Not sure why anyone has been, knowing what we now know, even considering anything other than those prospects being in the cards at all.
First comment - of the three prospects laid out in the Minnesota link there is ONE that is the worst, by FAR - that is the “Fall Peak” one … and one that is the least poor is the “Slow Burn”. Fall Peak not only has the largest peak (thus most able to exceed health system capacity) but is most likely to occur along with influenza. A double catastrophe. That would occur with Of the possibilities the one would most want to TRY to create is “Slow Burn” … which includes having some level of cases over summer, a controlled burn allowed that is not allowed to get too hot by the degrees of mitigation measures in place in various areas.
Second comment - critical inputs are still placeholder wild assed guesses. The Science link, more rigorous in its modeling, accepts that the very fundamentals are just not known.
Interesting that they are raising the issue of degrees of cross-immunity with other coronaviruses. Not something that gets mentioned too often. They continue -
Then they go on to create some models that explore different scenarios of seasonal variation, cross-immunity, immunity duration, based off of various other placeholder assumptions.
A variety of possibilities result.
One would be “smaller peak incidence during the initial pandemic wave but larger recurrent wintertime outbreaks” with a lighter summer season. Again, the nightmare option, timed with influenza.
Another -
“If immunity to SARS-CoV-2 is permanent, the virus could disappear for five or more years after causing a major outbreak” … of note in that scenario some of the common cold causing HCoVs could go away too “if SARS-CoV-2 induced 70% cross immunity against them, which is the same estimated level of cross-immunity that HCoV-OC43 induces against HCoV-HKU1.”
Another -
"Even if SARS-CoV-2 immunity only lasts for two years, mild (30%) cross-immunity from HCoV-OC43 and HCoV-HKU1 could effectively eliminate the transmission of SARS-CoV-2 for up to three years before a resurgence in 2024, as long as SARS-CoV-2 does not fully die out "
They then modeled impacts of mitigation, both “one time” and “intermittent” under “the worst-case scenario” … that really needs to be emphasized, and is not mentioned in the NYT communication of the article.
They also modeled variation in efficacy of mitigation as well and come up with results that might surprise some.
Let’s really highlight that, even as we fully acknowledge the limits of the worst case assumptions they use. Achieving greater and longer initial suppression would, in their model of intermittent suppression, lead to bigger peaks later.
From the discussion section:
Let’s maybe consider broadening from “intermittent” to “dynamically adjusted and graduated mitigation measures chose for most efficacy over least harms as the data as collected informs.” Note also that they do allow that if cases become low enough that “aggressive contact tracing and quarantine” become practical (current per them not) it "could alleviate’ the needs.
Also from the discussion section:
The take away to my read -
IF one realistically believes with some surety and confidence that we will be able to get new infection rates very low and then be able to get enough people cooperating with testing and quarantining in an ongoing basis for an indefinite future then one should try to push down to near zero. Note not “should” but real world “will”.
The risk of trying for that and failing though is dramatic. That is the Fall Peak nightmare. Systems overrun with a high peak occurring timed with influenza.
If one is not sure of being able to accomplish that then a controlled slow burn (in their model achieved by intermittent social distancing) may be the least poor choice.
Again, my preferred variation is controlling it with “dynamically adjusted and graduated mitigation measures chose for most efficacy over least harms as the data as collected informs”, with special attention to doing MUCH better at protecting the most vulnerable than we have done do date.
The problem with trying to dynamically adjust and graduate distancing protocols is getting the public to actually participate when needed. The social dynamics of the contagion are the biggest unknown in a giant pot of unknowns, and we’ve seen already how defiant and obstructive many people have been to even minimally intrusive (and marginally effective) measures such as cloth face coverings in businesses or asking people to refrain from large social gatherings like parties and ceremonies, much less repeated actual stay-at-home isolation measures. Expecting enough people to ramp up and down their interactions not to mention the effect on businesses that cannot maintain consistent procedures is just probably not going to happen in most of the United States because the infectiousness of this virus and the often asymptomatic spread means that even a minority of violators will rapidly achieve epidemic levels of contagion.
There are a lot of people pinning their hopes on a vaccine being ready for deployment by the end of the year, and one of the significant failings of the public health system from the top down has been a failure to discourage that kind of magical thinking. The “controlled burn” model combined with a heavy emphasis on developing pharmaceutical and procedural interventions to keep patients from getting to the point of having to be put on mechanical ventilation is the best, most realistic path to returning to something like a normal economy and social interactions, and even that is going to be on the timeframe of another two years. However, from what I’m seeing currently, the “Fall Peak Nightmare” seems all too likely, and there needs to be a concerted effort to get as many people inoculated against influenza to minimize the impact of co-morbidities in two potentially simultaneous epidemics. There also needs to be an emphasis on food security and good nutrition, including Vitamin C and D supplementation to boost immune system response for vulnerable people, and effective protection for all workers who are in customer-facing roles; not just doctors, nurses, and first responders, but cashiers, service people, et cetera, because these are the people who are most likely to be core spreaders if infected.
I’ve seen a lot of emphasis on track & trace which would make sense to maintain marginal infection levels in the “slow burn” scenario but if the contagion returns to epidemic levels (and it seems that the unrestricted basic replication number is much higher than even the revised official estimates), then the effort for tracking and tracing in general society may be a waste of time (but still potentially useful in care facilities and other restricted situations) unless testing is frequent and pervasive, which would require a near-real time antigen test capability that just isn’t currently available.
Seriously. Millions and millions of people are being financially destroyed.
Those over 65 are retired or can retire. That incomes requires that people work to generate money for taxes to pay that income. They can shelter in place.
There’s an extremely low death rate among children and none of them are considered essential workers so they can shelter in place.
People with type 1 diabetes need to take extra care monitoring their blood sugar level but your 1 in 3 statistic is just an emotional rant. Age is the overall marker for death from this disease just as it is for the flu. We don’t shut the country down for the flu and we’re not going to shut down the country indefinitely for this particular virus.
It’s been 8 weeks. We’ve prevented the health care system from being overrun and it’s time to go back to work. There will be peaks and valleys going forward just as there will be improvements in treatments.
To be fair, good scientists tend to hedge their language like this. I’m more wary of experts who speak confidently than those who don’t.
I agree that a surge is definitely going to happen, though. But if I were called upon to give my expert opinion about this, I’d probably be a little wishy-washy too just out of habit.
For a scientist, everything has to be expressed in terms of conditional probability, especially when reference to model predictions in the aggregate. However, you can safely bet your mortgage that there will be a surge in cases and everybody who hasn’t run multiple waterfront casinos into the ground understands this to be an essential fact; it is just a question of how big those surges will be, and whether the measures in place can manage to keep them from peaking so sharply that people who could be saved with medical interventions (and others who require treatment for other non-related issues) will die because the health care system is overwhelmed or dysfunctional.
I prefer “financially destroyed” to “actually destroyed.”
There’s something wrong with a system that assumes the elderly are less valuable than other members of society.
But the main thing I came in to say is that you’re falsely assuming a binary outcome: either you die of COVID or you don’t. That’s not actually the case: detailed reportsare circulating about individuals with long-term consequences, from mildly debilitating to severe, following recovery. Whether those are for a couple of months or lifelong is impossible to know. I haven’t seen anything like a percentage, but if you recover from the flu, you’re fine. That’s not necessarily the case here, and I’d really like to know what the actual health costs would be of just letting it run through the population. How many of us would recover, only to be unable to work again?
We have the hospital problem under control because of the lockdown. Open things up too much, and it won’t be under control any more.
Little Dutch boy has his fingers in the dike. Only a little bit of water is leaking out. Problem solved. He’s very very hungry - why not go and get lunch? What can go wrong?
Careful reopening yes. But you’re assuming that careful people are going to expose themselves to risk, and idiots like the protesters standing next to each other without masks are going to respect the social distancing guidelines. Like in bars. People are real careful in bars.
“Financially destroyed” isn’t really a thing. Poverty is a thing. Millions of people are entering poverty. That’s an extremely bad thing, because poverty is terrible, and sucks. But it’s not the same as something being destroyed. The chief difference is that after something is destroyed, it’s permanently gone and you can’t get it back again.
Framing the the bad economic consequences of quarantine/shutdown measures as a type of ‘destruction’ not only offers a false equivalence between losing money and actually dying, it makes a great avoidance strategy for the people who can actually do something about this (those with money).
“Financially destroyed” implies an irreversible process that, once it happened, all you can do is live with it. Poverty can be alleviated. The people in power in the US right now have not historically been all that interested in alleviating poverty but it’s the sort of thing that governments are well-equipped to do, unlike bringing people back from the dead, which they’re not any better at than the rest of us.
Governments should not be allowed to get away with any of this “oh, we can’t take such and such a measure because people would be financially destroyed”. They should acknowledge that some of the things that can be done to save lives are going to put people at risk of falling into poverty and then do their actual job of alleviating that
You wish. Most people who might be able to retire could barely afford necessities, if that.
So kids’ actual job–education and becoming socialized–you’d just write off. And let’s not forget the kids who’ve recovered from COVID only to get sick or die from inflammation.
Odd your definition of rant. I don’t think extra care is going to keep them alive when their organs start failing.
THIS. IS. NOT. THE. FUCK. ING. FLU.
And fuck whoever those people happen to infect. Because they should have retired or monitored their blood sugar better or not had a heart or lung condition.
By this time, bringing again the dead horse argument that we should compare this to the flu, makes it a very asinine argument.
That report was back from early April when more than 12,000 died in the USA, now we are over 80,000 dead and we are bound to see more that 100,000 way before the end of the year.
It is more likely that we would see even people in the White house die and create more chaos. What is happening in the administration is a good example of what would had taken place multiplied many times over in the financial world too. The ones that disagree are barking up the wrong tree; testing and masks for every one are needed before coming back to a resemblance of what it was before and the ones that are just fleecing states for medical and equipment and not ramping up efforts to get proper masks and testing for all need to explain why other nations where able to do so and not the USA.
We have experience now. Locales that shut down fastest and hardest recover fastest economically. The US administration did not react fast and furious enough and now we face the consequences of inept leadership. Opening up without restrictions guarantees further surges in infection and death rates, and slower financial recovery. Metaphor: Do not jump from moving train.
“Peaks and valleys” means boxcar loads of corpses. Will you sacrifice your parents for the cause?
dead is dead. If we’re going to shut the country down what’s the magic number of dead per capita? In other words, why don’t you care about large numbers of people who die because of the flu?
Well we’re harming a 100 million people’s financial lives. Again, what’s the magic number to shut a country down and keep it shut down? Clearly 60,000 people don’t mean a thing to you because… flu?
This is not about sheltering in place. We’ve already done that. It’s about the structured return to work.
Broke is broke. Dead is dead. They’re different. Broke can be recovered from; dead can’t. Can you cite a source showing that more deaths will improve the US economy?
Let’s be clear, there is no assumption being made, it is an observation that children are at relatively very little risk of severe COVID-19. Very little is not the same as “do not”. It is just much much less than they do from influenza and the cases of “Pediatric Multi-System Inflammatory Syndrome Temporally Associated with COVID-19” do not change that fact, even if they are an order of magnitude more widespread than expected.
I completely agree which is why I both think that it is unrealistic to think that the general public will cooperate with behaviors needed to get new infection rates very low and then with repetitive testing and quarantining in an ongoing basis for an indefinite future.
And it is why I think intermittent approaches would not work.
I think instead you open up gradually and slowly enough that the risk of having to reverse is low but fast enough that the risk of inadequate compliance is low as well. Parameters to be decided as discussed in the Science article.
Maybe there is something wrong with me then but I actually do think that a 28 year old entering parent of two entering the most productive working years of their life is “more valuable” than I would be at 84 and disabled. IF this was a trolley problem and you had to save one but let the other die, would you save that future me or the young adult? Who would you value more?
That said it is not the choice being proposed even by Magiver (and I do not endorse his analysis). To some degree it is the opposite. Do an actual good job at protecting the vulnerable (which is not being done) while letting the lower risk people take the risks, in stages, if they wish. It is accepting the fact that some will die as more get exposed and that the way to minimize that number is to have more of those exposed be those at lower risk than higher risk. There is some rank order (that as of yet still has to be guessed at) of relaxation moves of least risk to increase numbers of hospitalizations and death over most benefit of decreasing deaths long term worldwide from economic collapse, as well as increasing quality of life and facilitating compliance. Figure that list out and go up it gradually as parameters allow. Opening up bars likely not first on the list. Crowded screaming sporting events not first either. Younger without other risk factors likely out and about first.
You are very wrong by the way about influenza. Those who have ARDS from influenza are at substantial risk to have “consequences” for minimally months to even years afterwards. So far there is no evidence that those recovered from COVID-19 related ARDS are at any more risk of that than those with ARDS from influenza have been. It is not so always true that “if you recover from the flu, you’re fine” … But you are in good company thinking that influenza is a much less big deal each year than it is. It really is not as benign as many seem to think.
That said, my initial hopes and even expectations that this would end up in a the range of a compressed very bad flu season have clearly been proven wrong. That would have been not “just” anything and would have been very very bad and avoiding that, trying to flatten it out so it would not be so compressed would have been worthwhile. This is worse but even more it is its own thing and requires its own response appropriate to what it is.
