Notice how you did not mention any testing there. Again, once testing is finally available for anyone that suspects was sick or had contact with a sick person is that then we can open shop.
The nonsensical thing is when some insist that just random testing will do.
QFT. The economy is not closed down. It’s been disrupted but it is not closed down by any means. The statistic I heard was that 10% of the workforce has been laid off. That means 90% hasn’t. The 90% may include some people who are still drawing a paycheck while not working, but most of them are still on the job.
Right now, the economy is like a computer running in safe mode. All the important processes and functions are still running. Some bells and whistles have been disabled. Most of the disabled processes are at the top layer - the user interface, as it were and are highly visible, while the stuff that’s still running is the more opaque stuff we take for granted and don’t think about much.
And, like a computer running in safe mode - the bells and whistles have been disabled in order to keep the rest of the machine operational. The important stuff. If we lose a significant portion of the viral sectors of the economy, we won’t just be inconvenienced anymore. We’ll be screwed.
Yeah, ‘random’ (sample) testing is used when you want to make an estimate of the prevalence of immunity (or other measured factor) in the population under the assumption that the population is homogeneous enough that a ‘small’ sample (quantity of which is dependent upon your best guess of the prevalence of this factor, could be as few as 30 depending on your desired confidence level) is adequately representative. To “open up the economy” for normal operations, you’d actually have to give people confidence that they do (or do not have) immunity via comprehensive individual testing.
A term that is getting thrown around a lot is “herd immunity”, in the apparent belief that once some hypothetical level of immunity is reached the virus goes away and there is no longer a threat, or at least, we can somehow isolate all “at risk” people in their own hermetic bubbles while everyone else goes back to normal life. Setting aside the absurdity of that premise (as in how are you going to isolate people in elder care facilities or needing medical treatments from the supposed “low risk” population caring for them?), herd immunity just assures that the virus is kept to endemic levels similar to influenza or chickenpox, and will continue to outbreak in occasional waves but without sufficient paths to achieve epidemic status, or at least not continuously. It does not protect individuals from contagion, and as it has been repeatedly stated, severe and critical presentations of COVID-19 are occurring in people in there twenties and thirties without any apparent underlying conditions or co-morbidities. Herd immunity is the ultimate end to the pandemic by definition, but trying to somehow rapidly achieve herd immunity by deliberate exposure simply assures that the largest number of people will present COVID-19 in the shortest possible period of time, inevitably overloading the medical system versus trying to restrict the spread and even out that peak so more people can get treatment, and people with non-COVID-19 maladies and traumas can still get medical treatment.
Stranger
VITAL sectors of the economy. My autocorrect is reacting to the situation, and the SDMB lags made me miss the edit window
Then your right wing leaders should have the courage of their convictions. The President is a Republican. These scientists are employed at his pleasure and he can fire them anytime he wants. He’s got a tight stranglehold on the Executive branch and pretty good, if not absolute, control of the legislative branch.
There’s a lot he could do. If he truly believes it’s gaslighting, he could issue an order opening everything back up. He could withhold grants and loans from businesses that don’t defy their state governments and reopen.
What he’s trying to do is set up the situation where he gets the credit if there’s a good outcome and passes the blame on the bad outcomes.
It’s his crisis to manage, he owns it. That’s because he’s President. If you don’t like the restrictions, blame him. He could release them in a heartbeat with the tools he has at his disposal. There would be screaming and pushback, but he could stand up to it and show the world he has the courage of his convictions. And if he truly believes that the economy has been deliberately sabotaged that’s what he and the Republican leadership should do.
And if he’s not doing this, maybe he’s gaslighting YOU.
Not to bring politics into this thread any more than it already has, but I think an objective review of the last few years will show who is ‘gaslighting’ whom, starting from 21 January 2017.
The “experts in this field” who “are incapable of being objective and incapable of approaching this virus in a non political fashion”, e.g. scientists from the National Institutes of Allergic and Infectious Disease and from various academic and industry research labs developing testing, treatments, and vaccines may not be perfect or completely accurate in everything they say because like the rest of us they are working in the proverbial ‘fog of war’, but the idea that there exists some mass conspiracy to deceive the public and divert attention from effective solutions goes beyond conspiracy wankery and right into offensive denialism of fact. The very idea that these people–many of whom have passed upon more lucrative career options to work in public service or infectious disease research for which there is little opportunity for great profit or even professional renown outside of the field–are deliberately misleading the public is absurd on the face of the argument.
Stranger
Or trump could start a war.
Factories a humming. People a workin and united!
War the fuel of capitalism.
“The” election. Y’know, the only one. All the world’s scientists are holding off on solutions until after that single day in November when the whole world heads to the polls to decide if their Republican heads of state will remain in power.
So what is your plan with testing? What are the requirements on the testing? Do we need results in seconds? How do we get enough capacity to carry out the testing you are taking about to keep the vulnerable protected?
I never claimed random testing will do.
Personally I don’t see how we can protect the most vulnerable by sitting around and waiting. We can for a time, but we can’t keep the world shut down until we have a vaccine. There is a distinct possibility we will never have a vaccine. It makes no sense to keep things completely shut down unless that plan includes a way to stop the virus and get rid of it. So some keep advocating staying shut down but never say what comes after that. I’m asking you. What comes next?
As Stranger points out, trying to keep the most vulnerable away from this is exceedingly difficult. But I never hear a true solution other than to keep saying we can’t possibly move towards controlled exposures because there is a non-zero chance some might get sick. Which ignore the fact there is that same risk even if we have a vaccine because some just will not tolerate the vaccine well at all.
Please understand that I fully agree with you.
Who the hell wants a “complete collapse of the economy”? Names, please.
The medical community is (mostly) reality biased. If that happens to line up more with one party than the other, then that just means one party is also more reality biased than the other.
Just asking questions I see…
I would point at what other countries like Taiwan and Singapore did. Even while waiting 3 days for results, the ones that were tested were advised or taken to quarantine until results were given, then the ones that tested negative can continue social distancing, and the ones that tested positive back to quarantine.
Regarding capacity, now as pointed before the failure to not get more in place is a big reason why we are in this situation. IMHO there are a lot of delays due to the ones in power still trying to get a profit out of all this. There is very little reason to not use executive powers to gear up companies to produce the items that are in short supply to make the kits.
See why the Just Asking Questions is a fallacy? In this case that was already replied at (and the sources linked or proper cites that are not hard to find to explain it), the testing of anyone that has symptoms or has to work with people should be in place.
Well, that is telling, it tells me that you do follow more anti vaccine propaganda rather than science, that is what herd immunity is for! It is available in a safe way by vaccinating almost all of the ones that we can so the few that can not have the vaccine will employ the herd immunity obtained with the vaccinations.
But this also makes clear that you do not like the answers, so you look for something that supports your misguided opinion, in Latin America we have to say to the one making those questions: No hay the pina! There is no pineapple flavor! As in, follow the advise of experts, not of pundits that have no expertise.
ALL of them?
There are many many options of how to open back up and the several that he bemoaned are no where close to “all of them.”
I am repeating myself in multiple threads I think but we still do not have the key critical information to be able to have confidence in forming a best approach. The seroprevalence studies remain the likely single most critical missing piece.
The other information we will have over the next weeks is how other nations fare as they try relaxing their restrictions some.
psychonaut has been sharing Austria’s plans and the Czech Republic is also starting to gradually loosen restrictions.
We will (?should?) learn from watching what happens (or does not happen) in those countries over the next several weeks before we make any changes here.
I’m not anti vaccine. Not even close. But there are times when people have severe reactions to vaccines. It happens. Given that whatever vaccine we come up with for this will be new, there are going to things that need to be learned in administering it. Or are you advocating that whenever a vaccine is available there won’t be any serious reactions in anyone at any time?
I’m not just asking questions. You offered a half assed article about how herd immunity won’t work and didn’t like the answer that it was mostly worthless. Great.
The quotes you provided seem to suggest you feel we really do need to get to a vaccine before we can roam free again. That is certainly one way to go about this. I happen to think that is impractical.
I had addressed the Singapore/China angle of giving everyone an app and tracking that way. I deleted that part because I didn’t want to ramble on. Personally, again, I don’t think that kind of thing will happen in the US. Maybe it would work in other places and I could be way off that it would work here. Even with an app, there are going to be people that slip through, and then those at risk will be exposed.
As for testing, if testing lags by days, which is what you talked about, imagine how many people one orderly in an assisted living facility can infect in that time. They get tested on Thursday, Monday they are told they are clear, but over the weekend their wife/kid/whoever infected them or they picked up something at the grocery story. Unless you are advocating that people can’t move around at all and can’t visit with anyone ever again.
No, I’m not just asking questions. I really am very curious how others view this moving on from here.
The problem of “severe reactions to vaccines” is why we have the three phase testing protocol to first assess safety in a small population, then in a larger population, and finally efficacy. The infamous Cutter Incident, which ironically served to prevent US adoption of the more effective and safer vaccines, and the later revelation that many people were SV40 have served as a cautionary warning about adopting vaccines without a rigorous safety testing program and strong quality controls on production. Reactions can still happen–I had a severe systemic reaction to the influenza vaccine in 1992 or 1993–but they are increasingly rare as immunologists understand what kind of substrates or formulations can produced an unintended immune or inflammatory response. This is the very argument for not rushing the first vaccine that appears to have some efficacy into immediate production.
This notion of just exposing people to the live virus and letting nature take its course is just ensuring the maximum degree of mortality. From an epidemiology standpoint it is complete nonsense, because the entire point of reaching some threshold of herd immunity is to minimize the chance of spread and spare the unnecessary deaths that come from uncontrolled contagion. Before we make any plans about loosening isolation measures, we (by “we” I mean epidemiologists and immunologists representing society as a whole) need to better understand how the disease is transferred, how to identify everyone that is vulnerable instead of mistakenly assuming that it is only the old and immunocompromised, and develop science-based plans for informing the public for how to protect against further spread, which means wide scale serologic (antibody) testing to determine who has developed an effective immune response (and how long that immunity will last). Anything short of that is not only condemning people to die needlessly but also ensuring distrust in government and scientific guidance in giving false confidence to the safety of relieving such measures.
Of course, the costs of maintaining isolation need to be weighed against the harms–having such severe strictures means that people often aren’t getting treatments for their other non-COVID-19 related maladies, and every percent increase of unemployment is often assumed to be an increase in unnecessary mortality of 37,000 people, so there are significant downsides in maintaining long term isolation measures–but that argues for having an actual plan to mitigate harms rather than just opening the floodgates and encouraging everyone to mingle so we get to some hypothetical level of “herd immunity” in record time.
Stranger
I’ll reiterate a point made earlier.
Even if you exclude the elderly and known co-morbidities, somehow magically walled them off from the rest of community, nobody thinks you would get the CFR down to say 0.01% And that is with infinite medical resources.
That is a one in 10,000 death rate. Now imagine that the vaccine was known to have a 1 in 10,000 death rate when administered. There would be rioting in the streets if the government mandated everyone be vaccinated. But that is exactly the same as “protect the vulnerable and open up to gain herd immunity.” Except, in reality, we could never keep the CFR that low.
Nobody has any clue how you protect the vulnerable. Right now they are protected by limiting movement of everyone. This protects them by reducing the chance that those that care for them become infected in their social lives. This protection ceases when the intent is to infect everyone else to achieve herd immunity.
The idea that all the exit plans are terrible is sort of true right now but also misses the point. We don’t have the numbers and available resources (in the form of enough reliable mass testing capability) to settle on an exit strategy. That is coming. There is no special magic about that the strategy will be. The options have already been discussed, and we hope the numbers will support one of the easier options - one that may involve some relaxation with large scale and repeated testing and quarantine. But we can’t know right this moment if this is a viable plan. Lots of unknowns need to be filled in to be sure. The cost of a premature relaxation, and the subsequent second wave, would vastly exceed the cost incurred so far. So caution is well advised.
Thanks for the info on the steps to vaccine qualification. I’m not sure how much of that can be accelerated given the current state of affairs. Hopefully we won’t be trading too much risk for speed.
I really and truly understand that there will be more deaths by opening things up too quickly and I’ve never, not once, said this is just an old person disease. There are millions of people at risk who are not old, and so care must be taken to try and protect them, too.
It will be interesting to see how things progress in China given the relaxation they’ve implemented. Hopefully that will help guide us here.
Most of the things you talked about sound like months of waiting. Wide scale serologic testing, length of immunity, etc. are all at least months away.
If the stat about 37,000 is correct, and we are approaching a 10 point change in unemployment, that would mean 370,000 additional deaths just due to unemployment. As I’ve been saying, we are trading killing grandma for killing mom, dad or junior. Grandma at least has medicare. New estimates for death told are 1/6 of the 370,000 total, but that would require lock down until August, I think.
I’m still not sure how any plan works to keep the vulnerable from getting this. Maybe I’m just missing it, so I apologize. I hear isolation is needed to keep from overwhelming the medical system. That is obvious and working. I also know we can slow down the spread with isolation, but I’m under the impression we are way beyond any hope of stopping it with that. Testing keeps getting mentioned, but is it realistic to think the type and scale of testing that would be needed to attain the type of confidence we need to to avoid putting people at risk attainable?
That true, however, diabetes and hypertension can present with minor symptoms initially. Isn’t it possible that people with no “apparent conditions” simply didn’t know they had them?
An effective antibody test, once validated, could potentially be deployed quite rapidly with targeted prioritization toward people at greatest risk and most need. Ideally it would be a combination of a simple IgA test you could do at home with a nasal or throat swab (even if efficacy isn’t great, as long as it doesn’t produce a significant number of false positive results it would provide confirmation) which could be followed up with an IgG serology test for confirmation. With a coordinated federal-state response and pressing commercial testing labs into prioritizing producing test kids, they could be cranking out hundreds of thousands or even millions of test kits per week just like they do with pregnancy tests. More detailed serological surveys can be done later as followup to assess things like variations in immune response and make estimates of how long acquired immunity will last, but just getting testing available starts to fill the gaps in the big unknowns about how many people have been infected and the actual case fatality rate.
Stranger