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Old 03-22-2020, 06:21 AM
Francis Vaughan is offline
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A case for controlled infection?


The thought occurs to me.
Everything is the current strategies assumes that everyone will eventually be infected, and the effort should be to "flatten the curve". However not everyone is equally at risk from the virus. There would therefore be a case for offering a managed infection. essentially get prepared, self isolate, open a vial of virus , inhale, and ride it out. Three weeks later you should test clear. Essentially as effective as immunisation, but riskier and not always pleasant. But a person would be clear to work, help others, travel. As more and more took this route herd immunity would rise, and would rise faster than in the current system where we are trying to lower the value of the exponent, which has the unfortunate effect of slowing down the herd immunity.

There are lots of problems with this. One could only offer it voluntarily, the ethics would be difficult at best, and the liability issues impossible in some places.

However, these are not ordinary times. Personally I would more than happily sign up. The risk reward makes sense to me. I have very elderly parents, and right now I worry that I can't help look after them. I'm already working from home, and the city has just had cafés restaurants and bars shut down. Maybe I would be too ill to work for a while, but that is assumed to be on the agenda anyway. If I could get it done with now in a controlled manner I could be useful, and be able to look after my parents. Right now is the worst answer. It is assumed I will eventually get sick and need to isolate, but nobody can control when, and for this entire time I can't look after my parents effectively, or help anyone else.
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Old 03-22-2020, 07:14 AM
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This reminds me of the chicken pox parties that parents used to participate in.

If a child living nearby got the chicken pox during the summer, parents would send their children over to play with the infected child in the hopes of getting it over with when it wouldn't interfere with school. What you are suggesting was a common part of our culture until a few decades ago.
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Old 03-22-2020, 07:29 AM
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Originally Posted by Alley Dweller View Post
This reminds me of the chicken pox parties that parents used to participate in.

If a child living nearby got the chicken pox during the summer, parents would send their children over to play with the infected child in the hopes of getting it over with when it wouldn't interfere with school. What you are suggesting was a common part of our culture until a few decades ago.
But in those days, most adults had immunity to chicken pox because they already had it. So chicken pox parties didn't put the children's families at great risk. That is not the case for SARS-CoV-2.
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Old 03-22-2020, 07:33 AM
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There are lots of problems with this.
...this was, of course until very recently, the British plan. Until they redid the numbers and realized that it would be a fucking disaster resulting in the death of hundreds of thousands.

So yes, to say there would be "a lot of problems with this" is a bit of an understatement. So no: there isn't a case for "controlled infection." Unless you intend to do permanent damage to your lungs and you want to be gasping for breath if you walk quickly for the rest of your life, in which case I would still say no: there isn't a case for "controlled infection."
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Old 03-22-2020, 08:18 AM
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...this was, of course until very recently, the British plan.
I don't think I made the case well enough then. It is nothing like the old British plan. I am not suggesting any relaxation of any of the current controls and restrictions. The point about controlled infection is exactly that - it is controlled. Only designated people at known times and in controlled numbers become infected deliberately.

The question about damage to lungs etc also misses the point. There seems to be no expectation that most people will avoid infection. Expectations are that the majority of people will get it sometime in the next year. All that is being done now is to slow things down. The only hope of avoiding infection is a vaccine becoming available before you get it. Any hope of snuffing the virus out with the current restrictions and controls is fantasy. It will come back the moment restrictions are lifted.

A problem I have with the current situation is that the numbers are not clear, or at least widely known. If the plan is to keep the number of seriously ill - and thus in need of critical care - below the threshold where the medical system is overloaded, the time for which restrictions on the populace are needed is derivable. As is the required rate of transmission required to keep infections below that threshold. There is scant information of what those numbers are, and I suspect they are grim. Basically we won't meet the needed rate, and the medical system is going to get overloaded, and even then, the time for restrictions to remain is understated. It is early days, an the number are fluid, but some idea of the thinking would help. In amongst this, lots of people are expected to become infected with low to no impost on their health. But they are required to be restricted in their movements, unable to work in many cases, and whilst they have never been infected they remain a possible infection vector, rather than adding to herd immunity. One doesn't just let the virus run free and try to cope. But I remain unconvinced the current measures are going to work by themselves.
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Old 03-22-2020, 08:23 AM
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...this was, of course until very recently, the British plan. Until they redid the numbers and realized that it would be a fucking disaster resulting in the death of hundreds of thousands.

So yes, to say there would be "a lot of problems with this" is a bit of an understatement. So no: there isn't a case for "controlled infection." Unless you intend to do permanent damage to your lungs and you want to be gasping for breath if you walk quickly for the rest of your life, in which case I would still say no: there isn't a case for "controlled infection."
It's not just the deaths; it's the hundreds of thousands of deaths nearly all at once - it would shut down the entire healthcare system.

The reason why we are being told to stay away from each other is to make the situation manageable for healthcare workers. Even if you don't die from the disease, there is probably a 1 in 5 (slightly higher or lower) chance of ending up needing hospitalization. The herd immunity strategy would mean a massive rush on the NHS. It would shut the entire system down within months. It would mean that not only would COVID patients die, but patients with treatable cancers would die, patients with manageable diabetes would die, patients who have liver and kidney problems would die, people with treatable pneumonia or bacterial infections would die. It would be a mega-fucking disaster.
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Old 03-22-2020, 08:46 AM
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I don't think I made the case well enough then.
...you haven't made any case for controlled infection. You've simply described the process. It wouldn't be "essentially as effective as immunisation." You wouldn't "open a vial of virus , inhale, and ride it out." You would run the very same risks as everyone else exposed to the virus: including the risk of permanent damage to your lungs and even death.

Quote:
It is nothing like the old British plan. I am not suggesting any relaxation of any of the current controls and restrictions. The point about controlled infection is exactly that - it is controlled. Only designated people at known times and in controlled numbers become infected deliberately.
The only difference between your plan and the (original) British plan is that your plan somehow manages to be even sillier than the British plan. The point about controlled infection is that it isn't exactly that: it wouldn't be controlled. The only thing in your control is the knowledge you have been exposed: thats it.

Quote:
The question about damage to lungs etc also misses the point. There seems to be no expectation that most people will avoid infection. Expectations are that the majority of people will get it sometime in the next year. All that is being done now is to slow things down. The only hope of avoiding infection is a vaccine becoming available before you get it. Any hope of snuffing the virus out with the current restrictions and controls is fantasy. It will come back the moment restrictions are lifted.
It isn't inevitable everyone will get it. There is no downside to avoiding exposure and you should be doing everything you can to avoid it, not only for your own sake but for the people that are around you. But if you choose to deliberately expose yourself then you are opening yourself up to the very real possibility of permanent damage. I'm not the one missing the point here.

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But I remain unconvinced the current measures are going to work by themselves.
Of course they won't. But deliberately exposing yourself to the virus isn't going to help. It will only make you sick: and it could quite possibly kill you.
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Old 03-22-2020, 08:50 AM
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Fact 1: Not everyone is going to get it.

Fact 2: Total deaths are related to the number of people who get it. More infections implies more deaths.

Fact 3: Timing is important. The death rate is higher if more people get infected in a short time. Spreading things out helps a lot. You definitely do not want to have people getting infected sooner rather than later.

So other than that, it's a ... great terrible idea.
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Old 03-22-2020, 09:00 AM
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Plus, I don't think we know for a certainty that you are immune after you have it once, do we?
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Old 03-22-2020, 09:06 AM
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Sadly I still don't think anyone gets what I'm try to say. So I'll leave it at that.
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Old 03-22-2020, 10:01 AM
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Sadly I still don't think anyone gets what I'm try to say. So I'll leave it at that.
I do. But you are far better off on this board with this group to just not go there. Trust me.
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Old 03-22-2020, 10:10 AM
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If I could get it done with now in a controlled manner I could be useful, and be able to look after my parents.
I get what you are trying to say. You don't want to spend the next year worrying that you may have contracted the virus and endangering people around you. You want to take the risk now and go into isolation, in the hopes that in a few weeks, you'll be recovered and have immunity to it. And if other young people did that, we'd have a workforce of people who are immune to it, able to work as home home helpers, retail, etc without exposing their customers to infection.

But I see several problems with this. First, how are you going to make sure you don't pass on the infection to more people? Hospitals don't have the capacity to isolate all the people who infect themselves voluntarily. Maybe you plan to isolate yourself at home, but can you actually cut off all contact with all other people for 3 or 4 weeks? Not even food deliveries?

Also, if people start getting infected voluntarily, a small fraction of those people will get sick and require hospitalization. 20% of those hospitalized were in the 20-44 age group. The rate may be lower for people without comorbidity, but nevertheless this would worsen the shortage of medical resources.

The other issue is, if you can delay getting infected, you will have a better chance of full recovery. Vaccines may be 18 months away, but effective antiviral drugs and other treatments may become available sooner.

Other problems I see are:
  • How will you know you actually got it? Many are asymptomatic.
  • After X weeks in isolation, how will you know you've recovered, rather than still being an asymptomatic carrier?
  • Do we know for sure that people cannot get it twice?

Last edited by scr4; 03-22-2020 at 10:11 AM.
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Old 03-22-2020, 10:16 AM
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Here is my 3 point plan for getting us out of the apocolapyse

1. Intentionally infect everyone under age 20 with the virus since they don't die from it.
2. After they recover, put all the children to work operating the machinery and delivering pizzas while the rest of us adults stay at home and watch netflix.
3. After we have a vaccine, vaccinate all the adults.

Its foolproof.
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Last edited by Wesley Clark; 03-22-2020 at 10:17 AM.
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Old 03-22-2020, 10:27 AM
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We do get it.

It's still stupid.

There are some assumptions in this scheme that are laughably untrue.

There are at least 2 strains out there now, and possibly more. You'd have to make sure any such exposed people have gotten through both and, further, hope and simply assume that no other serious mutations occur. Getting through one of them does not guarantee immunity from any other mutated strains. And the more people are exposed to each other, the greater the chance of such a mutation. I.e., this is a recipe for creating new strains and feeling safe despite deliberately introducing new, uncontrolled vectors of transmission without anybody the wiser.

Another is the idea that a person who has gotten through it will be safe to interact with your parents (or whoever) after getting over it. Again, laughably untrue. While you might not shed the virus yourself, you can still transmit.

I get it. We're smart. Smart enough to think "hey, maybe the experts missed this really obvious thing and we should be doing things this way". But no. Just no. We live in an age where we regularly question experts. It is true that sometimes the experts aren't right. But they are right so much more than they are wrong that is mind-boggling that as individuals, we think we can find a 'hack' that "they" haven't thought of. We all want to be the heroes of our own stories and feel like we're doing something, but the best thing to do is listen to medical professionals, even if that is unsatisfying. We can't avoid new diseases getting out there, but ignoring the best advice of professionals is precisely why the US response has been late and lackluster.

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I do. But you are far better off on this board with this group to just not go there. Trust me.
See last paragraph above.
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Old 03-22-2020, 10:57 AM
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See last paragraph above.
You make many great points. Most of which are true. I learned my lesson and I won't try to discuss this with you. My comment was not directed at you nor at proposing this be done. I was letting the OP know I get his argument and to let it drop. Why you then felt the need to make a pointed comment at me I do not understand. Leave me alone.

Last edited by cmosdes; 03-22-2020 at 10:58 AM.
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Old 03-22-2020, 11:16 AM
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We do get it.



There are at least 2 strains out there now, and possibly more. You'd have to make sure any such exposed people have gotten through both and, further, hope and simply assume that no other serious mutations occur. Getting through one of them does not guarantee immunity from any other mutated strains. And the more people are exposed to each other, the greater the chance of such a mutation. I.e., this is a recipe for creating new strains and feeling safe despite deliberately introducing new, uncontrolled vectors of transmission without anybody the wiser.



Another is the idea that a person who has gotten through it will be safe to interact with your parents (or whoever) after getting over it. Again, laughably untrue. While you might not shed the virus yourself, you can still transmit.
Do you have actual citations for any of those points? Despite the media hoopla about L and S strains, is there a source showing that immunity to one would not confer immunity to the other? Ie, that the epitope acted on by antibodies differs significantly from one to the other?

And please explain with a citation how it's possible to not shed virus but still be able to transmit it.

Thanks.

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Old 03-22-2020, 11:45 AM
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The thought occurs to me.
Everything is the current strategies assumes that everyone will eventually be infected, and the effort should be to "flatten the curve". However not everyone is equally at risk from the virus. There would therefore be a case for offering a managed infection. essentially get prepared, self isolate, open a vial of virus , inhale, and ride it out. Three weeks later you should test clear. Essentially as effective as immunisation, but riskier and not always pleasant. But a person would be clear to work, help others, travel. As more and more took this route herd immunity would rise, and would rise faster than in the current system where we are trying to lower the value of the exponent, which has the unfortunate effect of slowing down the herd immunity.

There are lots of problems with this. One could only offer it voluntarily, the ethics would be difficult at best, and the liability issues impossible in some places.

However, these are not ordinary times. Personally I would more than happily sign up. The risk reward makes sense to me. I have very elderly parents, and right now I worry that I can't help look after them. I'm already working from home, and the city has just had cafés restaurants and bars shut down. Maybe I would be too ill to work for a while, but that is assumed to be on the agenda anyway. If I could get it done with now in a controlled manner I could be useful, and be able to look after my parents. Right now is the worst answer. It is assumed I will eventually get sick and need to isolate, but nobody can control when, and for this entire time I can't look after my parents effectively, or help anyone else.
It wouldn't have been a bad idea actually, but it is too late for it as a tactic. That would be a tactic to create a presumptively immune essential services workforce if you could have timed it so they were all recovered before they were really desperately needed. If infected today though, they won't be recovered to the point of being able to work for something like three weeks (5ish days to symptoms onset, the rest getting sick and better to considered noncontagious). And even if they are restricted to very low risk populations a certain fraction will get sick enough to require services themselves two weeks from now, which is a likely time for demands on the healthcare system to be at a peak.

Meanwhile those essential providers who have gotten infected early and recovered will be the best front line workers.


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We do get it.

...There are at least 2 strains out there now, and possibly more. You'd have to make sure any such exposed people have gotten through both and, further, hope and simply assume that no other serious mutations occur....
There is in fact NO solid evidence that there have been enough mutations to consider anything to be separate strains. There was one article claiming such that was pretty much dismissed by other experts. And there is NO thought among experts that the variation out there currently or in the near future is enough to escape immunity. They are modeling under the assumption that herd immunity does at a certain point occur, not that the bug changes so quickly as to preclude that.

But of course you are smart and maybe the experts missed this really obvious thing.
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Old 03-22-2020, 12:01 PM
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This may be of interest:
Do You Get Immunity After Recovering From A Case Of Coronavirus?

The answer is that, for COVID-19, no one really knows whether immunity develops at all or how long it lasts if it does. The guesses that are being made are based on knowledge of traditional coronaviruses: "Researchers do know that reinfection is an issue with the four seasonal coronaviruses that cause about 10 to 30% of common colds. These coronaviruses seem to be able to sicken people again and again, even though people have been exposed to them since childhood."

Additionally, intentional exposure introduces risks of serious complications even in healthy people, and a small but non-zero risk of fatality.

I'm also not persuaded that "everyone will get it eventually" -- China seems to have stabilized with just 46 new cases among the entire population in the last 24 hours, whereas the US has gained 6,032 new cases. OTOH, the growth rate charts still look exponential and are showing recent upticks even on a logarithmic scale.

The best we can do is follow the advice of public health officials who are themselves being advised by researchers working overtime to understand more about this disease and develop a vaccine for it. Personally, I'm staying home as much as possible even though I have no specific medical reason to self-quarantine. I'm about as well stocked with everything I need as is practicable and will only be going our for essential needs.
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Old 03-22-2020, 01:03 PM
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Didn't we already do this argument last week? (Was it cmosdes arguing for that?)
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Old 03-22-2020, 02:09 PM
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There is in fact NO solid evidence that there have been enough mutations to consider anything to be separate strains.
Ok, fair enough. I was operating off insufficiently vetted information. That's on me.

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But of course you are smart and maybe the experts missed this really obvious thing.
Nope. They got it. Or if not, they've made the most reasonable conclusion based on the information at hand.

But I'm also NOT the one suggesting we start deliberately infecting people in the midst of a growing epidemic.

I'll note again I recommended we leave the medical response to the experts instead of coming up with our own belated responses. I'm still sticking with that, even if you appear to be denigrating that response.

I'll own that I missed some things, but don't toss out the baby with the bathwater. We should be listening to the experts. I'll admit I deserve some snark, but I hope that doesn't extend to the notion that maybe, just maybe, the best thing we can do in the middle of an ongoing emergency is listening to the experts.

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It wouldn't have been a bad idea actually, but it is too late for it as a tactic.
Still disagree with this though. It's a novel disease. Though logistically difficult, it wouldn't have been a bad idea back in December or January if we had the knowledge we have in mid-March, both about the disease itself, how it would spreadh, and how it would affect our society.

We can only consider it a potentially good idea because we've learned a bit over the last few months. Hindsight is 20/20.


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And please explain with a citation how it's possible to not shed virus but still be able to transmit it.
Really? You don't have to be personally infected to transfer disease to somebody else via physical contact. Thorough and frequent hand washing is encouraged for a good reason, even in people who aren't sick.

I could find a citation for that, but I'm pretty sure this is now common knowledge or should be.

And many people who feel safe because they've already contracted it and gotten over it will tend (though not guaranteed) to be less careful about casual contact. No cites for that, but I'm pretty sure a look outside at how people behave is pretty strong circumstantial evidence.
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Old 03-22-2020, 03:14 PM
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Look, it literally doesn't matter what you plan is.

There are thousands of highly trained individuals who have spent every minute of their working lives thinking about this, examining every possible scenario, all feasible responses, and multitudes of circumstances.

No random untrained individual on the internet can come up with a plan that they haven't already thought of, and either put into effect, or dismissed or postponed for good reasons. The chances of your brainstorm being better than their accumulated thousands of years of experience and expertise is exactly zero.

Same thing goes for random untrained posters who think they've found a hole in quantum mechanics or figured out a new way to interpret the constitution. Your ideas are either obvious or useless. There's no third category.

I understand that people want to help. The best way to do so is listen to the experts and not second-guess them.
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Old 03-22-2020, 03:40 PM
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This reminds me of the chicken pox parties that parents used to participate in.



If a child living nearby got the chicken pox during the summer, parents would send their children over to play with the infected child in the hopes of getting it over with when it wouldn't interfere with school. What you are suggesting was a common part of our culture until a few decades ago.
These chicken pox parties were done by new-ager anti-vaxxers who falsely, ignorantly believed that catching a case of chicken pox from a mild case meant that their kid's case would be mild, too. Not so. Just as in COVID-19,its a crapshoot.
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Old 03-22-2020, 04:17 PM
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This is all based on the myth that Covid-19 is only dangerous for old people. From February 12 to March 16 20% of hospitalizations were for people 20-44 years old, and another 18% were in those 45-54 years old. Sure, that is a minority of cases, but those are still huge percentages. 80% of deaths were in people 65 or older, but that is still 20% of the deaths in people under 65.

12% of the people admitted to ICU were 20-44. That was at a time when the hospitals could handle all of the cases they had. When the curve ticks up a bit, there won't be ICU beds, and many of those people who might have been saved with treatment will die; old and young alike.
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Old 03-22-2020, 04:44 PM
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This is all based on the myth that Covid-19 is only dangerous for old people. From February 12 to March 16 20% of hospitalizations were for people 20-44 years old, and another 18% were in those 45-54 years old. Sure, that is a minority of cases, but those are still huge percentages. 80% of deaths were in people 65 or older, but that is still 20% of the deaths in people under 65.

12% of the people admitted to ICU were 20-44. That was at a time when the hospitals could handle all of the cases they had. When the curve ticks up a bit, there won't be ICU beds, and many of those people who might have been saved with treatment will die; old and young alike.
In order for those percentages to be meaningful, you'd need to consider the percentages of the groups that were exposed at the time. If I expose 100 people to this disease, 2 over 65 and 98 under 30 and 1 from each of those age groups ends up in the hospital it is easy to say 50% of the hospitalizations were for people under 30.

None of this is based on the myth it is only dangerous to old people. It is dangerous to anyone of any age, just as vaccines are. But we are playing percentage games now. There are no certainties.

Exapno Mapcase is right. The experts have weighed in and said we need social distancing. I'm not second guessing that. There are a myriad of reasons why other proposals won't work, including trying to gain herd immunity through controlled exposure. I'm doing my part, to be sure. But if the call goes out for people with little risk to step up and take a risk so others with a much higher risk can be spared exposure, I'll be first in line. I'm mid 50s but in perfect health. I'd rather not the likes of Green Bean or ThelmaLou risk exposure.

Last edited by cmosdes; 03-22-2020 at 04:46 PM.
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Old 03-22-2020, 05:14 PM
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It is dangerous to anyone of any age, just as vaccines are.
Please tell me this doesn't mean you're an anti-vaxxer. Sorry for the <snip>, but there wasn't anything in the context to help infer your meaning. I' hoping you meant that the tiny danger of vaccination is consistent across age cohorts, but that's certainly not what this says.
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Old 03-22-2020, 05:24 PM
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These chicken pox parties were done by new-ager anti-vaxxers who falsely, ignorantly believed that catching a case of chicken pox from a mild case meant that their kid's case would be mild, too. Not so. Just as in COVID-19,its a crapshoot.
Chickenpox vaccine was licensed for use in the United States in 1995. Before then, the chickenpox parties were hosted by ordinary moms and dads who got their children all the shots that were recommended at the time. Yes, new-ager anti-vaxxers continue to host them today, but they are just continuing the tradition that regular people started.
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Old 03-22-2020, 05:33 PM
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There would therefore be a case for offering a managed infection. essentially get prepared, self isolate, open a vial of virus , inhale, and ride it out.
Sounds a little like variolation (Google it).

I not sure if a live virus unattenuated vaccine is something it would be 100.00 percent bonkers to do research on. The doozy of a problem I see is that people taking it could violate quarantine and give it to others.

Like any vaccine, dosage is a BIG question. Too much, and you wind up in the ICU. Too little, and no immunity.

It might take just as long to develop and test a safe and effective live virus unattenuated vaccine -- your sniff-it tube -- as it would to develop one that didn't have the tremendous disadvantage that other people can catch the disease from you.
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Old 03-22-2020, 07:13 PM
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Please tell me this doesn't mean you're an anti-vaxxer. Sorry for the <snip>, but there wasn't anything in the context to help infer your meaning. I' hoping you meant that the tiny danger of vaccination is consistent across age cohorts, but that's certainly not what this says.
Very much in favor of vaccinations.
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Old 03-22-2020, 07:21 PM
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Originally Posted by Alley Dweller View Post
Chickenpox vaccine was licensed for use in the United States in 1995. Before then, the chickenpox parties were hosted by ordinary moms and dads who got their children all the shots that were recommended at the time. Yes, new-ager anti-vaxxers continue to host them today, but they are just continuing the tradition that regular people started.
I have only ever encountered the new-age anti-vaxxers doing it. In either case, parents were badly misinformed as to the notion that one mild-case exposure led to new mild cases. It could be a very serious condition. From your link:
Quote:
Before the chickenpox vaccine became available in 1995, an average of 4 million people got varicella, 10,500 to 13,000 were hospitalized and 100 to 150 died each year, according to the CDC".

Last edited by needscoffee; 03-22-2020 at 07:23 PM.
  #30  
Old 03-22-2020, 07:38 PM
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Quote:
Originally Posted by needscoffee View Post
I have only ever encountered the new-age anti-vaxxers doing it. In either case, parents were badly misinformed as to the notion that one mild-case exposure led to new mild cases. It could be a very serious condition. From your link:
It was, before your time, done by parents who wanted to time the disease their kid would surely be getting in any case to a less inconvenient time. In the context of the time it made sense actually.

Of the 100 to 150 deaths attributed to chickenpox the vast majority occurred in the very few who got chikenpox in teen aged years or later and extremely few in the vast majority who got it in earlier childhood. While that was not the timing most parents were think of, timing it to happen before then was also a very good choice.
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Old 03-22-2020, 11:46 PM
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Allow me to share my experience. My mother did not host chicken pox parties, but as soon as a kid in our neighborhood got chicken pox, I was taken over to play. They didn't feel great and didn't want to play. I often didn't want to play with them. Too bad. My mother's thinking was it was better for me to get chicken pox as a kid than later on. It was NOT a matter of convenience. She worked, so there WAS no "convenient time."

Alas, I didn't get chicken pox then. Mom said I must be immune. I wish. She was right about it being better to get it as a kid, though. I got it in my late twenties and was very, very ill.
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