Of course they are. We were speaking in reference to achieving herd immunity by exposing uninfected people to the virus.
You can think what you like if it helps avoid you feeling better about your error, but triage never involves exposing people to new risks that they currently aren’t exposed to.
And the ones who are at-risk through that are the ones who are at-risk - whether it’s obvious beforehand or not which ones they are.
So vaccines are 100% safe? Do you know, when you give a vaccine to someone, that they absolutely will at some point in the future be exposed to that illness and be protected? No? Then why are you giving them something that exposes them to danger?
Any non-zero chance that the next injection which you give will cause an unexpected allergic reaction and kill or harm that patient?
Overall, do you want 1m people to die or 10k people to die?
Can we put the whole planet under genuine quarantine for 18 months? Is there someone who is going to organize a program to ensure that Covid-19 is eradicated from every corner of the Earth, before we end that quarantine? I would be astonished if the answer to either of those questions is a yes.
You can organize releasing people in some sort of rational and logical way or…not. But, again, there isn’t a case where you keep everyone on lockup until summer of 2021. There isn’t a third option that I’m aware of.
Similarly, you can organize the protection of some small percentage of people based on the manpower physically available to you or, you know, just tell people “Go and be free!” sometime in May. Which of those do you think is better?
Should or should you not have some sort of plan that considers that you factually do have some percentage of the population who are definably at high risk and who have no way to receive any protection against a disease which continue to bounce around the population until next summer, unless you organize something?
The Coronavirus’s Unique Threat to the South: More young people in the South seem to be dying from COVID-19. Why?
Why? Kaiser Family Foundation ran a study.
Why? More smokers and fat WalMart shoppers. And their leaders.
The firestorm is imminent. It’s not like we weren’t warned.
Sorry, CarnalK.
Yet every year influenza hits rural America worse than it hits urban America. Despite its lack of density, lack of public transportation, and relative isolation.
I’d have to see your definition of “worse” and some data before I take that at face value. Maybe a greater percentage of infected people die, maybe more people have underlying health conditions, maybe fewer people get vaccinated. I agree with all that. But we’re not going to see more aggressive spreads of infection than we did in denser areas. Epidemics just don’t work that way.
Again you’re talking about mortality, not epidemic spread.
I will agree that of the relatively few people in the south who get COVID, many of them shouldn’t have been infected, and you can 100% blame inept politicians for that. I will also agree that many of those people will have worse outcomes because their underlying health is worse.
But there is not going to be any kind of epidemic “firestorm” where there are more cases per 100,000 than urban areas, and there will not be a rapid exponential spread like we saw in urban areas.
I see this sentiment online from so many people who appear to be hoping for southern governors to face a Biblical-scale reckoning for their craven, stupid, politically motivated responses to the pandemic. I get it, we want to see consequences for bad decisions, preferably severe political consequences that punish Republicans. I am not immune to that temptation myself. But I’m here to tell you it’s not going to happen, full stop, and whatever our politics are, we should be glad that at least some Americans are protected by geography and low density.
From what I’ve gleaned, there are two main reasons why the case fatality rate could be higher in a given situation: Overwhelming of healthcare capacity or vulnerability of infected individuals. Has the NY healthcare system been overwhelmed to the point of outpacing ICU spots and ventilators? I don’t know. If not, a high number of cases initially doesn’t matter all that much.
Googling it, I see that headlines from 2 April say NY state could run out of ventilators in 6 days which would be 8 April. It’s 11 April now. Has NY state run out of ventilators? I would expect that if this were the case and NY doctors were choosing who to unplug from ventilators, we’d hear about it but maybe it’s my own insufficient Googling skills.
If healthcare capacity isn’t outpaced, what will matter more is vulnerability of the infected individuals. And there, these kinds of map are going to be relevant: https://www.google.com/search?q=bmi+by+state&rlz=1C1SQJL_enCA829CA829&sxsrf=ALeKk01g4VWS5PqN69WLMocHXL5l6y9Smw:1586612174643&source=lnms&tbm=isch&sa=X&ved=2ahUKEwjrj8P4vuDoAhUml3IEHZxwDWcQ_AUoAXoECBoQAw&biw=1497&bih=967#imgrc=AboUObdb5u1FNM https://www.google.com/search?q=smoking+by+state&tbm=isch&ved=2ahUKEwiDz6L5vuDoAhXNAd8KHVPqBDMQ2-cCegQIABAA&oq=smoking+by+state&gs_lcp=CgNpbWcQAzICCAAyAggAMgYIABAHEB4yBggAEAcQHjIGCAAQBxAeMgYIABAHEB4yBAgAEBg6CAgAEAgQBxAeUKGQA1i6lgNgwZ4DaABwAHgAgAFeiAGeBJIBATeYAQCgAQGqAQtnd3Mtd2l6LWltZw&sclient=img&ei=0MeRXoOnDM2D_AbT1JOYAw&bih=967&biw=1497&rlz=1C1SQJL_enCA829CA829#imgrc=y0JhmBbMEIitnM https://www.google.com/search?q=diabetes+by+state&tbm=isch&ved=2ahUKEwiL3Y2Tv-DoAhVtl-AKHb-nCgsQ2-cCegQIABAA&oq=diabetes+by+state&gs_lcp=CgNpbWcQAzICCAAyAggAMgYIABAHEB4yBggAEAcQHjIGCAAQBRAeMgYIABAFEB4yBAgAEBg6CAgAEAcQBRAeOggIABAIEAcQHlCG3wFYx-oBYJbsAWgAcAB4AIABWogBwwWSAQE5mAEAoAEBqgELZ3dzLXdpei1pbWc&sclient=img&ei=BsiRXovCF-2ugge_z6pY&bih=967&biw=1497&rlz=1C1SQJL_enCA829CA829#imgrc=cTuAne_yzHDTJM
Back to the OP, I am no expert but I am going to say both yes and no. I dont think it will be the “vast Majority” but I think many, I dont know how many, will get it and have antibodies against it. Heck many people may have already had it but didnt know it.
I am basing that on the number of people who have recovered. No, I’m not saying one should get it on purpose.
But no, many people will never ever be exposed.
Worse is by death rates. Significantly more of rural populations die from influenza each year than of urban ones.
Points made in this article btw.
More detail in the article about why many rural areas are on a death rates basis likely to get hit hard. Correct that because of built in social distancing it hits them usually later and possibly more slowly … but still … many more of them are likely to die.
The saddest part is that because of the baseline of social distancing being already there it would not take too much to lower it likely by lots. All the sadder that the little extra effort is to such a large degree not being done.
HMS also please recognize that death rate per 100K is a reasonable proxy for ICU and ventilator need rates. There may not be absolutely more cases, but many more of the cases will have need for hospital care, for intensive hospital care, and will be dealing with rural healthcare systems that are short of those beds and staff as a baseline. Swaths of rural counties have NO ICU beds at all. Or even no hospital period.
This is fair enough, I have no problem with saying that the cases that hit the south, many of which are/were entirely avoidable, may well be more severe and have less treatment facilities.
What I do take issue with is people saying the rural south/midwest is facing a firestorm of new cases. There’s just not enough density or absolute population numbers to support that.
There is a period between when we get this virus under control and when a vaccine is developed. During this time we have to open up the economy just enough to keep the infection rate under control and be ready to shut things down for a couple of weeks whenever we need to.
This means that everyone that can work from home continue to work from home. We have a curfew. We have lots of testing. No social gatherings. Move K-12 online.
Bolding mine.
There is little debate about the first part - once some level of control is achieved the economy should be opened up to the degrees that allows the infection rate to stay within an acceptable level.
Thing is though that NO ONE at this point can be very sure about what that means. Maybe it does mean what you state for a year, or maybe more. But maybe not. Key information is being collected and analyzed now and over the next several weeks and will inform what guidance the experts give (which hopefully will be listened to). But even then the guidance will still be well informed best guesses.
A change of some sort will be made. And the response of the disease to that change will be monitored, perhaps regionally. If the disease stays under the acceptable control parameter for a few weeks (say ICU admissions due to COVID-19 stay below a certain threshold ) then another move gets made, also informed by the best guess that the experts can come up with based on more new data gathered by that time. If they get above the parameter some tightening needs to occur. Given human nature is as it is it is likely better to err on the going slow side and to avoid having to sell a return to greater restrictions.
Move K-12 online. That’s good one! Do tell us who is going to watch the little ones while Mom and Dad are at work? As they get older, who is going to supervise them and make sure that are paying attention to their lessons? What about tests? No cheating.
My youngest niece just began her first year as a teacher last September. She teaches art to the little ones. Luckily her school district is paying her full salary, even though she cannot do online what she does in the classroom.
It looks like California and, possibly, others are trying to put their focus into tracing and they want that to be viable before letting people go.
I’m not sure that I trust that the technology will be very effective. Hopefully, it will, obviously. But the issue I see is that say that I’m infected and infectious. Maybe I have symptoms, maybe I don’t. At best, I will have symptoms at some point but I’m still infectious for a couple of days before that point.
During the two days that I’m asymptomatic and infectious, I’m walking by people on the street, using the coffee machine at work, going to the bathroom at work, sneezing on things, etc. Some of those, the tracer app will pick up but some it won’t (to be fair, it looks like transmission of colds via objects is only about 2% - most transmission happens through sneezing and breathing on people).
If I actually get symptomatic, maybe I go to the doctor, maybe I don’t. But I might not ever become symptomatic - most likely I won’t. If I do go to a doctor or get tested, maybe a few more days have already passed. During all this time that I’m infectious, I’ve possibly interacted with dozens or hundreds of people. And the odds that I get symptomatic is fairly low (though, we’ll say 50% since I presume that there’s a correlation between infectiousness and likelihood of becoming symptomatic) and the odds that I am tested might only be 50% as well (quite possibly lower). So usually it won’t be me who get tested, it will be half the symptomatic people among those I came near, about a week later - after they’ve all had a chance to expose a few dozen or hundred people.
And well, now we know to quarantine a thousand or so people once those tests finally come back. But, among a thousand people, a pretty good quantity are going to be people who were at-risk. We just killed them because we told everyone that Google was going to use magic to make the disease go away and so they all decided that they can just live nice, normal lives again. Maybe they’re skipping shaking hands and doing a few small things, but mostly they’re still doing everything they usually would that helps to spread a disease.
And that all assumes that Google is watching everyone.
It looks like we have been tracking down illegal immigrants through their cellphones, so they have probably begun refraining from using smartphones.
Some people turn off GPS on their phone; some people don’t carry their phone around; sometimes service is bad; and so on.
A large vector of infection will be people traveling into the country from somewhere else. Their phone might not work here or it would be expensive to use, so they turn it off.
Overall, we’re going to have fairly significant gaps and that will compound the delay in detection by quite a lot and allow for some invisible Typhoid Maries to wander around. It will also make it impossible to identify people who were exposed in a not insignificant percentage of cases.
If your average person exposes 30 people and we only identify 80%, 6 won’t be discovered. We would expect 1 of those to become symptomatic and, possibly, more to become infectious but asymptomatic. Those 6 people might create another 60-90 exposures of whom, again, 20% will be undiscoverable. That’s enough error for a perpetual chain to not only continue but possibly even branch and expand.
Plausibly, we will get enough data that we can keep cutting off each outbreak at around 1-2k people and resetting the virus so that it has to find a new way in. But that really just slows things down. And, I don’t know that it slows it enough to protect at-risk groups from infection for an 18 month period. It’s good for the hospital system, but not for the people who will be killed in each of those outbreaks.
I think that tracing will make us feel good about ourselves. But then, when we go back and count the deaths from 2020, we’ll realize that we were deluding ourselves that our massive, heroic effort was doing the best that it could do.
I still believe that it is more practical, and likely to be more effective, to identify at-risk groups and focus on defending them. With tracing, you might not know that you failed until an at-risk person is dying in the hospital and you only discover that as ambulances are called out to the other hundred homes of at-risk person who were affected by the same outbreak.
Not much but realistically little of what you read in media or internet can separate itself from political affiliation.
On what % will eventually get it, I believe that’s still highly unknown. Numbers from awhile ago that went with death tolls an order of magnitude higher than what appears likely now can probably be discarded. Also ‘eventually’ in a theoretical of slow spread could easily overlap the development of a vaccine or highly effective treatment* which isn’t contained in those projections naturally, because it isn’t known.
Back to politics making projections about the US in a predominantly US forum is always political. But you can look at various countries where the infection curve is bending down to where it’s simply not consistent with 10’s of % ever getting it. Except under the assumption ‘they open their economies then it takes off like wildfire’. Except it’s not at all clear that would happen. ‘Opening up’ would not be going back to as if nobody knew about the virus. It’s impossible to project what the infection rate would be in a ‘reopened’ economy without detailed information what the preventative measures would be, and how people actually get the virus. For example, how many people now actually get it by going to the supermarket if there’s enforcement of 6’ separation, masks and hand washing? It might be a tiny number, and if so it wouldn’t make a big difference to open back retail stores in general with the same precautions. OTOH in NY could you have low infection rate with normal crowds on the subway? Perhaps not, a big dilemma for NY. But it wouldn’t apply to car oriented places where commuting itself might also result in only a tiny number of infections. Infection rates at various workplaces, with precautions, could vary greatly. Bars, dine in restaurants, live sports and entertainment events, those might not be able to go back close to normal before a vaccine/treatment without spiking the infection rate. And if so, they may very likely not.
But again without reams of details including stuff that’s probably just unknown by anyone yet, I don’t see any way to put a meaningful number of ‘how many people will eventually get it’. 20-60% could be a gigantic overstatement, the authors of which might be defended by pointing to their stated assumptions and caveats. But it could still be a useless number.
duplicate
How does this jive with and R0 of 2 to 3?
I’ve been saying this from the beginning. Often to the accusations of being unscientific and unreasonable. Often the chorus goes up that we don’t know who is truly at risk and that we can’t defend the at risk even if we did know who they are because this spreads too easily.
In short, I’m in agreement with you.
The R0 is the population-level effect of the virus. It’s how quickly it grows, on average, not how many people are infected by a single person. A large number of people never even get the disease. Only a small percent ever become infectious, and they have to make up for all of the people who are naturally immune, non-infectious, or otherwise never pass the disease on.
An average spread of 2.5 might mean that 10 people never spread it and 1 person spreads it to 28 people.
I would also note that an R0 is a count of people infected, rather than exposed. So we’re not saying that of the 11 people, 1 of them was infected and exposed 28 other people to the virus, they actually gave it to 28 other people.
That’s probably hard to accomplish, so the average infectious person is probably not spreading to quite that many people, but it is still an R0 of 2.5.