a very mild or asymptomatic form. Many of these people don't get tested. (People point to the fact that places which have tested more aggressively have lower mortality rates as evidence of the efficacy of testing, but ISTM more likely that the bigger factor is that testing more aggressively puts a lot of mild/asymptomatic cases into the denominator, which brings down the rate.)

So it seems at least theoretically possible that the mortality rate for infected people is somewhere in the same range as the flu, but that a lot more people are infected with Covid-19 than we assume. As a practical matter, the implication of this is that even if drastic measures were not taken, that it might not be more harmful than the flu. Assuming, that is, that the natural spread of the disease is also comparable to flu (it would appear that the percentage of people who contact flu viruses each year - even those who are not immunized - is significantly less than 100%, so it makes sense to assume that the same might apply to Covid-19).

The point of all this is not to argue that any of the above is true, and certainly not to argue against any particular public health measure (let alone to promote "media is trying to discredit Trump" nonsense). Rather, that very little is known about the virus at this point, and ISTM that many possibilities are hard to rule out or refute.
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Old 03-13-2020, 04:37 PM
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The point of all this is not to argue that any of the above is true, and certainly not to argue against any particular public health measure (let alone to promote "media is trying to discredit Trump" nonsense). Rather, that very little is known about the virus at this point, and ISTM that many possibilities are hard to rule out or refute.
Except that we can listen to actual experts who have studied the matter instead of just hypothesizing.
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Old 03-13-2020, 04:54 PM
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Here is my impression on why people should take it more seriously and not compare it to the flu.

The flu kills about 0.1% of people who get it. COVID-19 kills closer to 2-4%, making it 20-40 times more deadly.

COVID-19 is more contagious. The flu has an R0 of about 1.3, meaning for ever 1 person who gets it, they infect 1.3 new people (so if 3 people have the flu, then infect 4 more). Because of this, about 10% of America gets the flu each year (around 30 million people). COVID-19 has an R0 of closer to 2-3, and there are predicts that anywhere from 20-70% of Americans will catch the virus before this is all said and done.

If you do the math, a virus that infects 10% of people and kills 0.1% of them can't even begin to compare with a virus that infects 20-70% of people and kills 2-4% of them.

Granted, hopefully the actual death rate is lower. It may be as low as 0.5% when you factor in all the people who have mild symptoms and aren't tested, but since its more contagious even the best case scenario means that it'll kill at least 25x more people than the flu. Worst case scenario is it could kill well over 250 times more people than the flu.

Also there is another massive issue with the virus. It will overload hospitals, which could raise the death rates for both COVID-19 patients and people who need medical care for issues unrelated to the virus but can't get it because all the hospital beds are occupied by COVID-19 patients.

For every 100 patients who get it I think about ~10% end up in the hospital. Around 5% end up on ventilators.

America only has 925k hospital beds total and 160k ventilators total. And most of those are already being used up for patients with other illnesses (we don't have 925k empty hospital beds and 160k ventilators that aren't being used, we have 925k and 160k total of each, the vast majority of which are currently being used for other sick patients).

If 20 million people have COVID at the same time, that means around 2 million people need hospital beds and 1 million people need ventilators. They won't be able to get the ventilators, which means the death rate for the virus will go up.

Not only that, but what happens to all the people with emergency medical issues unrelated to COVID-19? You still have car accidents, strokes, heart attacks, accidents at work, etc. People will have these, go to the hospital but all the doctors, nurses, hospital beds and ventilators will be occupied by COVID-19 patients. People won't be able to get the care they need for emergency medical issues unrelated to COVID-19.

So due to an overload of the hospitals, death rates from COVID-19 and death rates from other illnesses (strokes, accidents, heart attacks, etc) could also go up due to lack of proper medical care.

Among the elderly, the death rate is closer to 10%. If the virus infects a large enough share of the public (50-100%, that means 5-10% of the elderly will die. Globally, I assume the worst case scenario is about ~50 million deaths.

Also we have a vaccine for the flu, there is no COVID vaccine yet. There are also approved meds to help control the flu. THere are no meds to control COVID yet. There are experiments with protease inhibitors to control it, but there may not be a big enough supply of them yet.

A lot of people who say we are overreacting seem to think this is the peak of the illness. This isn't the peak of the illness. If the Illness takes a year to run its course, we are basically on month 2. It'll likely be a whole lot worse in summer.

TL;DR
  • COVID-19 is anywhere from 5-50x more deadly than the flu in patients who get it
  • COVID-19 is more contagious than the flu, while the flu infects about 10% of Americans each year, COVID-19 may infect 20-70% of Americans. No idea what the rate could be overseas but I assume similar.
  • We have a flu vaccine, we don't have a COVID-19 vaccine
  • We have pharmaceutical therapies for the flu, we have no therapies for COVID-19 yet other than experimental ones
  • COVID-19 will overwhelm hospitals, meaning lots of people who need care for COVID-19 or other diseases will not be able to get the care they need
  • COVID-19 will cause a lot of economic damage that will take years to recover from. The flu does not.
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Old 03-13-2020, 05:15 PM
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The true number is the issue, depending on testing policy you will get very different mortality rates.

Here in the Netherlands for instance, it has been made public for a while now that they are not testing many people who are presumed to be infected (but not counted in the official numbers). If the mom is positive and the rest of the family shows symptoms...no tests, but just being told to stay home. I just heard about a couple I know vaguely, that just returned from Northern Italy...and are showing all the main symptoms: no test because they are otherwise healthy and in their thirties.

When this started here a week or so ago, one of the hospitals tested everyone working there that wasn't feeling well. 300 people, 28 had corona. Some of whom literally felt off for a single day, but were fine after that.

Of course not very reliable for any hard conclusions...but it indicates that you are still more likely to have a common bug, instead of corona...and that many more people might be infected than it seems now. For all I know I have it as well...

To het back on topic: it will take time until we know the real mortality rate.

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Old 03-13-2020, 05:20 PM
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The difference is the flu has been with us since we believed evil spirits were responsible, and we learned to accept it as part of life from a time where we were helpless to do anything about it. We even hear today, people take their risk with the flu, go without the flu shot, and don't take measures protect others. Acceptance of the flu is generationally ingrained and people are very resistant to change, and without mass change there is little difference a single person can make. It would also be politically very hard to get people to go along with CoVid19 restrictions for 'just the flu', and one really would need international cooperation in such a effort. But if the flu just started today it might be very different then if it was with us since Adam ate the apple. With this said many people know that we could do things better to beat back the flu, but it's very hard to coordinate.

OTOH Covid 19 has the traits to appear worse the the flu, and we have the momentum going to try to contain it and it is something 'new' so we are not accepting that we have to make it part of human life.
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Old 03-13-2020, 05:36 PM
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They way I've been explaining is that when it comes to the flu we know pretty much everything about it. We know how it spreads, we know how to treat it, we have a pretty good idea as to how many people will get it, be hospitalized by it and die from it in a given year and we have vaccines for it. We also know that, like clockwork, it'll show up around October and disappear around March.

We know all these things for the flu. We don't know any (or most) of them for this.

Also, my 'fear' is that when this all blows over, people are going to running around saying that it was a huge over reaction. We cancelled just about everything and for what? Every time someone calls it an over reaction, I've been trying to explain that if this all blows over without amounting to much that they shouldn't think of this as an over reaction, instead they should consider that it didn't amount to much because of how we reacted.

Also, maybe we should treat the flu like this. If everyone that had a symptom that could be considered flu like stayed home for X days or until cleared by a doc, maybe we could knock our flu numbers in half and cut a few months off the flu season.
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Old 03-13-2020, 05:50 PM
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Also, my 'fear' is that when this all blows over, people are going to running around saying that it was a huge over reaction. We cancelled just about everything and for what? Every time someone calls it an over reaction, I've been trying to explain that if this all blows over without amounting to much that they shouldn't think of this as an over reaction, instead they should consider that it didn't amount to much because of how we reacted.
Oh, this is absolutely going to happen. "I never wore a seatbelt as a kid and I never died in a car accident!" We only hear about one side of this story and that's why the story never goes away.
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Old 03-13-2020, 05:58 PM
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But the thing is, in this case people are having their literal lives ruined. The opportunity cost of wearing your seat belt in tiny. Shutting down means losing literally everything for some people. So it's going to be even worse than the seat belt people. It's going to be "I lost everything because people panicked". I think we are doing the right thing, but I can imagine feeling different if the small business I'd built was getting destroyed, or if I was looking at not being able to feed my kids or keep a roof over my head.
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Old 03-13-2020, 06:00 PM
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Originally Posted by Joey P
Also, my 'fear' is that when this all blows over, people are going to running around saying that it was a huge over reaction. We cancelled just about everything and for what?
This is my fear too. Maybe our diligence will manage to prevent the worst outcome, which will unfortunately cause people to think this was all manufactured hysteria. "THE SCIENTISTS SAID THE SKY WAS FALLING AND IT DIDN'T! SCIENTISTS ARE STUPID!" And guess what happens then? The virus gains a foothold this summer and that's when we see the worst case scenario play out.

Yesterday I was riding down the escalator at work and I overheard people behind me talking about the "hysteria". IT'S JUST LIKE Y2K, one of them said. I'm not a Y2K expert, but I always thought that all the warnings and preparation helped prevent a disaster from happening. The Y2K disaster didn't happen, so naturally the uninformed think the hue and cry was all over nothing.

It's a damn-if-you-do-damned-if-you-don't situation. People kinda suck.

Last edited by monstro; 03-13-2020 at 06:01 PM.
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Old 03-13-2020, 06:02 PM
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This is my fear too. Maybe our diligence will manage to prevent the worst outcome, which will unfortunately cause people to think this was all manufactured hysteria. "THE SCIENTISTS SAID THE SKY WAS FALLING AND IT DIDN'T! SCIENTISTS ARE STUPID!" And guess what happens then? The virus gains a foothold this summer and that's when we see the worst case scenario play out.

Yesterday I was riding down the escalator at work and I overheard people behind me talking about the "hysteria". IT'S JUST LIKE Y2K, one of them said. I'm not a Y2K expert, but I always thought that all the warnings and preparation helped prevent a disaster from happening. The Y2K disaster didn't happen, so naturally the uninformed think the hue and cry was all over nothing.

It's a damn-if-you-do-damned-if-you-don't situation. People kinda suck.
I've wondered before if there is a name for this fallacy. The fallacy of, If you don't prevent it, you're incompetent - and if you do act to prevent it, and it is prevented, then it was unnecessary.
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Old 03-13-2020, 06:26 PM
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Originally Posted by HMS Irruncible View Post
Oh, this is absolutely going to happen. "I never wore a seatbelt as a kid and I never died in a car accident!" We only hear about one side of this story and that's why the story never goes away.
I tend not to argue with people who say that. Maybe a little back and forth to see where it goes, but if someone doesn't understand that while they're correct, the lack of seat belt made no difference, it's because they never got into a (serious) car accident. Some people can grasp that, many other's can't or won't.

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Yesterday I was riding down the escalator at work and I overheard people behind me talking about the "hysteria". IT'S JUST LIKE Y2K, one of them said. I'm not a Y2K expert, but I always thought that all the warnings and preparation helped prevent a disaster from happening. The Y2K disaster didn't happen, so naturally the uninformed think the hue and cry was all over nothing.
Someone on FB said that yesterday. The person is normally pretty smart and level headed so if may have been a sarcastic comment. In either case, I responded that the reason Y2K didn't amount to much is because a lot of programmers spent a lot of time writing, testing and pushing out patches to make sure everything went as smoothly as possible.
If we had simply ignored it, the way people want to ignore this, we would have had a lot of problems. Maybe not 'planes dropping out of the sky' problems. But a lot more problems than people realized.
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Old 03-13-2020, 06:27 PM
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I've wondered before if there is a name for this fallacy. The fallacy of, If you don't prevent it, you're incompetent - and if you do act to prevent it, and it is prevented, then it was unnecessary.
I believe that's known as "damned if you do, damned if you don't".
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Old 03-13-2020, 06:59 PM
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I have to admit when someone posts over and over and over again on Facebook that the Flu kills 12,000-61,000 people a year and this COVID-19 thing is overblown by the media and we are all needlessly panicking, I have trouble disagreeing with those numbers. Often the argument is coupled with the "media is trying to discredit Trump" charge which makes my back bristle even more.

Here are the arguments I have made so far, is there a better one?

-The infection rate appears to be higher
-So far the death rate is higher
-Its possible way more than 40,000 people will die

I have a feeling there is a better argument out there that these people are missing. Is there one?
You don't argue against it, you use it as part of the reason that a strong containment and mitigation response has been NECESSARY.

Our healthcare system was nearly swamped by the 2017-18 influenza season. People seem to forget quickly but many hospitals had to have tents set up to take care of patients and created makeshift ICUs. We are still seeing influenza cases now, most recent numbers still higher than last year's peak.

Anything more intense than peak 2017-18 influenza, either by itself or in combination with influenza, is horrific. We do not know how bad this germ is for sure but IF it is as bad as a moderate flu season and it happens concurrent with even a moderate level of influenza, then we are in disaster zone. There is significant risk that this may, without interventional action like social distancing and such, be worse than, maybe much worse than, 2017-18 influenza all on its own. Even a little worse than that is likely overwhelming.

I do not expect this to be much worse than a moderate level influenza event, but that level alone is reason for GREAT concern, especially occurring as we still have influenza active as well, and the uncertainty that it might be significantly worse justifies dramatic cautionary measures.
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Old 03-13-2020, 07:15 PM
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You don't argue against it, you use it as part of the reason that a strong containment and mitigation response has been NECESSARY.

Our healthcare system was nearly swamped by the 2017-18 influenza season. People seem to forget quickly but many hospitals had to have tents set up to take care of patients and created makeshift ICUs. We are still seeing influenza cases now, most recent numbers still higher than last year's peak.

Anything more intense than peak 2017-18 influenza, either by itself or in combination with influenza, is horrific. We do not know how bad this germ is for sure but IF it is as bad as a moderate flu season and it happens concurrent with even a moderate level of influenza, then we are in disaster zone. There is significant risk that this may, without interventional action like social distancing and such, be worse than, maybe much worse than, 2017-18 influenza all on its own. Even a little worse than that is likely overwhelming.

I do not expect this to be much worse than a moderate level influenza event, but that level alone is reason for GREAT concern, especially occurring as we still have influenza active as well, and the uncertainty that it might be significantly worse justifies dramatic cautionary measures.
Do any regions or nations have effective plans to drastically expand in-patient medical care in an emergency or do the odds of that happening occur so rarely that the resources for that are not allocated.

I always assumed ad hoc treatment centers would be set up in stadiums and other large covered areas in cases of large natural disasters or pandemics, but even so that doesn't mean they'd have the manpower or equipment to give people the care they need.
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Old 03-13-2020, 07:47 PM
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Quoth XT:

But that brings up something...we don't HAVE a vaccine for this thing. Yet.
Actually, we do. Developing the vaccine was very quick. The delay is in proving that the vaccine's safe enough. But of course, how safe is "safe enough" depends on how dangerous the disease is that it's protecting against. If evidence comes out that COVID-19 is much worse than epidemiologists think (i.e., if it's actually as bad as most non-epidemiologists think it is), then the vaccine will be approved more quickly.
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Old 03-13-2020, 08:41 PM
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I do not expect this to be much worse than a moderate level influenza event, but that level alone is reason for GREAT concern, especially occurring as we still have influenza active as well, and the uncertainty that it might be significantly worse justifies dramatic cautionary measures.
Earlier, you stated that you thought that doing things like Italy's quarantines were an over-reaction. I am not saying this as a gotcha at all--I have really, really respected and relied on your insights through this whole thing. Has your thinking on that issue changed? If so, what changed it?
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Old 03-13-2020, 09:26 PM
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This is a chilling but educational article that explains why local and state governments are smart to be taking such drastic measures

It is very likely that there are multiple folks reading this right now who have been infected and feel 100% fine. Assuming I am one of them, we won't find out that we're sick until some time next week, on average. There may be hundreds of thousands of us. And there just aren't enough hospital beds to accommodate the 20% of us who will need them. It's hard to believe, but we just need to go on and believe it.
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Old 03-13-2020, 09:36 PM
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Here is my impression on why people should take it more seriously and not compare it to the flu.

The flu kills about 0.1% of people who get it. COVID-19 kills closer to 2-4%, making it 20-40 times more deadly.
How many Americans (A) have died because of the flu this year? How many have (B) died due to COVID-19?

Until B > A, morons will think "No big deal" no matter how many scientists or doctors or other "Fake News" people tell us different.
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Old 03-13-2020, 10:31 PM
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Earlier, you stated that you thought that doing things like Italy's quarantines were an over-reaction. I am not saying this as a gotcha at all--I have really, really respected and relied on your insights through this whole thing. Has your thinking on that issue changed? If so, what changed it?
Thank you for the kind words.

I remain thinking that mass quarantine of a region is an inappropriate and disproportionate reaction of little likely benefit above and beyond measures much less draconian, although the opportunity for mitigation and flattening the curve in Italy was a ways back.
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Old 03-13-2020, 10:52 PM
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Do any regions or nations have effective plans to drastically expand in-patient medical care in an emergency or do the odds of that happening occur so rarely that the resources for that are not allocated.

I always assumed ad hoc treatment centers would be set up in stadiums and other large covered areas in cases of large natural disasters or pandemics, but even so that doesn't mean they'd have the manpower or equipment to give people the care they need.
"Effective plans"? No.

Yes a limiting factor is simply healthy trained healthcare providers in a surge circumstance. Among other limiting factors. Here, for example, is one analysis regarding ventilators from 2015.
Quote:
... The current U.S. health care system may have limited capacity to use additional mechanical ventilators during a large-scale PHE. In this paper, we provide a model to estimate the surge capacity of the U.S. health care system to use additional or stockpiled mechanical ventilators. This assessment includes identifying health system components (supplies, space, staff and systems) that may constrain the number of ventilators that could be effectively used during the peak of a national influenza pandemic outbreak. ...

... The number of available critical care physicians was the most constraining key component at the conventional capacity level, limiting the maximum number of ventilated patients to 18,900. The number of available critical care and intermediate care beds was the constraining key component at the contingency capacity level, limiting the maximum number of ventilated patients to 52,400. At the crisis capacity level, the number of available respiratory therapists was the key constraining component, limiting the maximum number of ventilated patients to 135,000. (Table 2) This assessment showed that even if bed capacity and some staff capacity could be expanded by including general ward beds and employing the services of noncritical care physicians and nurses, U.S. ventilation capacity would still be limited by the number of trained respiratory therapists at the crisis capacity level.
Not included in the model are numbers of staff out of commission sick themselves or caring for family members either due to illness or school closings.
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Old 03-13-2020, 11:07 PM
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I have to admit when someone posts over and over and over again on Facebook that the Flu kills 12,000-61,000 people a year and this COVID-19 thing is overblown by the media and we are all needlessly panicking,
One thing you can point out is the number of deaths is low *because* of these extraordinary precautions. China was welding the doors shut to apartment buildings in an attempt to contain it. Countries are setting up drive-thru testing stations. People with positive results are being immediately quarantined. Those are some extreme measures to take. Nothing like that is done to fight the flu. The flu is allowed to flow freely through the population without these kinds of impediments.
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Old 03-14-2020, 05:09 AM
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Thank you for the kind words.

I remain thinking that mass quarantine of a region is an inappropriate and disproportionate reaction of little likely benefit above and beyond measures much less draconian, although the opportunity for mitigation and flattening the curve in Italy was a ways back.
Thanks. What about what we are doing now in the US--closing schools, banning gatherings of any size, encouraging people to stay home? There are dreadful costs to these things. Do you think we are over reacting?
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Old 03-14-2020, 07:13 AM
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Yesterday I was riding down the escalator at work and I overheard people behind me talking about the "hysteria". IT'S JUST LIKE Y2K, one of them said. I'm not a Y2K expert, but I always thought that all the warnings and preparation helped prevent a disaster from happening. The Y2K disaster didn't happen, so naturally the uninformed think the hue and cry was all over nothing.

It's a damn-if-you-do-damned-if-you-don't situation. People kinda suck.
Yeah, this.

"Remember when the ozone hole was gonna explode and it didnt'? HAW HAW HAW" Yeah, because a bunch of eggheads figured out what was going on and advised the lawmakers to make the right laws.

"Remember when the black rhino were going extinct? HAW HAW HAW" Actually, they did go extinct. You're just too dumb to understand what was lost.

People suck.

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  #41  
Old 03-14-2020, 08:48 AM
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How many Americans (A) have died because of the flu this year? How many have (B) died due to COVID-19?

Until B > A, morons will think "No big deal" no matter how many scientists or doctors or other "Fake News" people tell us different.
This isn't helped by the facty - and a lot of people won't like me saying this but here we go - the fact that the wave of flu deaths is exaggerated. The number you see thrown around, about how 30,000 or 50,000 or 75,000 people die from flu in the USA every year (or whatever - the number varies from claim to claim) just aren't true. They are broad estimates, having no relation whatsoever to the official causes of death of people who died. They heavily rely on conflating flu with other causes of death, especially pneumonia, which can be caused by flu but can be caused by many other things. It just is not true. Flu is dangerous but the wild figures being put out there are dishonest, by at least an order of magnitude

COVID-19 can quite easily surpass the numbers flu REALLY kills, and the risk exists it'll surpass the fantasy numbers too.

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Old 03-14-2020, 09:38 AM
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OP: here’s a detailed article on that issue. No short bullet points in the article, but you might prepare some from the article and then post your bullet points and a link to the article.

I would stay away from any political comments if you’re hoping to change people’s thoughts on the issue. Keep it clinical.

https://amp.cnn.com/cnn/2020/03/14/h...sis/index.html
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  #43  
Old 03-14-2020, 03:21 PM
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Thanks. What about what we are doing now in the US--closing schools, banning gatherings of any size, encouraging people to stay home? There are dreadful costs to these things. Do you think we are over reacting?
For most of them IMO misreacting more than overreacting.

But yes you are on point about having some appreciation for the "costs" - which include very real health harms - and balancing it against possible or theoretical benefits.

To my mind job one was to get the information that we need to make actual intelligent decisions. I can think of no reason why by now there have not been good studies sampling the population at large in Hubei for antibody levels in order to determine basic critical bits of information such as what the true infection rate in different age and gender demographics was, and of those how many were completely asymptomatic, how many mildly symptomatic, etc.. It seems that those who are asymptomatic or extremely minimally symptomatic and then recover are of less contagion risk than those who at least become more moderately sick. Confirming that is key.

It is only with that information that experts can actually do more than wild assed guess about what sort of social distancing measures are most effective, where returns diminish, how possible containment was, and come up intelligent estimates of benefits to balance against possible costs. Without it we have no real idea what the shape of the curve might be with and without different social distancing measures.

Aggressive testing, including of contact tracing, and isolation of those positive, might have been able to hold off its widely spreading in the first days of its identification in America. It seems likely to me that that opportunity is now past.

So we are at a point in which we are trying to alter the shape of the curve, hopefully avoiding a peak (of it plus influenza) that exceeds health systems capacities, but doing so fairly blind, with no idea as to true infection mortality rates for each demographic, or how contagious people at different ages with different presentations are. No real idea of what the curve would look like in our demographics in any of the circumstances.

And in the face of that lack there is knee jerk application of near random and somewhat extreme bits from the pandemic flu toolkit, even though one the few things we already know is that this does not follow the same patterns. School closings, preventing gatherings in which people are NOT on top of each other, broad social isolation as the norm for who knows how long, taking those of lowish risk for serious morbidity and mortality but high risk of spreading it about when they get it and throwing them into the communities with those of high risk, instead of containing them on campuses, and much else, are to me misreactions.

Given that we are now past containment the issue is mitigation. We know that the highest numbers of deaths occur in specific populations. To my mind the ideal would be have aggressive surveillance testing across the country and as rates started to rise in certain areas implement aggressive protective measures for that population during the period of moderate to high COVID-19 in their communities. As practically as possible isolate them during the storm (wearing effective mask protection whenever visited or out) and when they come out, as rates drop back down on the other side, if this really is so contagious and 30 to 50% have been infected and are now, most of them, recovered, then they are in an environment with much reduced risk of exposure. The actual amount under the curve is reduced.

If we are to aim to alter the shape of the curve do not forget that the actual curve that matters is COVID-19 PLUS influenza demands. Be very cognizant of the risk that an attempt to flatten may end up resulting in just delaying the peak to coincide with next season's influenza demands. The less catastrophic would be to aim to backfill into a time period that we can reasonably expect influenza rates to be low. Which would imply that we want whatever it will unavoidably be to occur during weeks 16 to 42 (see the seasonal flu numbers over the years here), IOW mid April to mid October, if we knew enough to know how to do that, not to slow it to a degree that were still fairly maximal numbers of those susceptible in October and November as flu is likely to erupt.


FWIW much of what is being done in the name of mitigation is NOT what is currently advised by the CDC. School closures (grade, HS, and college) are, for example, only advised when there is "substantial" community transmission ("Large scale community transmission, healthcare staffing significantly impacted, multiple cases within communal settings like healthcare facilities, schools, mass gatherings etc.", and then mostly because of the expectation of too much staff or student body out sick.

Specific to school closures here.
Quote:
Available modeling data indicate that early, short to medium closures do not impact the epi curve of COVID-19 or available health care measures (e.g., hospitalizations). There may be some impact of much longer closures (8 weeks, 20 weeks) further into community spread, but that modelling also shows that other mitigation efforts (e.g., handwashing, home isolation) have more impact on both spread of disease and health care measures. In other countries, those places who closed school (e.g., Hong Kong) have not had more success in reducing spread than those that did not (e.g., Singapore).
Much of the extreme measures being taken in communities across this country are NOT advised by the CDC but political decisions.
  #44  
Old 03-14-2020, 04:26 PM
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If evidence comes out that COVID-19 is much worse than epidemiologists think (i.e., if it's actually as bad as most non-epidemiologists think it is), then the vaccine will be approved more quickly.
This article gives information rather than telling you what to think. But after reading it, I think -- a vaccine this decade might be a bridge too far:
Researchers rush to test coronavirus vaccine in people without knowing how well it works in animals

Quote:
Regulators require that a manufacturer show a product is safe before it goes into people, and while it isn’t enshrined in law, researchers almost always check that a new concoction is effective in lab animals before putting human volunteers at potential risk. . . .

What the company doesn’t say is that it has not yet brought a single product to market, even in non-emergency times. The majority of candidate vaccines fail.
Risk balancing, for release of a poorly tested pharmaceutical, requires knowing how many people have COVID-19 antibodies divided by how many people die of the disease. If something on the order of 2+ percent, a terrible risk is justified.

Knowing the results of that division requires first developing an antibody test, and then testing a random sample of a population in a society where death certificate causes of death can be trusted. Before the end of 2020, we probably will have some reasonable approximation of that number.

My guess is that, when good evidence is available, I'll think abbreviated testing a big mistake.
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Old 03-14-2020, 04:32 PM
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Also, my 'fear' is that when this all blows over, people are going to running around saying that it was a huge over reaction. We cancelled just about everything and for what? Every time someone calls it an over reaction, I've been trying to explain that if this all blows over without amounting to much that they shouldn't think of this as an over reaction, instead they should consider that it didn't amount to much because of how we reacted.
I've read this and the follow ups. Not that I disagree with the assessment, and although it could be a damned if you do damned if you don't situation, you are committing the same fallacy. As you said, we don't know many of the answers, but by framing it this way, you are making it a praised if you do, praised if you don't situation.

If nothing much would have happened anyways, you cannot baldly claim that the overreaction without question caused the not amounting to much.

One of the main CDC spokespersons said that the reason why COVID-19 may be underreported is that many people believed that they just had a bad cold and never sought treatment. Well, if that is so widespread, then it leads me to believe that this is not Dr. Tripps and that I won't be dreaming of Randall Flagg or Mother Abigail very soon.

And as Manda Jo said, we are paying a rather extreme price both economically and personally for something that for most people is very mild. And not to be an asshole, but does this whole thing boil down to giving a few 87 year olds a chance to survive this until the flu or something else minor kills them next year?

I'm not trying to be so cold-hearted, but is this the bottom line here?
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Old 03-14-2020, 05:01 PM
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This isn't helped by the facty - and a lot of people won't like me saying this but here we go - the fact that the wave of flu deaths is exaggerated. The number you see thrown around, about how 30,000 or 50,000 or 75,000 people die from flu in the USA every year (or whatever - the number varies from claim to claim) just aren't true. They are broad estimates, having no relation whatsoever to the official causes of death of people who died. They heavily rely on conflating flu with other causes of death, especially pneumonia, which can be caused by flu but can be caused by many other things. It just is not true. Flu is dangerous but the wild figures being put out there are dishonest, by at least an order of magnitude

COVID-19 can quite easily surpass the numbers flu REALLY kills, and the risk exists it'll surpass the fantasy numbers too.

I
This post contains a ton of inaccuracies and should be disregarded in its entirety.
  #47  
Old 03-14-2020, 05:47 PM
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And as Manda Jo said, we are paying a rather extreme price both economically and personally for something that for most people is very mild. And not to be an asshole, but does this whole thing boil down to giving a few 87 year olds a chance to survive this until the flu or something else minor kills them next year?

I'm not trying to be so cold-hearted, but is this the bottom line here?
Everyone, please don't conflate my views with this. I am not saying all these things aren't worth the cost, nor do I think the lives of old people are of low worth. Some of my favorite people are old.

UltraVires, it's worse for those over 60, but it kills other people, too. It especially kills them (us, maybe, me or you or someone you love) if we are stuck in a hospital hallway in an overwhelmed medical system.

Honestly, having read everything, it appears we just don't know what we should be doing. We don't have the information we need to make the right choice. It seems appropriate to me to err on the side of caution, just because it could be so very bad. Recognizing things have a high cost isn't arguing that they are inappropriate.

I look forward to reading the books about this, and hope they will make sense.
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Old 03-14-2020, 05:49 PM
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Everyone, please don't conflate my views with this. I am not saying all these things aren't worth the cost, nor do I think the lives of old people are of low worth. Some of my favorite people are old.

UltraVires, it's worse for those over 60, but it kills other people, too. It especially kills them (us, maybe, me or you or someone you love) if we are stuck in a hospital hallway in an overwhelmed medical system.

Honestly, having read everything, it appears we just don't know what we should be doing. We don't have the information we need to make the right choice. It seems appropriate to me to err on the side of caution, just because it could be so very bad. Recognizing things have a high cost isn't arguing that they are inappropriate.

I look forward to reading the books about this, and hope they will make sense.
I have no views to be conflated with. I am not saying old people are of low value. I am asking if this is indeed the choice we are making.
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Old 03-14-2020, 06:11 PM
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I have no views to be conflated with. I am not saying old people are of low value. I am asking if this is indeed the choice we are making.
It's not. It doesn't only kill old people, certainly not only people in their late 80s.
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Old 03-14-2020, 06:43 PM
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I have no views to be conflated with. I am not saying old people are of low value. I am asking if this is indeed the choice we are making.
It is estimated that 20-somethings who have been infected by COVID-19 have a 0.2% risk of dying (assuming they have access to adequate healthcare).

This doesn't seem like a big risk when we're talking about low numbers.

But let's say 30% of Americans ages 20-39 get infected by the end of the year. That's a little over 12 million people. 0.2% of that number is 24,000.

That's just 20-somethings.

And of course, that 0.2% is based on statistics from China, where people were literally welded into their homes for a month to keep this thing contained. China built extra hospitals and mobilized an army of doctors and nurses so that people of all ages would be treated. Needless to say, we aren't doing this here.
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