California sets Covid-19 daily record, Bay Area cumulative total passes 20k(eastbaytimes.com)
eastbaytimes.com
California sets Covid-19 daily record, Bay Area cumulative total passes 20k
https://www.eastbaytimes.com/2020/06/23/coronavirus-california-sets-another-daily-record-as-bay-area-surges-past-20000-cases/
398 comments
Great observation. I see the same pattern in other countries, too. One reason for this I believe is the lack of “goal clarity”. What’s the goal we’re aiming for? I see several options:
1) we want to eradicate the virus from our population => total cases matter and should be 0 sometime soon, I think that was and is China’s goal
2) we don’t try to eradicate the virus, but we want to keep the stress on the health system manageable => total cases don’t matter that much, bed capacity is the relevant indicator. This seems to be the goal of the “flatten the curve” thinking
3) we don’t care that much, let the virus spread like wildfire so we will have herd immunity asap => I am not sure, but from outside it seems like Brazil is trying to do this
I think the reason you and I are confused is because it’s seems to be unclear if we are trying to achieve 1) or 2). It’s not communicated. Maybe it’s unclear to policy makers, too.
1) we want to eradicate the virus from our population => total cases matter and should be 0 sometime soon, I think that was and is China’s goal
2) we don’t try to eradicate the virus, but we want to keep the stress on the health system manageable => total cases don’t matter that much, bed capacity is the relevant indicator. This seems to be the goal of the “flatten the curve” thinking
3) we don’t care that much, let the virus spread like wildfire so we will have herd immunity asap => I am not sure, but from outside it seems like Brazil is trying to do this
I think the reason you and I are confused is because it’s seems to be unclear if we are trying to achieve 1) or 2). It’s not communicated. Maybe it’s unclear to policy makers, too.
I think a lot of countries do have clarity.
The USA definitely does not. I'm starting to wonder if "not knowing what we want" will be the root cause for the end of American hegemony.
We entered 2 wars without clarity on what it would mean to win. This was the #1 post-mortem on Iraq and Afghanistan from basically every general involved over 15 years: they never had mission clarity.
On the back of that tough lesson, we immediately entered a trade war with zero clarity on what it would mean to win.
And before we could learn the lesson a third time we're now up against a pandemic and apparently can't decide what it means for us to win.
I'm starting to wonder if "not knowing what you want" is even worse than wanting something dumb.
The USA definitely does not. I'm starting to wonder if "not knowing what we want" will be the root cause for the end of American hegemony.
We entered 2 wars without clarity on what it would mean to win. This was the #1 post-mortem on Iraq and Afghanistan from basically every general involved over 15 years: they never had mission clarity.
On the back of that tough lesson, we immediately entered a trade war with zero clarity on what it would mean to win.
And before we could learn the lesson a third time we're now up against a pandemic and apparently can't decide what it means for us to win.
I'm starting to wonder if "not knowing what you want" is even worse than wanting something dumb.
If you don’t know what you want, you can’t be disappointed you didn’t get it. If you don’t know what you’ll get, you won’t be beholden to citizens for not getting it or getting it done. It may seem careless, but it’s also convenient to avoid accountability by avoiding responsibility, and avoiding responsibility by avoiding acknowledgement or awareness of an issue.
this seems true. but it kind of implies that there is a _secret_ agenda. it would kinda be more comforting if there was, but its not really clear.
I didn’t mean to imply such an agenda exists in America. Sovereign democracy in Russia is one example of what such a secret (or even explicitly public) agenda would look like.
https://en.wikipedia.org/wiki/Sovereign_democracy
https://en.wikipedia.org/wiki/Vladislav_Surkov
https://www.economist.com/europe/2013/05/11/an-ideologues-ex...
https://en.wikipedia.org/wiki/Sovereign_democracy
https://en.wikipedia.org/wiki/Vladislav_Surkov
https://www.economist.com/europe/2013/05/11/an-ideologues-ex...
at least with a pandemic there is a clear end goal of "no more pandemic," and we're not entirely reliant on the government to get us there. even if the journey ends up being way way way way way more painful than it should have been, with far too many lives lost, we do have a path to eradicating the disease through widespread vaccination etc and people in the private/academic sectors can push on making progress there. With the war and the trade war though, those are quagmires the government got us into (with the citizens vocal support for the wars), and it really mattered that there that our leadership didn't know what it wanted to achieve. At least we have a long term goal in fighting covid, even if our leadership doesn't know what short term success should look like...
The long-term goal in Iraq/Afghanistan was "peaceful muslim-majority western-values democracies in the middle east". In other words, a literal pipe dream.
The long-term goal of the trade war with China is... QoL that costs low six figure salaries plus a pension and union protection for every high school grad in the midwest willing to work in a factory, even as the rest of the world surpasses us in labor productivty. In other words, a literal pipe dream.
We always have some pipe dream. We just never have an actual sober-minded mission with realistic expectations.
Maybe America needs a war on the drug of American exceptionalism. idk. I know war is always the answer, though. :-\
If we weren't drunk on exceptionalism, we would be containing the virus and we would have a Manhattan project-level investment in vaccine research. We don't. Calling a spade a spade literally sounds like trolling these days.
The long-term goal of the trade war with China is... QoL that costs low six figure salaries plus a pension and union protection for every high school grad in the midwest willing to work in a factory, even as the rest of the world surpasses us in labor productivty. In other words, a literal pipe dream.
We always have some pipe dream. We just never have an actual sober-minded mission with realistic expectations.
Maybe America needs a war on the drug of American exceptionalism. idk. I know war is always the answer, though. :-\
If we weren't drunk on exceptionalism, we would be containing the virus and we would have a Manhattan project-level investment in vaccine research. We don't. Calling a spade a spade literally sounds like trolling these days.
> he long-term goal in Iraq/Afghanistan was "peaceful muslim-majority western-values democracies in the middle east".
This has never been the goal of the United states
This has never been the goal of the United states
I guess it depends on who (if any person or group in particular) we recognize as setting U.S. policy, but if it's the President then I think you're wrong: https://foreignpolicy.com/2010/11/17/bush-on-nation-building... Here's the full speech quoted early in that article: https://georgewbush-whitehouse.archives.gov/news/releases/20...
There is a whole lot of difference between actions and words.
US Presidents typically have a lot of problems with democracies/democratic movements in Iran, Venezuela, Haiti, Egypt etc but very much liked the dictatorships in Saudi Arabia, Egypt, Chile, Brazil, El Salvador.
I judge governments and people by their actions and not their words.
US Presidents typically have a lot of problems with democracies/democratic movements in Iran, Venezuela, Haiti, Egypt etc but very much liked the dictatorships in Saudi Arabia, Egypt, Chile, Brazil, El Salvador.
I judge governments and people by their actions and not their words.
> Calling a spade a spade literally sounds like trolling these days.
Maybe not the best way to phrase that these days.
Maybe not the best way to phrase that these days.
TIL: https://www.npr.org/sections/codeswitch/2013/09/19/224183763...
Until the 20th century phrase had exclusively the meaning I always thought it had, and that meaning dates back to the 1500s (spade = gardening tool).
In the 1920s some people started using "spade" to mean "person with dark-toned skin" (because spades are black in a deck of cards, so spade the gardnening tool => spade the suit in a deck of cards => poc). I've never heard "spade" used like that before, and the article suggests that use of "spade" remains fairly esoteric, but it's apparently in wide enough use that dictionaries have picked up on this meaning.
The article doesn't ever establish that the phrase itself is used as a double entendre. In a quick saerch, I can't find any in-the-wild uses of "Call a spade a spade" that evoke the double meaning.
TBH I think the article's advice is sound but also extremely jaded ("Rather than taking the chance of unintentionally offending someone or of being misunderstood, it is best to relinquish the old innocuous proverbial expression all together"). I'll stop using the phrase, but doing so feels like assuming the worst of my interlocutors' intelligence and intent.
Until the 20th century phrase had exclusively the meaning I always thought it had, and that meaning dates back to the 1500s (spade = gardening tool).
In the 1920s some people started using "spade" to mean "person with dark-toned skin" (because spades are black in a deck of cards, so spade the gardnening tool => spade the suit in a deck of cards => poc). I've never heard "spade" used like that before, and the article suggests that use of "spade" remains fairly esoteric, but it's apparently in wide enough use that dictionaries have picked up on this meaning.
The article doesn't ever establish that the phrase itself is used as a double entendre. In a quick saerch, I can't find any in-the-wild uses of "Call a spade a spade" that evoke the double meaning.
TBH I think the article's advice is sound but also extremely jaded ("Rather than taking the chance of unintentionally offending someone or of being misunderstood, it is best to relinquish the old innocuous proverbial expression all together"). I'll stop using the phrase, but doing so feels like assuming the worst of my interlocutors' intelligence and intent.
How sure are you that the goal in Iraq/Afghanistan wasn't purely and simply to get an unpopular president a patriotic polling boost and a seeminly unlikely second term with the bonus of putting money in the pockets of the military-industrial complex and owners of big media while providing a distraction from the endemic corruption of washington? I dunno, I'd like to be a lot more sure of that than I am.
Does that really sound like a conspiracy theory now we know that the regime deliberately and knowingly lied about Weapons of Mass Destruction?
If you think that possible then perhaps the "long-term goal" wasn't really what the liars were lying at the time? There are those who believer endless war was the precise goal. There hasn't been a lot of anti-corruption impetus in washington since that distraction was launched - save for Trump pretending he was anti-corruption at the last minute before the lasrt election. That last minute inspiration might have won it for him too.
Anyway if you have an unclear goal you can just move the goalposts and declare success, which is the kind of the point, right? And why the goals are unclear because otherwise America might lose and you'd be the loser president.
Out of interest how do Americans feel about the Vietnam war? Did America lose that war?
Does that really sound like a conspiracy theory now we know that the regime deliberately and knowingly lied about Weapons of Mass Destruction?
If you think that possible then perhaps the "long-term goal" wasn't really what the liars were lying at the time? There are those who believer endless war was the precise goal. There hasn't been a lot of anti-corruption impetus in washington since that distraction was launched - save for Trump pretending he was anti-corruption at the last minute before the lasrt election. That last minute inspiration might have won it for him too.
Anyway if you have an unclear goal you can just move the goalposts and declare success, which is the kind of the point, right? And why the goals are unclear because otherwise America might lose and you'd be the loser president.
Out of interest how do Americans feel about the Vietnam war? Did America lose that war?
> How sure are you that the goal in Iraq/Afghanistan wasn't purely and simply to get an unpopular president a patriotic polling boost and a seeminly unlikely second term with the bonus of putting money in the pockets of the military-industrial complex and owners of big media while providing a distraction from the endemic corruption of washington?
Pretty sure of all of most of that for both, though not the same parts for Iraq and Afghanistan. The political imperative for Afghanistan after 9/11 is pretty unmistakable. The long-term neocon objective with Iraq also was unmistakable. There's also pretty solid indication that factions I. The Administration wanted to use 9/11 as a pretext to execute the latter but were delayed by the political imperative for the former.
> Does that really sound like a conspiracy theory now we know that the regime deliberately and knowingly lied about Weapons of Mass Destruction?
Yes, the ascriptions of the motives cited to both Afghanistan and Iraq still sounds like a conspiracy theory. And I’m not sure what you mean by “now that we know”; that the claims were being advanced were false and that the administration had the information which showed them to be false was widely reported in the major media at the time the claims were made.
> If you think that possible then perhaps the "long-term goal" wasn't really what the liars were lying at the time?
No, but in the case of Iraq, it's what the leading figures of the neocon movement were telling the truth about the desires for right up to the moment the whole gang became the defense and foreign policy apparatus (and hyper-empowered VP) of the Bush 43 administration.
> There are those who believer endless war was the precise goal.
“There are those who believe” is not an argument that makes your position sound less like a conspiracy theory.
> There hasn't been a lot of anti-corruption impetus in washington since that distraction was launched
There wasn't a lot in the two decades before that, either. So unless the distraction was as effective backwards in time as forwards, I don't think it was really a significant factor.
> Out of interest how do Americans feel about the Vietnam war? Did America lose that war?
Most recognize that we lost the war; there are those who cling to loudly propounding the fact that we militarily defeated the VC before the NVA took over the main fighting as if that somehow negates losing the war.
Pretty sure of all of most of that for both, though not the same parts for Iraq and Afghanistan. The political imperative for Afghanistan after 9/11 is pretty unmistakable. The long-term neocon objective with Iraq also was unmistakable. There's also pretty solid indication that factions I. The Administration wanted to use 9/11 as a pretext to execute the latter but were delayed by the political imperative for the former.
> Does that really sound like a conspiracy theory now we know that the regime deliberately and knowingly lied about Weapons of Mass Destruction?
Yes, the ascriptions of the motives cited to both Afghanistan and Iraq still sounds like a conspiracy theory. And I’m not sure what you mean by “now that we know”; that the claims were being advanced were false and that the administration had the information which showed them to be false was widely reported in the major media at the time the claims were made.
> If you think that possible then perhaps the "long-term goal" wasn't really what the liars were lying at the time?
No, but in the case of Iraq, it's what the leading figures of the neocon movement were telling the truth about the desires for right up to the moment the whole gang became the defense and foreign policy apparatus (and hyper-empowered VP) of the Bush 43 administration.
> There are those who believer endless war was the precise goal.
“There are those who believe” is not an argument that makes your position sound less like a conspiracy theory.
> There hasn't been a lot of anti-corruption impetus in washington since that distraction was launched
There wasn't a lot in the two decades before that, either. So unless the distraction was as effective backwards in time as forwards, I don't think it was really a significant factor.
> Out of interest how do Americans feel about the Vietnam war? Did America lose that war?
Most recognize that we lost the war; there are those who cling to loudly propounding the fact that we militarily defeated the VC before the NVA took over the main fighting as if that somehow negates losing the war.
Neoconservatives genuinely wanted regime change in the middle east, and I think GWB was a genuine neoconservative. Certainly most of the people who voted for GWB and who expressed support for the wars in polls were true believers, in the sense that they weren't doing so in order to enrich chief executives of military contractors. At some point the electorate takes responsibility for the course of the nation, no?
There was a clear objective in Iraq and Afghanistan - justify (and grow) an already humongous defense budget. It worked.
That answer seems... too easy. I think our problem is much deeper than that.
I think the goal a couple/few months ago was #2, but in the meantime we've learned that there might be some bad long-term consequences to contracting the disease that weren't previously known, like possible permanent respiratory damage.
Without that, then we shouldn't be too worried about getting the disease as long as we keep transmission rates low enough so hospitals don't get overwhelmed. But if some people end up with long-term respiratory issues after contracting the disease, now there's a reason to keep people from getting it, period, regardless of hospital capacity.
But it would be nice to hear these goals actually articulated by public health officials. I'm not sure if my above paragraph is actually what any public health officials are thinking or are worried about (I'm just guessing), but it would be nice to know, because I agree with you that there seems to be a lack of "goal clarity" at this point.
Without that, then we shouldn't be too worried about getting the disease as long as we keep transmission rates low enough so hospitals don't get overwhelmed. But if some people end up with long-term respiratory issues after contracting the disease, now there's a reason to keep people from getting it, period, regardless of hospital capacity.
But it would be nice to hear these goals actually articulated by public health officials. I'm not sure if my above paragraph is actually what any public health officials are thinking or are worried about (I'm just guessing), but it would be nice to know, because I agree with you that there seems to be a lack of "goal clarity" at this point.
All American public health officials I've heard have been pretty clear about their goals: we're trying to titrate our social distancing, finding the least severe restrictions necessary to keep cases from spiraling out of control and then staying there until a vaccine. There were some early proposals to drive the pandemic extinct before reopening, but they've been uniformly abandoned in the US because they weren't working.
I think it's a mix between 1 and 2. Eradication is unrealistic. But the optimum is _not_ the point where every last hospital bed is used. It's where the balance between lockdown and infections is the most societally acceptable.
That is, we want to minimize infections, just not at all costs (to society/economy/...). And similarly, we want to minimize impact on society/economy/..., just not at all cost (to health).
Keep in mind that every infection bears a risk for long time health impact or short term (death), no matter if a hospital bed is available or not.
Finding this compromise is a matter of opinion and therefore a political question. It's not as easy and black-and-white to formulate as it would be to say whether we do 1 or 2.
That is, we want to minimize infections, just not at all costs (to society/economy/...). And similarly, we want to minimize impact on society/economy/..., just not at all cost (to health).
Keep in mind that every infection bears a risk for long time health impact or short term (death), no matter if a hospital bed is available or not.
Finding this compromise is a matter of opinion and therefore a political question. It's not as easy and black-and-white to formulate as it would be to say whether we do 1 or 2.
I believe the goal is/should be a transmission rate of < 1. As long as we can keep it so each infected person has a probability of infecting less than one other person on average, we will be relatively fine.
Eradication in the US seems unreasonable, and just keeping hospitals less than overflowing not enough.
Eradication in the US seems unreasonable, and just keeping hospitals less than overflowing not enough.
If you can persistently keep the rate < 1, you will by mathematical definition eradicate the disease. (0.99 * 0.99 * 0.99 ... eventually sums to zero.)
Keeping it under control but not eradicated means averaging exactly 1 over time, which seems like a much harder balancing act.
Keeping it under control but not eradicated means averaging exactly 1 over time, which seems like a much harder balancing act.
We're at 26k cases per day in the US, yes if you continue with r<1 for long enough you have few enough cases that you change strategy to eradication, but that isn't really important. Saying what your strategy is now doesn't mean you're bound to it for months or years, you have to shift based on reality, we're not just dealing with a mathematical model.
Focusing on the rate as the metric of attention seems very much like the right thing to be at the center of public policy.
Focusing on the rate as the metric of attention seems very much like the right thing to be at the center of public policy.
> Keeping it under control but not eradicated means averaging exactly 1 over time, which seems like a much harder balancing act.
Just put the control rods - I mean open restaurants - on a control loop driven by number of number of hospitalizations.
Helps if you have prompt and delayed transmission modes, so you can regulate at the slower speed.
Just put the control rods - I mean open restaurants - on a control loop driven by number of number of hospitalizations.
Helps if you have prompt and delayed transmission modes, so you can regulate at the slower speed.
Yeah but the r is by various proxies a function of the # of cases, so it is not so simple.
It confuses me why r < 1 isn't the goal everywhere. It seems like such an obvious thing to aim for. Any ideas?
If you don't set achievable goals then you just waste a lot of resources trying to achieve them.
Why is this not achievable? New York pulled it off...
Seems to be politicised. You have a significant portion of the country treating not wearing masks or social distancing as a political statement.
I'm not saying it's not achievable. Just that you need to evaluate if it is achievable before you focus on it and it certainly doesn't seem like its "obvious" that it is to me.
I'm not saying it's not achievable. Just that you need to evaluate if it is achievable before you focus on it and it certainly doesn't seem like its "obvious" that it is to me.
New York pulled what off? The highest cases per capita of anywhere in the US, bad policy allowing it to ravage their nursing homes.
Not surprising after COVID burned through their population (quarantine or not) the case numbers have subsided. If anything NYC demonstrates that quarantine was entirely ineffective, and that the biggest mistake was not focusing on protecting the people actually at risk.
The most interesting takeaway from COVID is that “both sides” were right. It is much more deadly than an average flu (for the elderly) and also much less deadly than the average flu (for those under 50).
Not surprising after COVID burned through their population (quarantine or not) the case numbers have subsided. If anything NYC demonstrates that quarantine was entirely ineffective, and that the biggest mistake was not focusing on protecting the people actually at risk.
The most interesting takeaway from COVID is that “both sides” were right. It is much more deadly than an average flu (for the elderly) and also much less deadly than the average flu (for those under 50).
> Not surprising after COVID burned through their population (quarantine or not) the case numbers have subsided. If anything NYC demonstrates that quarantine was entirely ineffective, and that the biggest mistake was not focusing on protecting the people actually at risk.
Are you serious? How do you even come up with misinformation like this and not even bother to back anything up with any sources? How do you seriously look at the case charts and pretend like going from 10k cases/day to 500 cases/day was an inevitable outcome resulting from burning through nursing homes? It would be funny if it weren't completely insulting to their herculean efforts in containing everything when so much of the rest of the country is going in the opposite direction. https://www.nytimes.com/interactive/2020/us/new-york-coronav...
Are you serious? How do you even come up with misinformation like this and not even bother to back anything up with any sources? How do you seriously look at the case charts and pretend like going from 10k cases/day to 500 cases/day was an inevitable outcome resulting from burning through nursing homes? It would be funny if it weren't completely insulting to their herculean efforts in containing everything when so much of the rest of the country is going in the opposite direction. https://www.nytimes.com/interactive/2020/us/new-york-coronav...
Unfortunately you seem to have misread what I wrote.
1) NY has the highest cases per capita and death rate per capita in the country. [1] [2] This is what I mean by burned through their population. Serology estimates about 20% of NYC population was infected. [3]
2) NY’s policy blunder in shipping COVID positive patients into nursing homes is well documented. [4]
#2 did not lead to #1, nor did I claim it did.
Their “herculean efforts” to contain COVID notwithstanding, NY is in the process of phased reopening, just like pretty much everyone else.
[1] - https://www.statista.com/statistics/1109004/coronavirus-covi...
[2] - https://www.statista.com/statistics/1109004/coronavirus-covi...
[3] - https://www.governor.ny.gov/news/amid-ongoing-covid-19-pande...
[4] - https://abcnews.go.com/Health/wireStory/ap-count-4300-virus-...
1) NY has the highest cases per capita and death rate per capita in the country. [1] [2] This is what I mean by burned through their population. Serology estimates about 20% of NYC population was infected. [3]
2) NY’s policy blunder in shipping COVID positive patients into nursing homes is well documented. [4]
#2 did not lead to #1, nor did I claim it did.
Their “herculean efforts” to contain COVID notwithstanding, NY is in the process of phased reopening, just like pretty much everyone else.
[1] - https://www.statista.com/statistics/1109004/coronavirus-covi...
[2] - https://www.statista.com/statistics/1109004/coronavirus-covi...
[3] - https://www.governor.ny.gov/news/amid-ongoing-covid-19-pande...
[4] - https://abcnews.go.com/Health/wireStory/ap-count-4300-virus-...
You can't shut the entire country down for months on end. People will starve. No other solution has proven effective enough to get below 1.
You can't measure R; you can only model it, and your model is going to involve lots of hard to validate assumptions. So most places are using something easier to measure, such as "metrics are declining before advancing to the next reopening stage".
It requires coordinated societal action, which is definitely the same as the death of Freedom and Liberty and thus is to be avoided.
Some places have made total eradication possible (e.g. New Zealand)
Most places just aren't being transparent. Wearing a mask has turned into a political or moral statement without being driven by a goal. Leaders aren't really selling any goals, though CDC / various health departments probably have goals, the technical details are not being communicated. Instead all you see is vague information and seemingly arbitrary action from leaders and virtue signaling from the population.
In Trump-led America, I think the goal is pretty obviously positive political outcomes for Trump. CDC and others might have goals but I haven't seen them.
Part of the problem is people are generally so stupid about failure that any goal setting sets you up to be a target for people angry about not meeting your goal or not setting an aggressive enough goal so being vague is seen as the best strategy, even though I think it leads to the sort of "fake news" vs "moral crusade" problem.
Most places just aren't being transparent. Wearing a mask has turned into a political or moral statement without being driven by a goal. Leaders aren't really selling any goals, though CDC / various health departments probably have goals, the technical details are not being communicated. Instead all you see is vague information and seemingly arbitrary action from leaders and virtue signaling from the population.
In Trump-led America, I think the goal is pretty obviously positive political outcomes for Trump. CDC and others might have goals but I haven't seen them.
Part of the problem is people are generally so stupid about failure that any goal setting sets you up to be a target for people angry about not meeting your goal or not setting an aggressive enough goal so being vague is seen as the best strategy, even though I think it leads to the sort of "fake news" vs "moral crusade" problem.
> Some places have made total eradication possible (e.g. New Zealand)
Eradication seems possible when there's a small number of cases, and effective border control (being an island nation helps a lot). In the US it's going to be difficult to eradicate, because people can move about the country easily and the case load is high.
I haven't looked at other states, but Washington state has fairly clear metrics for opening restrictions at a county level. We'll see how well that works, I guess. Other states will be doing their own thing, as well as other countries, and maybe we can figure out which methods are more or less effective and either switch or know for next time.
Eradication seems possible when there's a small number of cases, and effective border control (being an island nation helps a lot). In the US it's going to be difficult to eradicate, because people can move about the country easily and the case load is high.
I haven't looked at other states, but Washington state has fairly clear metrics for opening restrictions at a county level. We'll see how well that works, I guess. Other states will be doing their own thing, as well as other countries, and maybe we can figure out which methods are more or less effective and either switch or know for next time.
Eradication is unrealistic for the US _now_.
I feel bad that we're putting a continuous load + risk on US healthcare workers, 3+ months and counting.
They probably expected to see light at the end of the tunnel last month, like other countries. Now, maybe next year?
They probably expected to see light at the end of the tunnel last month, like other countries. Now, maybe next year?
That is also what a lot of people forget: the people on the frontline are... People. They also suffer, they also get tired and they also get extremely fed up and burnt out if they have to work months and months with no end in sight.
We are not being treated by robots and the longer the pandemic lasts the more healthcare professionals suffering (physically and mentally) we will see, the more churn we will get and less care capacity we will have...
We are not being treated by robots and the longer the pandemic lasts the more healthcare professionals suffering (physically and mentally) we will see, the more churn we will get and less care capacity we will have...
> Maybe it’s unclear to policy makers, too.
I think rather than it being "unclear" to policy makers, it's rather that there's a short-term economic imperative to go for 3), or if not, then 2), while 1) upfronts economic cost. This means that while the general desire might be to go for 1) from an ethical/expert/academic-advice perspective, policy makers are doing their best to hedge (while not wanting to appear as if they are).
I think rather than it being "unclear" to policy makers, it's rather that there's a short-term economic imperative to go for 3), or if not, then 2), while 1) upfronts economic cost. This means that while the general desire might be to go for 1) from an ethical/expert/academic-advice perspective, policy makers are doing their best to hedge (while not wanting to appear as if they are).
In Germany its 50 cases per 100'000 in a borough. After that lock downs are supposed to happen again. (with discretion, if, for example, cases can be isolated)
What other country do you think of that doesn't have clarity?
What other country do you think of that doesn't have clarity?
To me, it is definitely unclear what the goal is in Germany. Is it eradication like New Zealand? Is it controlled herd immunity? Remember that Merkel said that around 70% of the population will get infected anyways. If that’s true, hospitals should not be empty. Instead controlled infection should take place. But that’s not what we have seen. We have seen an eradication strategy. Highly confusing
> I think that was and is China’s goal
I agree, and with the recent outbreak, I don't think it's possible, at least not for China. New Zealand has a shot at it.
I agree, and with the recent outbreak, I don't think it's possible, at least not for China. New Zealand has a shot at it.
When I think about the vaccine side, I still wonder how long that will take. I don’t know how it works, will there just be almost immediate economies of scale to vaccinate people?
If vaccines will also be available in ‘waves’ as they are produced, then that must mean testing is some kind of a prerequisite to know who to give the vaccine to that needs it most - and who also may already be immune from exposure?
It seems like the total cases —> 0 option is virtually unattainable in the near term (probably into 2021). Maybe with more cases being reported, we are aiming for 2) but actually going through 3).
If vaccines will also be available in ‘waves’ as they are produced, then that must mean testing is some kind of a prerequisite to know who to give the vaccine to that needs it most - and who also may already be immune from exposure?
It seems like the total cases —> 0 option is virtually unattainable in the near term (probably into 2021). Maybe with more cases being reported, we are aiming for 2) but actually going through 3).
It’s definitely 2 for most western countries
It looks like policy makers are sort of starting to work under the assumption that a vaccine is around the corner (the plan AFAIK is if all goes well to start around October in the US). Assuming that's correct, I guess the goal is/should be somewhere between 1 and 2. Keep as few people as possible from getting it for a few more months, while not collapsing society/economy completely.
I've seen nothing to indicate that a vaccine will be ready in three months. We wouldn't even have completed a Phase 3 clinical trial by then. Fauci has said he's optimistic that we might get a vaccine by the New Year, but he wasn't clear on whether that was a good candidate being identified, or a vaccine being widely available.
That is the most optimistic scenario, but it's still possible: https://www.telegraph.co.uk/news/2020/06/22/best-scenario-wi...
> maybe the biggest reason we're doing all this is to flatten the curb so hospitals don't get overwhelmed.
I think the other, possibly just as important, reason to lower the infection count is that medical professionals are yet unsure of the long-term, chronic health impacts of this disease and that there appear to be some preliminary signs of significant respiratory and pulmonary issues that can effect many age groups - perhaps even in those not necessarily requiring hospitalization.
It would appear that medical science has a few additional treatments in their toolbox now (as compared to, say, March or April) that lower the severity of the disease and helps prevent death in some populations, but still, many concerning unknowns remain.
At least that is what I have seen here and there from several medical professionals that I have seen on Twitter over the past few weeks...
I think the other, possibly just as important, reason to lower the infection count is that medical professionals are yet unsure of the long-term, chronic health impacts of this disease and that there appear to be some preliminary signs of significant respiratory and pulmonary issues that can effect many age groups - perhaps even in those not necessarily requiring hospitalization.
It would appear that medical science has a few additional treatments in their toolbox now (as compared to, say, March or April) that lower the severity of the disease and helps prevent death in some populations, but still, many concerning unknowns remain.
At least that is what I have seen here and there from several medical professionals that I have seen on Twitter over the past few weeks...
They say any vaccine would take at least a year, and I don't think we have the fear and determination to protect the majority from this for so long.
If everything goes perfectly, there are a couple vaccines that could start being given out in Q4 this year. Experts are being realistic and conservative though and not playing those timelines up.
The obsession with total cases is maddening. First, they are driven significantly by amount of testing. Secondly, whether they lead to complications is significantly impacted by age and health. The recent article routinely fail to acknowledge that age of infection has fallen drastically (from 65 to 35 in Florida, for example). The people getting infected now, the out-and-abouters, are much, much lower risk of complications. Which is why death rates continue down (lowest in US since March).
On the contrary, one should absolutely be concerned about the number of total cases. In ~ 15 % of cases the convalescence period is greater than a month, and there is reason to be concerned about CFS in recovered patients. With SARS, the incidence of CFS was 40 %!.
If you aren't sufficiently worried, John Campbell has a video about the clinical presentation: https://www.youtube.com/watch?v=U7BbXEOB1gk
If you aren't sufficiently worried, John Campbell has a video about the clinical presentation: https://www.youtube.com/watch?v=U7BbXEOB1gk
15% of cases among what demographic/clinical groups, though? I don't think it's anywhere near 15% (or even 1%) of cases in healthy people under 60 with no complicating conditions, but I could definitely be wrong. I don't think our testing, especially in the US, is strong enough to draw any real conclusions given how many people are asymptomatic/mildly symptomatic.
Half the country has one of those "complicating conditions" - obesity, hypertension, diabetes...
Sorry, what is CFS?
edit: thanks!
edit: thanks!
I think Chronic Fatigue Syndrome? https://www.washingtonpost.com/health/could-covid-19-cause-l...
Chronic fatigue syndrome
[deleted]
probably Chronic Fatigue Syndrome
For 2.5 month now we are always two weeks away from a catastrophe with mass graves and hospital parking lots full of dead people. And then two weeks pass and nothing really happens. Reality just doesn't seem to square up with the fearmongering.
The US has had around 8,000 deaths from COVID in the last two weeks.
And around 110,000 from other causes.
Which are still happening. Your point would have resonance if Covid were replacing a sufficient number of those deaths. But, it's additive.
Global coronavirus death toll could be 60% higher than reported
https://www.ft.com/content/6bd88b7d-3386-4543-b2e9-0d5c6fac8...
https://www.ft.com/content/6bd88b7d-3386-4543-b2e9-0d5c6fac8...
What was the average life expectancy last year, and what is it now?
The lockdown is causing deaths too which also need to be considered.
We shut down cancer screening and gyms for 3 months in Ontario; that’s almost certainly going to kill more people than COVID did.
We shut down cancer screening and gyms for 3 months in Ontario; that’s almost certainly going to kill more people than COVID did.
How will shutting down gyms for 3 months kill more people that covid? ~2600 people died from covid in Ontario. Are you saying that they gyms being closed caused more than that?
At ~10y of life lost per COVID death that's about 320,000 months of life lost to COVID in Ontario.
If there are ~1 million gym patrons in Ontario, then the gym lockdown (which is still ongoing) only needs to decrease a gym patron's lifespan by 10 days on average to be worse than COVID.
Also, I claimed cancer screenings + gyms combined. Hundreds of people get diagnosed with malignant tumors every day in Ontario and those tumors are now 3 months more advanced than they should be (and will be for a long time after the lockdown until the queues for medical care clear up).
If there are ~1 million gym patrons in Ontario, then the gym lockdown (which is still ongoing) only needs to decrease a gym patron's lifespan by 10 days on average to be worse than COVID.
Also, I claimed cancer screenings + gyms combined. Hundreds of people get diagnosed with malignant tumors every day in Ontario and those tumors are now 3 months more advanced than they should be (and will be for a long time after the lockdown until the queues for medical care clear up).
That's just silly. You would get into the most ridiculous moral quandaries with thinking like that. If 75,000 people commute 1 hour each day on a highway and then someone offers to reconfigure the highway to cut the time in half and all he is asking for is the lives of 100 children, its a good trade!
At an avg lifespan of 78 years, 100 kids is ~68 million hours. 30 minutes saved a day / 261 days / year for 75,000 people is ~9.7 million hours a year, so after 7 years, it basically free. Except we would never do that because we don't measure human value in hours because the people in power would be free to make some really terrible optimizations.
You are right though, you did include cancers and I ignored it so we can call it a tie.
At an avg lifespan of 78 years, 100 kids is ~68 million hours. 30 minutes saved a day / 261 days / year for 75,000 people is ~9.7 million hours a year, so after 7 years, it basically free. Except we would never do that because we don't measure human value in hours because the people in power would be free to make some really terrible optimizations.
You are right though, you did include cancers and I ignored it so we can call it a tie.
"and cancer screening"
That's why the Paleolithic had shorter lifespans than moderns... no gyms....
Heart disease and cancer kill more people per day than COVID even now.
Edit: and it's not just the gym obviously, we've removed any incidental exercise one might get from work or leisure activities that were locked down too
Edit: and it's not just the gym obviously, we've removed any incidental exercise one might get from work or leisure activities that were locked down too
Please show your calculations of excess cancer deaths being greater than the projected non-lockdown Covid deaths over the same time period?
50% of those could be nursing home patients. Could be more or less, depending on your region.
Those are absolutely moving deaths forward by a couple months at best.
I'd be willing to put money on a fair amount of the rest of the deaths also being people who are pretty ill. Not all, of course.
Maybe not even most of the rest.
But enough to not be a rounding error.
Those are absolutely moving deaths forward by a couple months at best.
I'd be willing to put money on a fair amount of the rest of the deaths also being people who are pretty ill. Not all, of course.
Maybe not even most of the rest.
But enough to not be a rounding error.
The operative point is not how many have died — it's how many could die. If we gave up altogether on mask-wearing and social distancing, the numbers would get to be much larger. This is partly because the ratio of deaths to infections would increase as the hospitals were overwhelmed. The relentless march of exponential growth would see to that.
The fact that the numbers don't seem that dramatic yet doesn't mean that measures to slow the progress of the virus aren't important.
The fact that the numbers don't seem that dramatic yet doesn't mean that measures to slow the progress of the virus aren't important.
So due to coronavirus the US has experienced a 7% increase in general mortality. That seems pretty significant.
For 2.5 months the cases (both in the US and worldwide) have climbed steadily, even with all the measures implemented worldwide to cooldown the rate of infection, we are beating day after day the record of infections and deaths in the world.
The US didn't devolve into mass graves and people dying waiting for hospital care yet, it doesn't mean that the fearmongering is misplaced and the more you doubt it the more you will be part of the problem.
The US didn't devolve into mass graves and people dying waiting for hospital care yet, it doesn't mean that the fearmongering is misplaced and the more you doubt it the more you will be part of the problem.
>we are beating day after day the record of infections and deaths in the world.
No, we are not setting death records day after day. Deaths worldwide have held steady since mid May; deaths in the US have been trending downwards since May.
No, we are not setting death records day after day. Deaths worldwide have held steady since mid May; deaths in the US have been trending downwards since May.
But it did in NYC. The freezer truck outside of my local funeral home only disappeared about 2 weeks ago.
Well that's not actually wrong. The number of cases can go up 20 fold in two weeks without social distancing measures and people wearing masks.
Just wait until two weeks from now...
Go work at the nearest meat processing plant.
That's just hyperbole and a statements to shut down a conversation. That statement has nothing to do with "one should absolutely be concerned about the number of total cases".
The fact that there are continuously new outbreaks in meat processing plants shows that indoors the disease is easily transmitted, and it's so serious that the workforce is off sick with high fever for weeks.
The CFR for coronaplague is ~ 1 %, comparable to the Spanish Flu in Germany. The impact was catastrophic, the High Command had to decide between sending young men to the front or keeping them at work in coal and steel. In those days there was little automation, the infection would spread like wildfire through the workforce at any large employer. The only reason we aren't seeing the same now is that people adhere to some form of social distancing - work from home, no going out to bars, no gym, no church, kids are not in school, but as soon as guard is dropped infection rates jump up again. We are seeing this as well. Israel had new cases down to 1 per 100000 people until they opened up the schools and cases increased by two orders of magnitude.
The CFR for coronaplague is ~ 1 %, comparable to the Spanish Flu in Germany. The impact was catastrophic, the High Command had to decide between sending young men to the front or keeping them at work in coal and steel. In those days there was little automation, the infection would spread like wildfire through the workforce at any large employer. The only reason we aren't seeing the same now is that people adhere to some form of social distancing - work from home, no going out to bars, no gym, no church, kids are not in school, but as soon as guard is dropped infection rates jump up again. We are seeing this as well. Israel had new cases down to 1 per 100000 people until they opened up the schools and cases increased by two orders of magnitude.
On some points I agree, the disease is really terrible, the problem is elected officials are wildly unprepared for the job at hand. I'll never forget Gavin Newsom's dire proclamation that 25M Californians would have covid 19 in a few weeks(we have 174k currently), this was late march [1]. In addition in Santa Clara county I remember this statement saying 16k deaths from covid by end of May(we have 152 currently) - [2]. Don't get me started on Trumps statements! If I put out these insane numbers at my job I would have been fired, and if I wasn't fired I would have resigned in shame. These statements bring extreme anxiety and fear to people and I feel like there will be repercussions come Nov.
[1] - https://www.latimes.com/california/story/2020-03-20/newsom-c...
[2] - https://www.sanjoseinside.com/news/san-jose-braces-for-2000-...
[1] - https://www.latimes.com/california/story/2020-03-20/newsom-c...
[2] - https://www.sanjoseinside.com/news/san-jose-braces-for-2000-...
Weren't those projections for the "business as usual" scenario? Isn't the fact that the number of actual cases are far lower just a reflection of the fact that society has, in fact, responded by changing the situation and thus lower transmission?
"They told us all that we shouldn't jump off a bridge into shallow water, so none of us did—and not one single person got hurt. I can't believe we all listened to such wild fearmongering."
You've made a classic converse error.
You've made a classic converse error.
When the total number of positive tests and the percentage of tests that are positive both rise, that implies that the issue is not driven by the amount of testing, and in fact you’re seeing community spread.
> First, they are driven significantly by amount of testing.
But that's not the only driver. And when you increase testing and the percentage of positives you find goes up from 5% to 20% (as it's happening in some states) instead of going down you really have a problem.
> The people getting infected now, the out-and-abouters, are much, much lower risk of complications.
But the people that will now be infected by them (relatives, coworkers, customers) will be closer to the general population and have higher risk.
But that's not the only driver. And when you increase testing and the percentage of positives you find goes up from 5% to 20% (as it's happening in some states) instead of going down you really have a problem.
> The people getting infected now, the out-and-abouters, are much, much lower risk of complications.
But the people that will now be infected by them (relatives, coworkers, customers) will be closer to the general population and have higher risk.
> The obsession with total cases is maddening. First, they are driven significantly by amount of testing.
I think more significantly they're driven by total cases. Are you suggesting we test less?
Also you seem to have a very black and white view of outcomes. It's not clear cut between alive or dead. There's many things that we still don't know about this virus and the harm it causes. https://www.bbc.com/future/article/20200622-the-long-term-ef...
I think more significantly they're driven by total cases. Are you suggesting we test less?
Also you seem to have a very black and white view of outcomes. It's not clear cut between alive or dead. There's many things that we still don't know about this virus and the harm it causes. https://www.bbc.com/future/article/20200622-the-long-term-ef...
Cuts on the confirmed cases by age group and to some extent race/gender will help understand upcoming hospitalization and death.
There have been 10 million confirmed cases and probably 10x that many infections with very few reports of longer term adverse impacts.
Long term effects can take a long time to show up. We don't know what they might be.
Of course this is a case where no long term effects are something we are only sure of after currently young people die of old age.
Of course this is a case where no long term effects are something we are only sure of after currently young people die of old age.
What long term? This disease has existed for about 6 months in the public eye (and a bit longer now that there are cases in Europe being found from October/November) how can you even consider talking about long term effects when we haven't yet lived through the time it can be considered "long term".
Or do you work with the concept "long term = next quarter"?
Or do you work with the concept "long term = next quarter"?
Hospitalizations have also been rapidly increasing. Houston hospitals expect 100% ICU usage in less than two weeks.
That's weird. To me, it makes perfect sense to horse-race total case percentage increase.
Young people are generally on the front lines now. Both voluntarily through outings, bars, etc, and front-line jobs, so they are a leading indicator that "things are getting worse."
And while that doesn't guarantee that most "at risk" people will get sick and require hospitalization, it's a safe assumption that the probability of that occurring is increasing.
It's the same reason you get a mole checked out. Might be nothing now, but it could be something much worse in the near future.
Young people are generally on the front lines now. Both voluntarily through outings, bars, etc, and front-line jobs, so they are a leading indicator that "things are getting worse."
And while that doesn't guarantee that most "at risk" people will get sick and require hospitalization, it's a safe assumption that the probability of that occurring is increasing.
It's the same reason you get a mole checked out. Might be nothing now, but it could be something much worse in the near future.
>> First, they are driven significantly by amount of testing.
That depends which numbers you follow. "Cases" is different than "clinical cases". A clinical case will show some sort of symptom. While asymptomatic spread is almost certainly a thing, symptomatic patients spread much more readily than asymptomatic. So rather than look only a total cases, look for data on clinical cases because those are the ones that are most likely to spread to others. That will normally be patients under treatment rather than the larger number of people who have tested positive, show no real symptoms, and are sitting at home waiting for another test.
That depends which numbers you follow. "Cases" is different than "clinical cases". A clinical case will show some sort of symptom. While asymptomatic spread is almost certainly a thing, symptomatic patients spread much more readily than asymptomatic. So rather than look only a total cases, look for data on clinical cases because those are the ones that are most likely to spread to others. That will normally be patients under treatment rather than the larger number of people who have tested positive, show no real symptoms, and are sitting at home waiting for another test.
> First, they are driven significantly by amount of testing.
Daily case numbers in Illinois, at least, have no correlation with the increase in testing. I'm certain all we've found with the extra tests is people who never had it.
Daily case numbers in Illinois, at least, have no correlation with the increase in testing. I'm certain all we've found with the extra tests is people who never had it.
I've been watching the number of deaths (although it's a morbid way of looking at it), too. If the number of cases goes up but after a suitable lag time and the number of deaths doesn't, then we are likely just uncovering more people who had it through more thorough testing. If the number of deaths rises, then it's not just that we're testing more - it's spreading more.
The logic behind this is that people are going to the hospital whether or not they have been tested, they are not going to stay away because they haven't been. I don't have easy access to numbers of hospitalized patients, so I watch the number of deaths. Right now they have been flattening out or decreasing, as you pointed out. When that changes I'll get worried more. In either case, I am playing it safe by social distancing and wearing my mask and reducing the amount of time I'm in the office.
The logic behind this is that people are going to the hospital whether or not they have been tested, they are not going to stay away because they haven't been. I don't have easy access to numbers of hospitalized patients, so I watch the number of deaths. Right now they have been flattening out or decreasing, as you pointed out. When that changes I'll get worried more. In either case, I am playing it safe by social distancing and wearing my mask and reducing the amount of time I'm in the office.
The death rate is most likely lower due to a higher percentage of the infected being lower risk.
White people under 50, to be specific. As many as 50% of new hospitalizations in Texas are under 50.
The problem will be if they infect higher risk groups, potentially in catastrophic numbers, and the deaths surge along with cases.
Also, deaths remaining somewhat flat is concerning considering the low risk population getting infected.
White people under 50, to be specific. As many as 50% of new hospitalizations in Texas are under 50.
The problem will be if they infect higher risk groups, potentially in catastrophic numbers, and the deaths surge along with cases.
Also, deaths remaining somewhat flat is concerning considering the low risk population getting infected.
The number of cases has nothing to do with the amount of testing!
The number of reported or confirmed cases is correlated with testing.
That's a significantly different statement, and also tautological and essentially vacuous.
Average time to death after confirmation of disease is around 13 days, so the death rate today has essentially nothing to do with the number of cases confirmed today. The death rate today has a lot to do with the number of cases confirmed a few weeks ago.
One of the reasons the US is doing so incredibly poorly is the incredible sloppiness of the analyses in so much of the media. I don't know if it's willful -- an attempt to pretend that nature will bend to political delusion -- or if it's simple innumeracy.
The number of reported or confirmed cases is correlated with testing.
That's a significantly different statement, and also tautological and essentially vacuous.
Average time to death after confirmation of disease is around 13 days, so the death rate today has essentially nothing to do with the number of cases confirmed today. The death rate today has a lot to do with the number of cases confirmed a few weeks ago.
One of the reasons the US is doing so incredibly poorly is the incredible sloppiness of the analyses in so much of the media. I don't know if it's willful -- an attempt to pretend that nature will bend to political delusion -- or if it's simple innumeracy.
> but I don't get why (from what I've seen) hospitalizations don't seem to be all that important when reporting on COVID numbers in general.
To an extent, by the time the hospital numbers are going up sharply, it's too late, and the hospitals will inevitably be overwhelmed, so it's not a good guide of policy. New case count is the only vaguely timely indicator we have.
To an extent, by the time the hospital numbers are going up sharply, it's too late, and the hospitals will inevitably be overwhelmed, so it's not a good guide of policy. New case count is the only vaguely timely indicator we have.
"inevitably be overwhelmed" now looks less likely than it did in March. There is less use of ventilators and ICU usage has been less than initially anticipated.
To be clear, I mean that hospitals will inevitably be overwhelmed once you see a sharp upswing in hospitalisations; by the time you see that the pipeline is likely already primed and nothing you can do will change the trajectory of the upswing much for days. If you see a sharp upswing in cases, though, swift action can maybe deal with that (assuming you have decent observability). Most the the cases will never see the inside of a hospital, but they provide a somewhat useful proxy for the future of hospitalization.
If you need to pick a metric on which to reinstitute lockdowns, hospitalization isn't really very useful; it's better than nothing but if you use it you're probably going to overshoot.
If you need to pick a metric on which to reinstitute lockdowns, hospitalization isn't really very useful; it's better than nothing but if you use it you're probably going to overshoot.
Was that not precisely because of the stay-at-home orders?
At one point ventilators had a 90% fatality rate or something like that. I think they found that in a lot of cases they either weren't helping or were hurting.
One difficulty is that while there have been improvements in treatment resulting in less ventilator and ICU usage, and we've substantially increased number of ICU beds in many areas, we're still seeing staff attrition. In my metro, major hospitals have been diverting cases to further-out hospitals not because of equipment shortages but because of staff shortages. Staff are getting sick, and then they're out for a while. Their training can't easily be replaced -- you can train other medical folks to do sort of a half-assed job in an emergency, but you'll see higher mortality in that situation.
Arizona would like to contradict your claims.
The only reason the hospitals aren't overwhelmed is that we kept the total case count low enough. Now that the case count is going up, we're seeing the same problems.
Yes, we don't seem to have quite the same equipment shortages as we had in March. That's good. That was part of the reasoning behind the lockdowns.
Yes, we seem to be doing better at keeping people dying, that's good ... but it's going to take up more hospital resources for longer periods, that's going to exacerbate shortages.
The only reason the hospitals aren't overwhelmed is that we kept the total case count low enough. Now that the case count is going up, we're seeing the same problems.
Yes, we don't seem to have quite the same equipment shortages as we had in March. That's good. That was part of the reasoning behind the lockdowns.
Yes, we seem to be doing better at keeping people dying, that's good ... but it's going to take up more hospital resources for longer periods, that's going to exacerbate shortages.
That's because most major metros shut their econmies down in march well ahead of them having significant community spread. We are now starting to see the results of opening back up and the daily incident rate is increasing super linearly again.
For some reason headlines always seem to be number of cases or positive test results, and maybe then the number in the hospital is mentioned
The problem is that in a lot of places, the information about hospital use isn't available, isn't timely, or isn't reliable.
Hospital owners and their lobbying groups have blocked some states and county health departments from reporting such information, claiming it's "proprietary information."
One of the Las Vegas newspapers had a series of articles about it. The hospital lobbying group actually somehow "prohibited" the state from releasing the information, as if hospitals have some kind of authority over the government.
The problem is that in a lot of places, the information about hospital use isn't available, isn't timely, or isn't reliable.
Hospital owners and their lobbying groups have blocked some states and county health departments from reporting such information, claiming it's "proprietary information."
One of the Las Vegas newspapers had a series of articles about it. The hospital lobbying group actually somehow "prohibited" the state from releasing the information, as if hospitals have some kind of authority over the government.
> I always thought, based on what I've read/heard, that one of the big reasons, maybe the biggest reason we're doing all this is to flatten the curb so hospitals don't get overwhelmed.
This was my understanding as well, and it is what is shown in Wikipedia:
https://en.wikipedia.org/wiki/Flatten_the_curve
The bigger thing that I have chatted about with several other is that the area under the curve is the same, i.e. the same amount of inidividuals will still get sick.
This was my understanding as well, and it is what is shown in Wikipedia:
https://en.wikipedia.org/wiki/Flatten_the_curve
The bigger thing that I have chatted about with several other is that the area under the curve is the same, i.e. the same amount of inidividuals will still get sick.
I am amazed at how many people repeat the point about the area under the curve being the same. It's just completely irrelevant unless we believe that we will make no medical advancements.
You flatten the curve to buy time for medical advancements, which will reduce the total area under the curve. It can be any or all of:
1) flattening the curve enough to make contact tracing viable, which can eradicate breakouts before they take hold
2) finding a decent anti-viral treatment so that number of deaths or "permanent damage" cases decrease, even if # of cases does not
3) developing a vaccine
This thing about "area under the curve remaining the same" is only true for calculus, it has no bearing on real life because we are making medical advances.
You flatten the curve to buy time for medical advancements, which will reduce the total area under the curve. It can be any or all of:
1) flattening the curve enough to make contact tracing viable, which can eradicate breakouts before they take hold
2) finding a decent anti-viral treatment so that number of deaths or "permanent damage" cases decrease, even if # of cases does not
3) developing a vaccine
This thing about "area under the curve remaining the same" is only true for calculus, it has no bearing on real life because we are making medical advances.
The other possible outcome is to get enough testing and contact tracing in place so that we don't have to all get sick. Other countries have successfully done this, but it seems impossible in the US.
It would have been possible in the USA, but we've seen a failure in leadership to prevent the spread of the virus.
If we had taken decisive action in January or February, we would have had enough resources for contact tracing, and really limit the spread. Instead we'll see at least 200K deaths from this before it is over.
Looking at the new case counts for the USA vs. the EU makes me sad and angry.
If we had taken decisive action in January or February, we would have had enough resources for contact tracing, and really limit the spread. Instead we'll see at least 200K deaths from this before it is over.
Looking at the new case counts for the USA vs. the EU makes me sad and angry.
California has plenty of contact tracers and testing. Rt is still above 1.
Because we have a whole bucketload of idiots who can't be bothered to wear a damn mask and stay the hell home.
When 2 Mother's Day gatherings account for 50% of the cases in Santa Cruz county, what can you do short of saying "You're a moron."
It probably also doesn't help that a lot of Arizonans travel to California at this time of year to escape the heat.
When 2 Mother's Day gatherings account for 50% of the cases in Santa Cruz county, what can you do short of saying "You're a moron."
It probably also doesn't help that a lot of Arizonans travel to California at this time of year to escape the heat.
To me (as a layman) it seems like if you take drastic measures early and get procedures and infrastructure for testing and contact tracing and isolate the sick and those who have been in contact with the sick it’s possible to get it under control so that you can start opening up schools and loosening social distancing rules/guidelines.
Look for example at Norway and Sweden. Norway took drastic measures early and were able to stop the spread to such a degree that schools opened up again after Easter and everything is almost back to normal now. Sweden did not take very drastic measures early and have had massive spread and 20 times more fatalities than Norway and now they have in many regards stricter social distancing rules than than Norway.
After a certain point it seems like you have to either shut down society for a long period of time (Italy) or just let it run its course through society somewhat controlled.
Look for example at Norway and Sweden. Norway took drastic measures early and were able to stop the spread to such a degree that schools opened up again after Easter and everything is almost back to normal now. Sweden did not take very drastic measures early and have had massive spread and 20 times more fatalities than Norway and now they have in many regards stricter social distancing rules than than Norway.
After a certain point it seems like you have to either shut down society for a long period of time (Italy) or just let it run its course through society somewhat controlled.
Comparing countries like this does not make sense. The spread of the virus is more a reflection of how people live, what they do day to day, rather than what measures they took protect themselves.
Austria and Italy, share a border, have ski lodges in the same Alps. Austria got off easy even though they had a one of the first outbreaks, Italy got hammered for two months. Yet Italy locked down harder during all this time.
I don't know in what way is Norway different from Sweden, Norway looks and feels a lot more rural and sparse. Sweden more cosmopolitan.
Austria and Italy, share a border, have ski lodges in the same Alps. Austria got off easy even though they had a one of the first outbreaks, Italy got hammered for two months. Yet Italy locked down harder during all this time.
I don't know in what way is Norway different from Sweden, Norway looks and feels a lot more rural and sparse. Sweden more cosmopolitan.
Sure there's lots of factors. My point is that if you can stop or limit gatherings and contact points early the spread will decrease dramatically. It will still spread within smaller communities like families, but as long as you can limit spread outside of smaller communities the virus will have no where to go. So it seems more like a timing issue than how people live. Oslo is similar to Stockholm, just smaller, but have dramatically less cases (Oslo was hit hardest in Norway).
You could also compare Sweden to Denmark which is more similar than Norway. Denmark took drastic measures quite early and were able to get it under control.
Further to that I agree it's too early to say what is the best strategy long term. All epidemiologists in Scandinavia basically agreed with the Swedish approach in the beginning of the outbreak, but politicians in Norway and Denmark thought otherwise. I guess epidemiologists didn't think it was an option to basically lock down a modern country for several months and maintain social distancing rules for months on end. If this works until the end I assume the books on the subject will be rewritten ...
You could also compare Sweden to Denmark which is more similar than Norway. Denmark took drastic measures quite early and were able to get it under control.
Further to that I agree it's too early to say what is the best strategy long term. All epidemiologists in Scandinavia basically agreed with the Swedish approach in the beginning of the outbreak, but politicians in Norway and Denmark thought otherwise. I guess epidemiologists didn't think it was an option to basically lock down a modern country for several months and maintain social distancing rules for months on end. If this works until the end I assume the books on the subject will be rewritten ...
At this point the pandemic is so widespread that testing and contact tracing would be unlikely to achieve containment. We would have to first impose a very strict lockdown for several weeks, which would be politically difficult.
You're never going to achieve containment with just contact tracing, testing, and politely requesting that people stay at home. People won't comply. Containment requires mandating compliance:
* Forcibly testing people regularly
* Forcibly quarantining people who test positive
* Mandating contact tracing regardless of personal preference
* Imposing travel restrictions on hot spots with actual blockades
* Restricting any gatherings that aren't essential, with "essential" actually meaning essential (grocery stores, pharmacies, hospitals, etc) rather than politically necessary.
* Mandating correct wearing of masks
* Closing borders or requiring quarantine upon entry
In effect, we need to do what China did. We absolutely lack the political will to do that in the US for a variety of reasons, and so we will not be able to approach containment until we get a vaccine.
* Forcibly testing people regularly
* Forcibly quarantining people who test positive
* Mandating contact tracing regardless of personal preference
* Imposing travel restrictions on hot spots with actual blockades
* Restricting any gatherings that aren't essential, with "essential" actually meaning essential (grocery stores, pharmacies, hospitals, etc) rather than politically necessary.
* Mandating correct wearing of masks
* Closing borders or requiring quarantine upon entry
In effect, we need to do what China did. We absolutely lack the political will to do that in the US for a variety of reasons, and so we will not be able to approach containment until we get a vaccine.
uhhh, it is not political will that we lack
most people do not want that at all
I most certainly not want to be forcibly tested or mandated to "correctly" wear the mask and you can fuck off you do
most people do not want that at all
I most certainly not want to be forcibly tested or mandated to "correctly" wear the mask and you can fuck off you do
Well, unfortunately your opinion doesn't change the fact that those are the requirements for containment outside of vaccine development. Any other strategy will likely ultimately fail. Sorry if that makes you unhappy; sadly the virus doesn't really care about our opinions.
4) find out that dexamethasone can reduce mortality for ICU patients by a lot.
Aside from medical advancements, if the health care personnel is not overworked, overstressed, overtired, patients have a better chance to survive.
Flattening the curve means lives saved.
Aside from medical advancements, if the health care personnel is not overworked, overstressed, overtired, patients have a better chance to survive.
Flattening the curve means lives saved.
This is something that people often forgot - even if hospitals do not reach their full "paper" capacity, you can easily burn out or even kill your irreplaceable (in the pandemic timescale) medical personnel, if they have to deal with constant influx of infected patients over long periods.
Not to mention hospitals usually shutting down elective procedures once the amount of infected patients in their care crosses a certain threshold.
Not to mention hospitals usually shutting down elective procedures once the amount of infected patients in their care crosses a certain threshold.
The way that we discovered dexamethasone can reduce mortality in ICU patients was through enough people being infected and dying to run studies testing a whole bunch of potential treatments on them. There's very limited potential to decrease the number of deaths by buying time for this to be discovered, at least from a global perspective.
“Flatten the curve” is a different strategy from “minimize until medical advances come through.” It’s the difference between finding a version of life that keeps hospitals just under saturation vs. maintaining full lockdown as long as it takes.
afaik not true; google for "epidemic overshoot"
I just did, and the first 6 answers do not really clear it up.
Do you have a specific source that can explain it?
Do you have a specific source that can explain it?
The mainstream media coverage of overshoot in publications like the New York Times is intentionally misleading in order to push the (false) narrative that herd immunity requires infecting and killing far more people than you'd naively think. (Their numbers are only accurate if you assume no social distancing at all, which probably isn't even possible at this point.)
Basically, the number of infections peaks at the point where - due to some combination of immunity and measures like social distancing - each person infects at most one other person on average. However, there are still a whole bunch of infected and susceptible people spreading the disease, meaning that quite a lot more people then become infected than is actually necessary to end the outbreak. If you assume no attempt to flatten the curve, then a lot more people become infected than the herd immunity threshold, and that's what the NYT and co have focused on. However, one consequence is that flattening the curve without fully surpressing the outbreak reduces overall infections and deaths - the peak is lower and happens after fewer total infections, making it possible to build a whole bunch of herd immunity without all the extra infections and deaths from massively overshooting it.
Basically, the number of infections peaks at the point where - due to some combination of immunity and measures like social distancing - each person infects at most one other person on average. However, there are still a whole bunch of infected and susceptible people spreading the disease, meaning that quite a lot more people then become infected than is actually necessary to end the outbreak. If you assume no attempt to flatten the curve, then a lot more people become infected than the herd immunity threshold, and that's what the NYT and co have focused on. However, one consequence is that flattening the curve without fully surpressing the outbreak reduces overall infections and deaths - the peak is lower and happens after fewer total infections, making it possible to build a whole bunch of herd immunity without all the extra infections and deaths from massively overshooting it.
Thank you for your explanation. That makes a lot of sense, and was a lot better than anythign i could find.
that's in the case that we even have to arrive at herd immunity through infections. By far the bigger factor here are the dozens of vaccines and treatments (eg monoclonal antibodies) in development, if any of them work in time, the "area under the curve is the same" idea is blown out of the water to the tune of millions of preventable deaths.
Millions of preventable deaths? Do you have a source handy? I’m wondering how that aligns with the latest data.
[deleted]
(number of uninfected that need to be infected to achieve herd immunity) * (case fatality rate) = future deaths
With the assumption that every vaccinated person counts towards herd immunity and isn't likely to die, you can plug in your own numbers to the equation above. Even with really conservative estimates, it's easy* to get into the millions when you consider the entire planet.
*Barring some highly effective treatments that may or may not surface.
With the assumption that every vaccinated person counts towards herd immunity and isn't likely to die, you can plug in your own numbers to the equation above. Even with really conservative estimates, it's easy* to get into the millions when you consider the entire planet.
*Barring some highly effective treatments that may or may not surface.
> (number of uninfected that need to be infected to achieve herd immunity) * (case fatality rate) = future deaths
You need the lower IFR, not the CFR, here.
You need the lower IFR, not the CFR, here.
Every vaccinated person will not count towards herd immunity. Vaccines can be tremendously helpful in controlling infectious diseases, but not every person who is vaccinated will produce neutralizing antibodies. This is why it's important to vaccinate as many people as possible in order to surpass the herd immunity threshold.
At this time we don't know how effective any of the vaccine candidates will be.
At this time we don't know how effective any of the vaccine candidates will be.
in addition it is also not clear if the vaccine will have a lower incidence of side effects than the virus itself
kids and young adults have less than 1/100,000 chance of dying of COVID. The vaccine needs to be better than that. There is an ethical issue at hand of vaccinating people that are not at risk to save those that are at risk.
For reference after administering 3.1 billion vaccines the US paid damages in about 3,000 cases thus across all vaccines the rate of serious side effects is about 1 in a hundred thousand (considering about 10 vaccines per individual).
kids and young adults have less than 1/100,000 chance of dying of COVID. The vaccine needs to be better than that. There is an ethical issue at hand of vaccinating people that are not at risk to save those that are at risk.
For reference after administering 3.1 billion vaccines the US paid damages in about 3,000 cases thus across all vaccines the rate of serious side effects is about 1 in a hundred thousand (considering about 10 vaccines per individual).
There is an ethical issue at hand when people are unwilling to protect 30-40% of the population because they fear a miniscule risk of vaccination.
I think you deliberately avoid taking an effort to appreciate the ethical side of the issue.
There is no vaccine that we currently mandate for the sole reason of protecting someone else.
The fundamental requirement of the Hippocratic Oath is "First, do no harm". If you are vaccinating someone, you better cause less damage to that person than the disease itself would do.
I have a kid, I am not an anti-vaxxer by any stretch of imagination: the whole family gets flu shots every single year.
But will I rush to get my kid vaccinated with a new thing rushed to market during a exaggerated hysteria, a vaccine not properly vetted for long term effects ... uhh most certainly not. I am going to wait a couple of years to see how others will fare.
(FYI I work in life sciences and I like to believe that I understand the inner workings of a living cell better than overwhelming majority of the population)
There is no vaccine that we currently mandate for the sole reason of protecting someone else.
The fundamental requirement of the Hippocratic Oath is "First, do no harm". If you are vaccinating someone, you better cause less damage to that person than the disease itself would do.
I have a kid, I am not an anti-vaxxer by any stretch of imagination: the whole family gets flu shots every single year.
But will I rush to get my kid vaccinated with a new thing rushed to market during a exaggerated hysteria, a vaccine not properly vetted for long term effects ... uhh most certainly not. I am going to wait a couple of years to see how others will fare.
(FYI I work in life sciences and I like to believe that I understand the inner workings of a living cell better than overwhelming majority of the population)
We impose many restrictions on individuals in the name of protecting others. Off the top of my head, my city doesn't allow driving under the influence, discharging firearms within city limits, public nudity, yelling fire inside a theater. We also vaccinate to build up community immunity, not just to address the health of an individual person.
And as far as COVID vaccinations go, you're trying to have your cake and eat it. Either COVID-19 isn't risky/dangerous for young people, (meaning we can safely vaccinate them), or it's dangerous to them. If you're trying to say that a vaccine for COVID-19 would have worse effects than the disease itself, I think this would be extremely unlikely, since it doesn't occur with other vaccines.
If a COVID vaccination has a 1 in 100K rate of deleterious side effects (up to and including COVID-19) in the general population, then vaccinating the US population (330M) would result in 3300 cases of COVID (or bad side effects). The benefit of this would be saving roughly 2M people from death, and countless others from hospitalization and long term complications.
And as far as COVID vaccinations go, you're trying to have your cake and eat it. Either COVID-19 isn't risky/dangerous for young people, (meaning we can safely vaccinate them), or it's dangerous to them. If you're trying to say that a vaccine for COVID-19 would have worse effects than the disease itself, I think this would be extremely unlikely, since it doesn't occur with other vaccines.
If a COVID vaccination has a 1 in 100K rate of deleterious side effects (up to and including COVID-19) in the general population, then vaccinating the US population (330M) would result in 3300 cases of COVID (or bad side effects). The benefit of this would be saving roughly 2M people from death, and countless others from hospitalization and long term complications.
Comparing vaccinating someone to driving under the influence makes no sense whatsoever.
As for the other content, it just shows you don't understand what kind of problems an insufficiently tested vaccine could cause. You should educate yourself better:
https://www.sciencemag.org/news/2019/04/dengue-vaccine-fiasc...
As for the other content, it just shows you don't understand what kind of problems an insufficiently tested vaccine could cause. You should educate yourself better:
https://www.sciencemag.org/news/2019/04/dengue-vaccine-fiasc...
You are correct that there is a utilitarian argument that vaccinations will save lives. You and the parent post disagree about the new vaccine risk level.
Do you think that they should be compelled to vaccinate their child with the unproven vaccine. What if the risks outweigh the benefit for the child, but are positive for society at large?
case fatality rate is the observed death rate based on known cases
infection fatality rate is the observed death rate based on all (known+undetected) cases
the Swedish report indicates of infection fatality rate of 0.1%
infection fatality rate is the observed death rate based on all (known+undetected) cases
the Swedish report indicates of infection fatality rate of 0.1%
<the Swedish report indicates of infection fatality rate of 0.1%>
That's incorrect. The IFR in Stockholm (the epicenter for COVID-19) in Sweden is .6% currently [0]. Only if you exclude anyone above 70 do you get an IFR of .1%. According to [1] 20% of the population is 65 and older, roughly 2m people.
[0]https://www.folkhalsomyndigheten.se/contentassets/53c0dc391b...
[1]https://www.indexmundi.com/sweden/demographics_profile.html
That's incorrect. The IFR in Stockholm (the epicenter for COVID-19) in Sweden is .6% currently [0]. Only if you exclude anyone above 70 do you get an IFR of .1%. According to [1] 20% of the population is 65 and older, roughly 2m people.
[0]https://www.folkhalsomyndigheten.se/contentassets/53c0dc391b...
[1]https://www.indexmundi.com/sweden/demographics_profile.html
ok, valid point I recalled it incorrectly,
FWIW the IFR is getting tiny as for younger people so using the the same preventive measures for low risk people that we use for high risk ones does not make much sense
FWIW the IFR is getting tiny as for younger people so using the the same preventive measures for low risk people that we use for high risk ones does not make much sense
The issue is that's completely impractical in our society to expect to be able to protect the 30-40% at risk from the 60% that has a lower level of risk.
If everyone gets vaccinated a year from now, the total area under the curve will be lower if it's spread out over a long time than if everyone got sick before the vaccine became available.
More so as treatments improve and if the virus weakens (which they usually do).
I don't know, look at Europe, quite a few places have managed to do quite a bit more than flattening the curve. At the current rate, reaching even 50% of the population would take decades, hopefully there will be a vaccine well before them.
The area under the curve need not be the same though. There are many things that can change the area under the curve. A vaccine is an obvious one, once one hits the area doesn't change, so the less there is the better. (ecconmics can debate how much we should have reopened after that) the virus could also mutate and affect everyone again thus increasing the area.
I have never been able flattening the curve. If people would just stay home for a month and take precautions this would be over as it wouldn't spread and those who have it get over it. The details of living like that are tricky but too many people didn't try.
I have never been able flattening the curve. If people would just stay home for a month and take precautions this would be over as it wouldn't spread and those who have it get over it. The details of living like that are tricky but too many people didn't try.
Exactly this, in fact we did such a good job, that people who were sick for other reasons didn't seek medical help and health care professionals have been laid off
https://calmatters.org/health/coronavirus/2020/05/health-car...
https://calmatters.org/health/coronavirus/2020/05/health-car...
> Could it be the people getting the virus now are less likely to end up in the hospital so that number won't keep going up to the point of causing trouble?
It could. Or it could be simply getting out of control (though specifically California is in much less trouble than Texas, Florida or especially Arizona at the moment). The point is that (1) it's fundamentally impossible to tell the difference until the bodies are counted and (2) the boundary between "well under capacity, we're fine" and "well over capacity, tens of thousands needlessly dead" represents just a week or two of growth.
We don't have time to wait and see, we need an answer now. And we can't get it until the demographics is done postmortem. So what is supposed to happen is that we all behave conservatively until the outbreak shrinks to the point where it can be contained via contact tracing.
And... that almost worked. It worked in Asia and Europe, It almost worked here, at least in the hardest hit areas with the early outbreaks. But... it didn't take. Half the population decided they didn't need to bother with this stuff (largely because of reasoning like yours) and walked back into enclosed indoor spaces.
And now we're right back where we were in March. Effectively no progress. While the rest of the industrialized world is finishing this off and coming back to life, we're having to talk about new lockdowns. It's so deeply frustrating.
It could. Or it could be simply getting out of control (though specifically California is in much less trouble than Texas, Florida or especially Arizona at the moment). The point is that (1) it's fundamentally impossible to tell the difference until the bodies are counted and (2) the boundary between "well under capacity, we're fine" and "well over capacity, tens of thousands needlessly dead" represents just a week or two of growth.
We don't have time to wait and see, we need an answer now. And we can't get it until the demographics is done postmortem. So what is supposed to happen is that we all behave conservatively until the outbreak shrinks to the point where it can be contained via contact tracing.
And... that almost worked. It worked in Asia and Europe, It almost worked here, at least in the hardest hit areas with the early outbreaks. But... it didn't take. Half the population decided they didn't need to bother with this stuff (largely because of reasoning like yours) and walked back into enclosed indoor spaces.
And now we're right back where we were in March. Effectively no progress. While the rest of the industrialized world is finishing this off and coming back to life, we're having to talk about new lockdowns. It's so deeply frustrating.
You have a mistaken perception of what the rest of the industrialized world is doing. South Korea is talking about new lockdowns, China has imposed them, and much of Europe still hasn't really opened up. Only a very few countries believe they're "finishing this off".
newacct583(1)
I think it's purely a media thing. When the public health folks I know have been modeling, they've been modeling with a primary eye toward number of ICU beds needed and number of ventilators needed. For instance if you look at https://mn.gov/covid19/data/modeling/index.jsp which has a pretty decent model (on Github at https://github.com/MN-COVID19-Model) you can see all their pdf slides predict peak infection, number of ICUs/vents needed, and then mortality. But that's not what gets headlines, as you observe.
It is certainly true that survival rates have improved as treatments have changed based on experience. I think folks know better how to manage things at home, to some extent. Earlier testing also allows earlier intervention, which allows treatment that may avoid ventilator usage. Vent usage corresponds with pretty poor outcomes, although that too is improving.
It is certainly true that survival rates have improved as treatments have changed based on experience. I think folks know better how to manage things at home, to some extent. Earlier testing also allows earlier intervention, which allows treatment that may avoid ventilator usage. Vent usage corresponds with pretty poor outcomes, although that too is improving.
> we're doing all this is to flatten the curb
Different people have different goals.
One goal would be to reduce the rate of new infections to a level that hospitals can handle.
A different strategy is to reduce the rate of new infections to a much lower level, so that contact tracing and containment is possible, and then open things back up.
If a vaccine is available at some point in the next year, the latter strategy saves many lives. It requires a sharp, relatively short (4-6 weeks) shutdown. Afterwards, it requires a high level of testing, quarantine for infected people, widespread use of fever checks in public places, a ban on large events, and extensive contact tracing. Many countries have now successfully deployed this strategy.
The US is stuck in limbo. Some states locked down hard, others didn't lock down enough. Things opened up too quickly, without the systems in place to contain the epidemic, and people are largely acting as if SARS-CoV-2 didn't exist any more. The consequence is that new infections never went down to a level where contact tracing is possible, and the rate of new infections is on the rise again.
Different people have different goals.
One goal would be to reduce the rate of new infections to a level that hospitals can handle.
A different strategy is to reduce the rate of new infections to a much lower level, so that contact tracing and containment is possible, and then open things back up.
If a vaccine is available at some point in the next year, the latter strategy saves many lives. It requires a sharp, relatively short (4-6 weeks) shutdown. Afterwards, it requires a high level of testing, quarantine for infected people, widespread use of fever checks in public places, a ban on large events, and extensive contact tracing. Many countries have now successfully deployed this strategy.
The US is stuck in limbo. Some states locked down hard, others didn't lock down enough. Things opened up too quickly, without the systems in place to contain the epidemic, and people are largely acting as if SARS-CoV-2 didn't exist any more. The consequence is that new infections never went down to a level where contact tracing is possible, and the rate of new infections is on the rise again.
>widespread use of fever checks
I've never understood this fascination with fever checks. I've never had a fever where I couldn't tell I had a fever -- everyone with a fever perfectly well knows they have a fever. The problem is people trying to hide it, I guess? And if they suppress it with medication, your forehead scanner will be useless anyway.
The solution for that is to make quarantine less painful. Here's a list of grocery delivery services, here's a guarantee your employer can't punish you for taking time off work, here's a nursing service that'll call you to check in daily, etc. Enjoy your vacation.
I've never understood this fascination with fever checks. I've never had a fever where I couldn't tell I had a fever -- everyone with a fever perfectly well knows they have a fever. The problem is people trying to hide it, I guess? And if they suppress it with medication, your forehead scanner will be useless anyway.
The solution for that is to make quarantine less painful. Here's a list of grocery delivery services, here's a guarantee your employer can't punish you for taking time off work, here's a nursing service that'll call you to check in daily, etc. Enjoy your vacation.
How do you know you never had a fever you couldn't detect? If you don't check your temperature daily those by definition would have passed you by.
The real reason though is people tend to think it ain't that bad and go out. Fever checks stop those people before they infect your shop.
The real reason though is people tend to think it ain't that bad and go out. Fever checks stop those people before they infect your shop.
You're right; a slight one, possibly. But the margin of error on the forehead scanners is so high you're not going to detect anything other than the most serious of fevers, which I guarantee people can tell they have.
If you want proper temperature checking you're going to have to get into oral checks, which nobody is willing to do. The forehead scanners are a placebo -- this has been known for a very long time: https://www.reuters.com/article/us-thermometers/accuracy-of-...
If you want proper temperature checking you're going to have to get into oral checks, which nobody is willing to do. The forehead scanners are a placebo -- this has been known for a very long time: https://www.reuters.com/article/us-thermometers/accuracy-of-...
I've never seen a toupée that I couldn't tell was fake.
> The US is stuck in limbo. Some states locked down hard, others didn't lock down enough.
Umm, I think you mean the world. the nordics can't decide what do do with Sweden. New Zealand will be perpetually close to zero cases, but be sealed off from the world. Obviously US/Brazil tourism is good to go.
> Some states locked down hard, others didn't lock down enough.
On the world scale, India locked down hard, but failed because arguably, the hard lockdown created more problems. I think Sweden had fewer cases per capita at the peak than the UK, despite avoiding a formal lockdown, but Norway had even fewer. A lot of factors you'd think would be meaningful haven't been, and the ones we're left with is developed East-Asian countries did OK, isolated developed countries did OK, countries lead by populists haven't done so well, and North Korea still claims to have zero cases.
Umm, I think you mean the world. the nordics can't decide what do do with Sweden. New Zealand will be perpetually close to zero cases, but be sealed off from the world. Obviously US/Brazil tourism is good to go.
> Some states locked down hard, others didn't lock down enough.
On the world scale, India locked down hard, but failed because arguably, the hard lockdown created more problems. I think Sweden had fewer cases per capita at the peak than the UK, despite avoiding a formal lockdown, but Norway had even fewer. A lot of factors you'd think would be meaningful haven't been, and the ones we're left with is developed East-Asian countries did OK, isolated developed countries did OK, countries lead by populists haven't done so well, and North Korea still claims to have zero cases.
> Umm, I think you mean the world.
Not most of Europe and East Asia, and a smattering of countries that have had effective responses. They have suppressed the epidemic to the point where they can reopen most things. They have to be vigilant and monitor the R value, but as long as it hovers around 1, they're okay. The levels of their epidemics are also low enough that they can do effective contact tracing (see, for example, what happened in Beijing recently).
In the US, by contrast, there are tens of thousands of new cases every day. Contact tracing is impossible at that point, and parts of the US will probably have to go into lockdown again, unless the US is willing to accept hundreds of thousands of additional deaths. A sharp lockdown lasting about 6 weeks would have put the US in a much better position.
> the nordics can't decide what do do with Sweden.
Because Sweden refused to lock down. This is the fault of Swedish politics, not the other Nordic countries that took effective action to suppress the virus.
> I think Sweden had fewer cases per capita at the peak than the UK, despite avoiding a formal lockdown
The UK has had a particularly bad epidemic because early on, the government pursued a "herd immunity" strategy. They waited far too long before locking down.
Not most of Europe and East Asia, and a smattering of countries that have had effective responses. They have suppressed the epidemic to the point where they can reopen most things. They have to be vigilant and monitor the R value, but as long as it hovers around 1, they're okay. The levels of their epidemics are also low enough that they can do effective contact tracing (see, for example, what happened in Beijing recently).
In the US, by contrast, there are tens of thousands of new cases every day. Contact tracing is impossible at that point, and parts of the US will probably have to go into lockdown again, unless the US is willing to accept hundreds of thousands of additional deaths. A sharp lockdown lasting about 6 weeks would have put the US in a much better position.
> the nordics can't decide what do do with Sweden.
Because Sweden refused to lock down. This is the fault of Swedish politics, not the other Nordic countries that took effective action to suppress the virus.
> I think Sweden had fewer cases per capita at the peak than the UK, despite avoiding a formal lockdown
The UK has had a particularly bad epidemic because early on, the government pursued a "herd immunity" strategy. They waited far too long before locking down.
Different people have different goals, but it's pointless to measure California's status against goals it's not trying to meet.
Will be interesting to see what happens in the next two weeks. Certainly most places have handled the bumps well so far, but some have not e.g. Texas hospitalizations are up
They say a 28-day lag between infection and death. So I'm curious about the last two weeks of July, if we'll have more deaths in that period than we've had over the last two weeks. I currently suspect we will, but I've been wrong about the south before.
Hospitalized Increase is being tracked. The good news is it hasn't increased with positive cases. That is likely because the younger infected cases.
https://vida.io/dashboards/ckbk04mht00000ul63lr6m53w
https://vida.io/dashboards/ckbk04mht00000ul63lr6m53w
Of course cases will go up as testing becomes more widespread. As you point out, headlines mention case numbers as those are the high, eye-catching numbers. The more important numbers to watch are positivity and hospitalization, which are starting to tick up after several flat weeks.
This article goes so far as to flirt with the testing numbers without actually siting them. I really don't see what's so hard for news outlets to throw the total number of tests alongside the total number of positive results.
There was an NYT article saying ventilators only give a 12% additional survival rate. This is the service hospitals provide.
Sure oxygen can be given at a hospital, but if we are overwhelmed, you can easily do oxygen at home.
Anyone have a different understanding?
Sure oxygen can be given at a hospital, but if we are overwhelmed, you can easily do oxygen at home.
Anyone have a different understanding?
I'm not sure what you're arguing for here.
There's a very short period of time between when a patient starts drowning in their own fluids and when they die. So you need to be oxygenating in a clinical setting because you need people immediately available to intubate in case your oxygenated patient starts drowning in their own fluids, which they do often. That's why it confers a 12% survival rate. If you've progressed to the point where supplemental oxygen doesn't work then you're pretty close to dying. I'll take 12% over 0% any day of the week.
As always you should look past the statistics to what actually needs to happen in those situations. Statistics provide very little assistance in determining whether an individual patient needs to be hospitalized or not. You can't look at someone and go "oh this guy is one of the X% that will eventually need a ventilator." You have to assume that any one patient that needs supplemental oxygen may be one of that X%.
So sending people home with supplemental oxygen should be a last-ditch effort if the hospitals become completely overwhelmed, not a routine activity. And to facilitate that, we should absolutely be trying to keep people from getting sick so our hospitals remain open for the unavoidable cases.
There's a very short period of time between when a patient starts drowning in their own fluids and when they die. So you need to be oxygenating in a clinical setting because you need people immediately available to intubate in case your oxygenated patient starts drowning in their own fluids, which they do often. That's why it confers a 12% survival rate. If you've progressed to the point where supplemental oxygen doesn't work then you're pretty close to dying. I'll take 12% over 0% any day of the week.
As always you should look past the statistics to what actually needs to happen in those situations. Statistics provide very little assistance in determining whether an individual patient needs to be hospitalized or not. You can't look at someone and go "oh this guy is one of the X% that will eventually need a ventilator." You have to assume that any one patient that needs supplemental oxygen may be one of that X%.
So sending people home with supplemental oxygen should be a last-ditch effort if the hospitals become completely overwhelmed, not a routine activity. And to facilitate that, we should absolutely be trying to keep people from getting sick so our hospitals remain open for the unavoidable cases.
Lots of strokes and other complications that can only be treated in a hospital. I haven't seen data on successful intervention there though (or maybe that it overlaps largely with the already low survivability).
There are many more therapies than just oxygen that hospitalized patients receive. Lots of monitoring of e.g., blood values that indicate stress on one organ or another, or danger of crisis due to many different processes. Drug therapy and supportive treatments are varied in response to those.
It's not as simple as "welcome to Wendy's, would you like the oxygen today, or can we supersize you to a ventilator?"
It's not as simple as "welcome to Wendy's, would you like the oxygen today, or can we supersize you to a ventilator?"
Cardiac arrest is a significant "side effect" of COVID-19, leading to death. Hospitals are better equipped for that.
Kidney problems are popping up in some folks post-infection; that's also better dealt with in a hospital.
Kidney problems are popping up in some folks post-infection; that's also better dealt with in a hospital.
My understanding is that just the most severe cases are put on ventilation, and understandably alas a lot of those people die. But the overall effectiveness of intensive care and general hospitalization is likely much higher, but I haven't seen a chart about this.
the stat that I read was that 86% of people put on ventilators die
as for those that survive - most have serious breathing problems for the rest of their lives -
https://www.webmd.com/lung/news/20200415/ventilators-helping...
as for those that survive - most have serious breathing problems for the rest of their lives -
https://www.webmd.com/lung/news/20200415/ventilators-helping...
Flatten the curve was meant to spread the infections across time to decrease stress on the healthcare system. Our lockdown was ineffectual because of lax enforcement and the public's apathy. So it achieved none of its goals. Places like Italy, Spain, New Zealand have "won" against the virus using lockdowns and are now on track to be back to normal. In NZs case they are already back to normal. Without another lockdown it's almost assured at this point that we will reach the breaking point of our healthcare system. It's inevitable unless a miracle vaccine arrives very soon.
But... we did flatten the curve enough to avoid overwhelming the healthcare system. To suggest it wasn't enough now is moving the goalposts.
> But... we did flatten the curve enough to avoid overwhelming the healthcare system
Well, the curve had somewhat flattened (but was still trending upward among the noise) before reaching the point of overwhelming the system before we started reopening and it unflattened. I think it was premature to say that it had been flattened enough to avoid rather than delay that outcome, though it's kind of immaterial anyway since we abandoned the effort to keep it flat and are heading straight for overwhelming the system.
Well, the curve had somewhat flattened (but was still trending upward among the noise) before reaching the point of overwhelming the system before we started reopening and it unflattened. I think it was premature to say that it had been flattened enough to avoid rather than delay that outcome, though it's kind of immaterial anyway since we abandoned the effort to keep it flat and are heading straight for overwhelming the system.
A building catches fire, the fire department starts spraying down the surrounding buildings causing water damage but keeping them from also catching fire. Everyone is ok with this trade off, the reason we are allowing the water damage is to avoid the building burning down. The fire department started doing this when the building fire next door was on the first floor but threatened the rest of the building.
The fire department was able to get that room where the fire started mostly put out, there's still a little bit of fire in the hallway, and they start putting the hoses away.
"There's much less fire than when we started, and people were getting really angry about the water damage to the surrounding buildings. We are all done here!"
Would you be happy about this situation, wouldn't you point out that even if there is less fire, nothing else has changed about the situation. Fire still spreads, it can still catch the building on fire, and that fire could still spread to the surrounding buildings.
The problem isn't over yet, and if the whole point of suffering the water damage was that my building wouldn't burn down, well now I have water damage and it might still burn down.
The fire department was able to get that room where the fire started mostly put out, there's still a little bit of fire in the hallway, and they start putting the hoses away.
"There's much less fire than when we started, and people were getting really angry about the water damage to the surrounding buildings. We are all done here!"
Would you be happy about this situation, wouldn't you point out that even if there is less fire, nothing else has changed about the situation. Fire still spreads, it can still catch the building on fire, and that fire could still spread to the surrounding buildings.
The problem isn't over yet, and if the whole point of suffering the water damage was that my building wouldn't burn down, well now I have water damage and it might still burn down.
[deleted]
Hospitals are starting to reach capacity in Tucson and Dallas right now.
And the curve is now going straight back up at exponential rates. The lockdown should have lasted until we had a vaccine. Period.
Ah yes, a member of the Zoom/Slack WFH class who is not impacted economically whatsoever by a 12-18 month lockdown.
Ah yes a member of the "Sacrifice your grandparents for the stonks" class. I'm sorry but the idea of discarding potentially millions of live for the economy is inhuman.
The economic impact began before the lockdown occurred. To imply that we can just reopen society by declaring the lockdown over is to be a bit naive about how people react to risk.
The pandemic and the government’s poor response caused the lockdowns, not white collar workers.
18 months is the rough expectation of the timeline for applying a vaccine to everybody.
Can people really go 18 months with no employment? Can students miss 18 months of schooling? Can people go 18 months without other medical care? Can housing go 18 months without upkeep because the landlords have no money since they can't evict rent nonpayers?
A lockdown that extended is not feasible, even before you get to any discretionary economic activity.
Can people really go 18 months with no employment? Can students miss 18 months of schooling? Can people go 18 months without other medical care? Can housing go 18 months without upkeep because the landlords have no money since they can't evict rent nonpayers?
A lockdown that extended is not feasible, even before you get to any discretionary economic activity.
"Period"? It's unknown how long a vaccine will take, or how effective it will even be.
Prolonged lockdowns have costs too, it's just not politically correct to compare them to peoples' lives so people like to ignore them.
Prolonged lockdowns have costs too, it's just not politically correct to compare them to peoples' lives so people like to ignore them.
To revise science and drop ideas not proven to work while adopting ideas proven to work can also be called "changing the goalposts" by people who simply don't understand how science works.
> Without another lockdown it's almost assured at this point that we will reach the breaking point of our healthcare system. It's inevitable unless a miracle vaccine arrives very soon.
What sources of information lead you to this conclusion?
What sources of information lead you to this conclusion?
LA County is reportedly 2-4 weeks from hitting capacity, lots of other smaller places are closer, and hospitalizations are trailing enough that even an immediate return to lockdown (aside from compliance issues, which after reopening are going to be significant) won't stop some places from being overwhelmed, but reopening continues to progress.
Uh Math? You have unconstrained exponential growth across the country in most major cities outside the Northeast. There is only 1 ending here unless there are massive changes.
Gotta get those clicks
I love how reporting on the increasing number of cases in a pandemic that has caused over 120,000 American deaths can somehow be "for the clicks".
Any news article that mentions the number of new positive cases without mentioning the number of new tests is doing it for the clicks. One is fairly useless without the other.
150 cases out of 150 tests? Yikes! 150 cases out of 150,000 tests? Yawn.
150 cases out of 150 tests? Yikes! 150 cases out of 150,000 tests? Yawn.
This tool is useful https://coronavirus.jhu.edu/testing/individual-states
California has been increasing raw number of tests but the positive tests percentage has been holding relatively steady around 4.5%
https://coronavirus.jhu.edu/testing/individual-states/califo...
Florida is a much different story, as their cases have increased the testing has not kept up, and the positive test rate has gone from 2.3% at the end of May to 12.2%
https://coronavirus.jhu.edu/testing/individual-states/florid...
One thing that everyone should keep in mind, even if you could attribute all of the increase in confirmed cases to testing, tests don't give anyone the coronavirus. The only thing increased testing can do is give you a more accurate picture of how bad the situation is, it can't make the situation worse.
California has been increasing raw number of tests but the positive tests percentage has been holding relatively steady around 4.5%
https://coronavirus.jhu.edu/testing/individual-states/califo...
Florida is a much different story, as their cases have increased the testing has not kept up, and the positive test rate has gone from 2.3% at the end of May to 12.2%
https://coronavirus.jhu.edu/testing/individual-states/florid...
One thing that everyone should keep in mind, even if you could attribute all of the increase in confirmed cases to testing, tests don't give anyone the coronavirus. The only thing increased testing can do is give you a more accurate picture of how bad the situation is, it can't make the situation worse.
The second metric is obviously more important, but when a pandemic as an Ro of more than 1, any increasing number of cases is a huge issue. Hence why the hospitalizations are on the way up, which is also reported in that article..
you've actually got it backwards. 150 cases out of 150 tests mean that testing isn't indicative of the infection rate, and is a yawner because the test itself is telling us almost nothing.
Exactly, if we want to achieve herd immunity then increasing the number of infected is a goal we want to achieve, keeping hospitalization levels steady is needed to not increase the amount of death (covid related or not).
Even though I'm young and relatively healthy, I'm not interested in acquiring the virus in the service of "herd immunity". Especially after hearing reports of it causing lung and organ damage even in asymptomatic patients. Please count me out.
Latest studies also indicate potential brain damage:
https://www.bbc.com/future/article/20200622-the-long-term-ef...
So definitely not something to get infected with, especially as it is still not clear if surviving an infection gives you immunity.
If it does not - you might get infected repeatedly until it "rolls the dice" just "right" and damages your health and possibly even kills you...
https://www.bbc.com/future/article/20200622-the-long-term-ef...
So definitely not something to get infected with, especially as it is still not clear if surviving an infection gives you immunity.
If it does not - you might get infected repeatedly until it "rolls the dice" just "right" and damages your health and possibly even kills you...
nothing has proven that you can get infected repeatedly, but also nothing has proven that it won't mutate every year like the flu does.
If this is your country's strategy then good luck (and it is the US strategy), but you can always try to avoid it as much as possible until enough people have caught it.
Never understood the point of herd immunity through deliberate infection with a potentially deadly disorder. I mean what the point of getting sick now, instead of later. I can kinda get a point that second could be potentially deadlier, but what if it never happens? SARS-CoV from 2003 never gave a second wave.
A lot of people argue that SARS-CoV-2 is more contagious and less fatal than first thought, without realizing that that means that herd immunity is even more difficult to achieve. The more contagious a virus is, the harder it is to achieve herd immunity.
> but what if it never happens
The problem is that if covid doesn't kill you, stopping the economy will (or at least will make it worse for a large part of the population).
There might be a right trade-off of making heavy use of masks and preventative measures, but this is not currently the implied strategy of the government (as masks are not really enforced).
The difference with SARS-CoV-1 from 2002-2004 was that symptoms were much more aggressive and quick, and thus it was much more easy to trace and quarantine people. With the current one we have a mix of issues: lots of asymptomatic people or symptoms take time to develop.
The problem is that if covid doesn't kill you, stopping the economy will (or at least will make it worse for a large part of the population).
There might be a right trade-off of making heavy use of masks and preventative measures, but this is not currently the implied strategy of the government (as masks are not really enforced).
The difference with SARS-CoV-1 from 2002-2004 was that symptoms were much more aggressive and quick, and thus it was much more easy to trace and quarantine people. With the current one we have a mix of issues: lots of asymptomatic people or symptoms take time to develop.
Still do not understand the point of "herd immunity" Swedish way. Pointless to me. What it is supposed to protect from? From the disease you are supposed to get sick with to acquire that immunity at first place?
Its to avoid economic shutdown. Its to protect people from economic disaster.
Why would you call it, hypocritically herd immunity then? It should be called sacrifice of weak, that woul be honest. Anyways, Sweden did not fare economically any better than Austria, Norway or New Zealand.
Who said anything about sacrificing the weak?
herd immunity is not about everyone catching it, it's about enough people catching it and getting immune, that the virus can't spread anymore.
buhhh(1)
Yes, flatten the curve is to prevent chaos. In that context, total cases is close to meaningless. Active case would be a far better metric. Cases that have "completed the process" have no value - other than fear-mongering.
Then you break active cases down by area (read: hospital) and carrier profile (e.g., age, pre-existing conditions, etc.). The point is, not everyone who tests positive is high risk. Not everyone who shows symptons will end up at hospital. Not everyone who ends up at hospital will need a ventilator. And so on.
As it is, this whole event has been a text book case of how not to use data and statistics properly.
Then you break active cases down by area (read: hospital) and carrier profile (e.g., age, pre-existing conditions, etc.). The point is, not everyone who tests positive is high risk. Not everyone who shows symptons will end up at hospital. Not everyone who ends up at hospital will need a ventilator. And so on.
As it is, this whole event has been a text book case of how not to use data and statistics properly.
COVID Articles start with a random selection of cases, tests or deaths over a random selection of time frames and areas.
Then halfway through the article it randomly changes to a different combination of cases, tests or deaths or a different time frame and different larger or smaller area.
And then finally it switches again, but about a totally different country or worldwide statistics.
Now you can procedurally generate multiple articles all day!
"Wow engagement is so high", said the Product Manager. "Our KPIs are through the roof, keep doing more of that our customers must love us."
Then halfway through the article it randomly changes to a different combination of cases, tests or deaths or a different time frame and different larger or smaller area.
And then finally it switches again, but about a totally different country or worldwide statistics.
Now you can procedurally generate multiple articles all day!
"Wow engagement is so high", said the Product Manager. "Our KPIs are through the roof, keep doing more of that our customers must love us."
We locked down _too soon_ in many places. Hear me out.
In my state, Oregon, we locked down when there were only a handful of cases, and not much community spread. Most spread was either in long-term care or familial. But we locked down _hard_ and had pretty good compliance. I am talking, standing in the middle of I-5 at noon compliance. Sure you'd have to keep an eye out for trucks from time to time. But still.
We set up surge capacity. Hospitals in Portland set up triage tents and cleared out other beds for a surge...... that never came. A few weeks in, the tents were taken down, the staff was laid off. We sat in our cocoon waiting for something, not sure what. Eventually the pain of being closed started to tick away, and we started reopening...
But nothing materially _changed_ between then and now. We just stopped community spread of an infection nobody really had. We've had less than 6k infections in Oregon. Now we are opening up and guess what? Cases are increasing! We didn't flatten the curve we crushed the curve. So there was no controlled spread, it was just us all feeling proud of ourselves for three months while the poor suffered.
The sneaky lie was that, in a country as big as the US, a flatten the curve strategy was never going to work at a national level. We need community level response.
We locked down Oregon over what was happening in NYC. That is akin to Northern Ireland locking down because of Moscow. That isn't an exaggeration. If anything, it is an understatement.
All of the European countries that we are saying "why can't we be more like them?" all had orders of magnitude more cases than Oregon. So if Oregon quadruples in cases over the next month we are still better off than a lot of nations.
To flatten the curve, there needs to be a damn curve to flatten. Had we waited until there was known, uncontrolled community spread and _then_ shut down, we would have a lot more political will. Now if it gets to that point after three months of being shut down, I doubt anyone will give a shit what the Governor says. Goodwill has been burned through and then some.
In my state, Oregon, we locked down when there were only a handful of cases, and not much community spread. Most spread was either in long-term care or familial. But we locked down _hard_ and had pretty good compliance. I am talking, standing in the middle of I-5 at noon compliance. Sure you'd have to keep an eye out for trucks from time to time. But still.
We set up surge capacity. Hospitals in Portland set up triage tents and cleared out other beds for a surge...... that never came. A few weeks in, the tents were taken down, the staff was laid off. We sat in our cocoon waiting for something, not sure what. Eventually the pain of being closed started to tick away, and we started reopening...
But nothing materially _changed_ between then and now. We just stopped community spread of an infection nobody really had. We've had less than 6k infections in Oregon. Now we are opening up and guess what? Cases are increasing! We didn't flatten the curve we crushed the curve. So there was no controlled spread, it was just us all feeling proud of ourselves for three months while the poor suffered.
The sneaky lie was that, in a country as big as the US, a flatten the curve strategy was never going to work at a national level. We need community level response.
We locked down Oregon over what was happening in NYC. That is akin to Northern Ireland locking down because of Moscow. That isn't an exaggeration. If anything, it is an understatement.
All of the European countries that we are saying "why can't we be more like them?" all had orders of magnitude more cases than Oregon. So if Oregon quadruples in cases over the next month we are still better off than a lot of nations.
To flatten the curve, there needs to be a damn curve to flatten. Had we waited until there was known, uncontrolled community spread and _then_ shut down, we would have a lot more political will. Now if it gets to that point after three months of being shut down, I doubt anyone will give a shit what the Governor says. Goodwill has been burned through and then some.
> We locked down _too soon_ in many places
Or maybe the real answer was a coordinated national response.
Why wasn't the NYC cluster confined to NYC or NY state? If the initial lockdown succeeded in killing community transmission in Oregon, how did it start growing again? Most likely from external sources.
Only a national strategy could have made these individual state-level lockdowns worthwhile. Since we didn't have that, the states implemented a haphazard, patchwork of lockdowns that weren't coordinated.
> I doubt anyone will give a shit what the Governor says. Goodwill has been burned through and then some.
Unfortunately you're right about that.
Or maybe the real answer was a coordinated national response.
Why wasn't the NYC cluster confined to NYC or NY state? If the initial lockdown succeeded in killing community transmission in Oregon, how did it start growing again? Most likely from external sources.
Only a national strategy could have made these individual state-level lockdowns worthwhile. Since we didn't have that, the states implemented a haphazard, patchwork of lockdowns that weren't coordinated.
> I doubt anyone will give a shit what the Governor says. Goodwill has been burned through and then some.
Unfortunately you're right about that.
State border closures are unconstitutional in the United States, we could never have a national lockdown. The interstate commerce clause prevents it. Among other laws I am sure.
> State border closures are unconstitutional in the United States
I'm not an expert, but that doesn't seem to be the case.[1]
> interstate commerce clause
I thought that just gave Congress the power to regulate interstate commerce. Again, I'm not a legal expert.
1. https://www.claimsjournal.com/news/national/2020/03/18/29607...
I'm not an expert, but that doesn't seem to be the case.[1]
> interstate commerce clause
I thought that just gave Congress the power to regulate interstate commerce. Again, I'm not a legal expert.
1. https://www.claimsjournal.com/news/national/2020/03/18/29607...
Right, closing borders between states could be seen as an uneven application of a law and prevent interstate commerce. Especially if it were applied unevenly in the sense of "Oregon can have an open border with Idaho but not Washington" because Washington had more cases. Businesses that rely on the border between OR and WA would sue for relief in a hot minute.
I am probably wrong about the law used. IANAL.
I am probably wrong about the law used. IANAL.
> Businesses that rely on the border between OR and WA would sue for relief in a hot minute.
So if you gave them relief preemptively they'd be OK, right?
In any case, you don't need border closures. Even things like suspending or massively reducing domestic air travel, introducing compulsory self-quarantine upon arrival in a new state etc. might be better than doing nothing. I'm not an expert, but it seems like we never even tried.
So if you gave them relief preemptively they'd be OK, right?
In any case, you don't need border closures. Even things like suspending or massively reducing domestic air travel, introducing compulsory self-quarantine upon arrival in a new state etc. might be better than doing nothing. I'm not an expert, but it seems like we never even tried.
In the EU most countries still had borders open for commercial traffic even during the height of the quarantine. This applied not only to trucks shipping tomatoes from southern Europe (rather vital), but also to a plumber hopping across the border to get slightly cheaper products (not so vital).
you cannot eradicate this disease unless you turn the nation into China.
The viable model is the Swedish model, schools are open, restaurants are open, nobody wears a mask. What they do is voluntarily keep more distance between people. That's it. that will do it.
The sky has not fallen, they are exactly on the same track as the US.
The viable model is the Swedish model, schools are open, restaurants are open, nobody wears a mask. What they do is voluntarily keep more distance between people. That's it. that will do it.
The sky has not fallen, they are exactly on the same track as the US.
The Swedish model is only viable as long as you don't mind killing 4700 extra people.
Sweden and Czech Republic has about the same population, there were strict lockdown measures in the Czech Republic and not much at all in Sweden.
So far 336 people have died in the Czech Republic due to Covid-19, daily cases are ~50. For comaparison Sweden has 5053 dead with daily cases about 500-600.
That does not look like something viable & I'm not sure how are they gonna get out of this with some many daily case & how many more people will have to needlessly die.
Sweden and Czech Republic has about the same population, there were strict lockdown measures in the Czech Republic and not much at all in Sweden.
So far 336 people have died in the Czech Republic due to Covid-19, daily cases are ~50. For comaparison Sweden has 5053 dead with daily cases about 500-600.
That does not look like something viable & I'm not sure how are they gonna get out of this with some many daily case & how many more people will have to needlessly die.
I think the point of people advocating the Swedish model is that it's not fair to compare Sweden now with the Czech Republic now. If a country implements strict lockdown measures for three months and then no lockdown measures it might well be it has equal or more deaths a year from now. This will only become a fair comparison at the end of the pandemic.
Yes, almost everyone will get it regardless. Sweden simply moved its deaths forward. Whether it was the right thing to do is left as an exercise for next year.
Except we already have an effective treatment, dexamethasone. So all those Swedish deaths could have potentially been pushed to now when the mortality rate is lower due to new treatments like dexamethasone. Instead, they were not pushed so they all died. Had they been pushed, a third likely would have survived. So already we know Sweden's strategy is total shit that lead to avoidable deaths.
It's a bit early to assert that given the drug was noted to help just days ago.
A randomized clinical study involving thousands of patients is not good enough to assert this?
The Swedish model was exacerbated for the same reason the NYC was. You can’t put old people with the disease in lock down with other old people. You’ll quickly kill them.
Of course you can't do that - anyone infected needs to be isolated and people who were in contact with them as well.
If you want to protect old people (and everyone of us will get old eventually) is to make sure they won't get infected, simple as that.
To achieve that, many care homes here locked down much earlier than the state wide lockdown (and in some cases were already in annual flu related lockdown, same thing for many hospitals). In quite a few cases, the care personnel even volunteered to basically camp out at the site to eliminate any possibility of getting the infection in from their homes.
This has been quite effective. The few cases where the infection did get in were pretty brutal, which validates the rather drastic steps taken.
If you want to protect old people (and everyone of us will get old eventually) is to make sure they won't get infected, simple as that.
To achieve that, many care homes here locked down much earlier than the state wide lockdown (and in some cases were already in annual flu related lockdown, same thing for many hospitals). In quite a few cases, the care personnel even volunteered to basically camp out at the site to eliminate any possibility of getting the infection in from their homes.
This has been quite effective. The few cases where the infection did get in were pretty brutal, which validates the rather drastic steps taken.
When people criticize Sweden, they usually quote the top-line number, leaving out that Sweden's admitted failures were in protecting the elderly and outreach to at-risk immigrant communities.
Why are you comparing them to the Czech Republic when the commenter was comparing them to the US and saying the US should model them? They're not saying the Czech Republic should model them.
> you cannot eradicate this disease unless you turn the nation into China.
Or India? 4x the population, 1/5 the deaths so far. Although they'll catch up eventually - this disease is simply too contagious. But they have a national strategy, everybody is making plays from the same playbook.
> nobody wears a mask
Why not though? If it's been proven to reduce transmission, it seems stupid to not do it.
> that will do it.
All that's done is take the US to the top in lives lost to this disease. If that's where we wanted to end up then mission accomplished, I guess.
> The sky has not fallen, they are exactly on the same track as the US.
See above.
Or India? 4x the population, 1/5 the deaths so far. Although they'll catch up eventually - this disease is simply too contagious. But they have a national strategy, everybody is making plays from the same playbook.
> nobody wears a mask
Why not though? If it's been proven to reduce transmission, it seems stupid to not do it.
> that will do it.
All that's done is take the US to the top in lives lost to this disease. If that's where we wanted to end up then mission accomplished, I guess.
> The sky has not fallen, they are exactly on the same track as the US.
See above.
We also have a much higher life expectancy than India. One of the theories as to why Africa has not been hit is that they have far fewer old people.
Hoisted by our own petard.
Hoisted by our own petard.
Yeah like Burundi. They ran 300 test.
Only 1 death attributed to COVID, making Burundi the country with the fewest deaths per population.
Only 1 death attributed to COVID, making Burundi the country with the fewest deaths per population.
India? You think they have the disease under control?
The US is at the top for two reasons, huge and extremely varied country, lots of testing and accountability.
China most likely has had more deaths than the US, they just simply chose not report it, ergo they are all good (and that's what Trump wishes the US could do).
The US is at the top for two reasons, huge and extremely varied country, lots of testing and accountability.
China most likely has had more deaths than the US, they just simply chose not report it, ergo they are all good (and that's what Trump wishes the US could do).
> India? You think they have the disease under control?
I said they've had a plan and they've tried to fight. Exhibit A: https://www.theguardian.com/world/2020/may/14/the-coronaviru... It'll ultimately overcome India, but it won't be because they waved the white flag like the US appears to have done.
> China most likely has had more deaths than the US,
China would have to underreport deaths by 20x to approach the American death toll. Covering up that many deaths doesn't seem possible. It makes me feel like you're just arguing in bad faith.
And even if China had exactly as many deaths as the US, they'd still be 3.5x better on a per capita basis. Despite being more densely populated, poorer, and likely having a population with more pre-existing respiratory issues due to more pollution. That's how poorly the US has performed in this whole affair.
I said they've had a plan and they've tried to fight. Exhibit A: https://www.theguardian.com/world/2020/may/14/the-coronaviru... It'll ultimately overcome India, but it won't be because they waved the white flag like the US appears to have done.
> China most likely has had more deaths than the US,
China would have to underreport deaths by 20x to approach the American death toll. Covering up that many deaths doesn't seem possible. It makes me feel like you're just arguing in bad faith.
And even if China had exactly as many deaths as the US, they'd still be 3.5x better on a per capita basis. Despite being more densely populated, poorer, and likely having a population with more pre-existing respiratory issues due to more pollution. That's how poorly the US has performed in this whole affair.
There maybe some merit to the claim that China is under reporting, but I haven’t seen any claim that they are under reporting by that much.
Deaths on this scale is hard to hide, even in a state controlled environment. Large cities outside of Wuhan have no seen this. I have colleagues and friends in the big cities and I haven’t heard of anyone catching let alone dying of covid.
Deaths on this scale is hard to hide, even in a state controlled environment. Large cities outside of Wuhan have no seen this. I have colleagues and friends in the big cities and I haven’t heard of anyone catching let alone dying of covid.
Oregon locked down over what was happening in Seattle. Seattle didn't become NYC because their pols listened to their public health experts.
Since we "crushed the curve" we've learned what masks are good for, and how they should be used. We've developed a lifesaving protocol for the most sick patients. We've gotten into the summer which plays somewhat in our favor.
In fact, it looks like universal masking and a bit of care is sufficient to get R0<1. Problem solved, eventually. Unfortunately... leadership matters.
Since we "crushed the curve" we've learned what masks are good for, and how they should be used. We've developed a lifesaving protocol for the most sick patients. We've gotten into the summer which plays somewhat in our favor.
In fact, it looks like universal masking and a bit of care is sufficient to get R0<1. Problem solved, eventually. Unfortunately... leadership matters.
Seattle locked down over what was happening in Italy. Seattle never had uncontrolled spread that risked its healthcare.
How many people died from other, preventable things, while we learned that masks work? Something we knew then, by the way. Just ask any country that dealt with SARS Ver. 1.0
How many people died from other, preventable things, while we learned that masks work? Something we knew then, by the way. Just ask any country that dealt with SARS Ver. 1.0
> Seattle never had uncontrolled spread that risked its healthcare.
Because they shut down. They observed community spread and they acted appropriately. https://www.newyorker.com/magazine/2020/05/04/seattles-leade...
Scientific knowledge is slow and hard to come by, and we didn't know that in February. What we knew was this: Masks don't work for every disease. They don't even work for all coronaviruses. Cloth masks worn by the public can increase transmission of some diseases. SARS-COV2 is not the same as SARS-COV1.
'If it looks like you're overreacting, you're probably doing the right thing' -Fauci https://www.washingtonpost.com/outlook/2020/03/17/overreacti...
Because they shut down. They observed community spread and they acted appropriately. https://www.newyorker.com/magazine/2020/05/04/seattles-leade...
Scientific knowledge is slow and hard to come by, and we didn't know that in February. What we knew was this: Masks don't work for every disease. They don't even work for all coronaviruses. Cloth masks worn by the public can increase transmission of some diseases. SARS-COV2 is not the same as SARS-COV1.
'If it looks like you're overreacting, you're probably doing the right thing' -Fauci https://www.washingtonpost.com/outlook/2020/03/17/overreacti...
> We locked down Oregon over what was happening in NYC. That is akin to Northern Ireland locking down because of Moscow. That isn't an exaggeration. If anything, it is an understatement.
Yep, this right here is the problem. Unfortunately, social media and the 24/7 news cycle (that magnified 100x by social media) has meant that people react strongly to events that have no effect on them, and then go and do things which have no effect on the underlying cause, just because they saw people doing is thousands of miles away.
This is what happened with the COVID lock downs. People panicked when they saw NYC, but there was no reason for most place to lock down (when they did). Far better to wait for a more effective time. But no, you had people slamming governors for doing nothing in states that had very few cases.
This extends to a ton of other causes and problems. See the BLM movement. You have people protesting in countries that have nothing to do with George Floyd and a very different police force, risking their lives and others by spreading covid, because they saw people on the news in another country protesting. Utterly absurd.
Yep, this right here is the problem. Unfortunately, social media and the 24/7 news cycle (that magnified 100x by social media) has meant that people react strongly to events that have no effect on them, and then go and do things which have no effect on the underlying cause, just because they saw people doing is thousands of miles away.
This is what happened with the COVID lock downs. People panicked when they saw NYC, but there was no reason for most place to lock down (when they did). Far better to wait for a more effective time. But no, you had people slamming governors for doing nothing in states that had very few cases.
This extends to a ton of other causes and problems. See the BLM movement. You have people protesting in countries that have nothing to do with George Floyd and a very different police force, risking their lives and others by spreading covid, because they saw people on the news in another country protesting. Utterly absurd.
The Czech Republic, here smack in the middle of Europe did something similar - pretty strict lockdown, hospitals cleared of non essential procedures to keep capacity, most shops closed & mandatory masks everywhere.
Seems to have worked fine, as the average number of cases has been around 50 daily for a couple of weeks, all that while most of the restrictions have been lifted.
So where is the difference ? I think in two aspects: - all the neighboring countries did similar strict lockdown and achieved similar levels of success - we closed our borders to everyone, including preventing residents from going out - the Prague international airport was deserted for month and a half, all international bus and train connections have been shut down & border crossing were guarded by police with army helping out, letting only trucks through
I think this really helped as each country could apply their lockdown separately for a limited period, without worrying about international travel bringing it right back in.
While from what I've read and even been told by people in the US - even is a single US state did a very strict lockdown with potentially huge economical cost - the neighboring state (or in some cases even the next city!) will do hardly anything at all. Combined with no state border lockdown, the strict state will get infections back in from the less responsible areas.
The Czech Republic border is no longer closed, buses and trains go over the borders again & local flights have been reestablished. Still, a version of the border lockdown is still going on, with the Czech Ministry of health maintaining a list of "red" countries, such as for example Sweden or Portugal, that you should not visit but if you do you should go to quarantine and get tested.
Seems to have worked fine, as the average number of cases has been around 50 daily for a couple of weeks, all that while most of the restrictions have been lifted.
So where is the difference ? I think in two aspects: - all the neighboring countries did similar strict lockdown and achieved similar levels of success - we closed our borders to everyone, including preventing residents from going out - the Prague international airport was deserted for month and a half, all international bus and train connections have been shut down & border crossing were guarded by police with army helping out, letting only trucks through
I think this really helped as each country could apply their lockdown separately for a limited period, without worrying about international travel bringing it right back in.
While from what I've read and even been told by people in the US - even is a single US state did a very strict lockdown with potentially huge economical cost - the neighboring state (or in some cases even the next city!) will do hardly anything at all. Combined with no state border lockdown, the strict state will get infections back in from the less responsible areas.
The Czech Republic border is no longer closed, buses and trains go over the borders again & local flights have been reestablished. Still, a version of the border lockdown is still going on, with the Czech Ministry of health maintaining a list of "red" countries, such as for example Sweden or Portugal, that you should not visit but if you do you should go to quarantine and get tested.
I call this the pool theory (hat tip to Merlin Mann). The problem as you said is that each state followed its own lockdown policy, yet travel between states is unregulated. It's as if we had a giant pool, and said, "you can pee in this area, but only this area." Not realizing how after a certain amount of time, all the water was tainted with urine.
Most of Oregon's neighbors had strict lockdowns. Idaho being the exception. Except I still went to Washington several times, because interstate travel was never restricted. It is a matter of debate (as someone mentioned in a different reply) if that would be legal in the USA.
"We never got wet... these umbrellas were useless!" :-)
I tend to agree with your point, though. Many many areas could likely have been just fine by only restricting large gatherings (concerts, etc), requiring masks, strongly encouraging WFH, and so on. But keep open hair salons, local shops, restaurants (with precautions), etc.
Even in the Bay Area, I can't help but think we shut too much down.
I tend to agree with your point, though. Many many areas could likely have been just fine by only restricting large gatherings (concerts, etc), requiring masks, strongly encouraging WFH, and so on. But keep open hair salons, local shops, restaurants (with precautions), etc.
Even in the Bay Area, I can't help but think we shut too much down.
Go stand with an umbrella in the Atacama. We literally had no "rain" here when we locked down. That is my point.
Now that it is raining in the Atacama, we have no political will to do anything.
Edit: I was sassy before I saw your edit :D. High-five on agreeing in principle!
Now that it is raining in the Atacama, we have no political will to do anything.
Edit: I was sassy before I saw your edit :D. High-five on agreeing in principle!
But of course what we can't see is the alternate timeline where Oregon didn't lock down, cases+deaths rose, and then everyone wishes the lockdown had happened sooner.
This is tough and it's a bit of a lose-lose situation. Like you said, there's not enough patience or personal savings to stay like this for another 8 months, and any course of action will be highly criticized, regardless of outcome.
This is tough and it's a bit of a lose-lose situation. Like you said, there's not enough patience or personal savings to stay like this for another 8 months, and any course of action will be highly criticized, regardless of outcome.
This is dumb. NYC became NYC because it didn’t lock down when SF or Seattle did.
If it had, it would have had about half the deaths it eventually did.
If it had, it would have had about half the deaths it eventually did.
That simply is not true. Not by a long shot. NY became NY because they responded poorly, infected nursing homes by housing non-critical patients there and intubated patients that didn't need it through "caution" or some excuse.
Also, NY is about as dense as the US gets, and has way more shared, multi-generational housing than the rest of the US. Also NYC has way more transit usage than any other area in the USA, which was one important vector.
Everyone keeps pretending like the lockdown is the only variable. It isn't!
Also, NY is about as dense as the US gets, and has way more shared, multi-generational housing than the rest of the US. Also NYC has way more transit usage than any other area in the USA, which was one important vector.
Everyone keeps pretending like the lockdown is the only variable. It isn't!
The problem is that a properly executed disaster response will be drama free.
How many people had covid, self quarantined, and never spread it ... unbeknownst to anyone?
The way exponentials work maybe nobody was saved, or maybe a whole nursing home or a city of old people.
I recall the y2k problem and the hysteria. In the end, nothing happened. But... was it an overreaction, or was it an appropriate reaction seeing that all these companies didn't meltdown financially?
How many people had covid, self quarantined, and never spread it ... unbeknownst to anyone?
The way exponentials work maybe nobody was saved, or maybe a whole nursing home or a city of old people.
I recall the y2k problem and the hysteria. In the end, nothing happened. But... was it an overreaction, or was it an appropriate reaction seeing that all these companies didn't meltdown financially?
This is a good point.
Looking back, it would have made more sense to do the lockdown in phases. Ask every company who can have their employees work from to do so. Track the numbers!
Ok, is it still spreading quickly? Well identify the next round of business that should shutter.
We basically did it all at once and like Oregon, CA was pretty adherent, but I just went for a walk this afternoon and it looks no different than per-Covid.
We basically went from on, to off, to on again.
Looking back, it would have made more sense to do the lockdown in phases. Ask every company who can have their employees work from to do so. Track the numbers!
Ok, is it still spreading quickly? Well identify the next round of business that should shutter.
We basically did it all at once and like Oregon, CA was pretty adherent, but I just went for a walk this afternoon and it looks no different than per-Covid.
We basically went from on, to off, to on again.
We stuck a knife in an electrical outlet and got shocked. We turned the power off and back on again and then expected it not to shock us the second time.
You make a good point. See Croatia for a similar example in the EU. However we have the advantage of final control over our borders (sovereignty is pooled upwards, not flowed downwards here) - so we are better able to tailor our response and deal with problem areas (Sweden, greater Lisbon).
Yes. Right now, there is large spread in a community in eastern Oregon around a church. Lets do phase 0 lockdown in that community. Let the rest of Oregon be in a different phase. If it breaks out in Portland, Portland restricts for a while etc. Not just "I am scared lets just close everything".
It was never going to work and people were screaming that at the top of their lungs in March. We were called ghouls or accused of supporting genocide. I am not kidding.
It was never going to work and people were screaming that at the top of their lungs in March. We were called ghouls or accused of supporting genocide. I am not kidding.
As an Oregon resident, I confirm that this is spot on. We handled the lock down very badly, to a point where I had to convince some of my friends that COVID-19 actually exists.
But ideally wouldn't we have wanted to crush it hard - get prepared with testing, isolation ability, contact tracing so that when we lift and cases rise we can smother them before they get too large?
It seems fairly successful so far in China/Korea/Australia etc. Maybe it was never possible with a fractured America filled with selfish idiots. I've completely lost hope in my country for the first time in my life I don't have confidence we can our system can fix itself
It seems fairly successful so far in China/Korea/Australia etc. Maybe it was never possible with a fractured America filled with selfish idiots. I've completely lost hope in my country for the first time in my life I don't have confidence we can our system can fix itself
This is a really good point, and it all goes back to treating US or even a state as a European nation.
The US is not like that at all.
What is appalling that the CDC seemed to be completely clueless to these basic observations, as if it weren't their job to make sane recommendations beyond the "everyone everywhere immediately shut yourself indoors for a few months" (a recommendation imported from China FWIW)
The US is not like that at all.
What is appalling that the CDC seemed to be completely clueless to these basic observations, as if it weren't their job to make sane recommendations beyond the "everyone everywhere immediately shut yourself indoors for a few months" (a recommendation imported from China FWIW)
Hindsight bias.
It is spreading fast amongst the Latino population and more slowly amongst other populations. In SF, Latinos are over 50% of the cases now. In San Mateo, it is closing in on 50% of the cases as well.
A couple of weeks ago, the number of Latino cases in San Mateo was about the same as the Asian and white groups. It is now over triple.
https://data.sfgov.org/stories/s/fjki-2fab
https://www.smchealth.org/san-mateo-county-covid-19-and-othe...
A couple of weeks ago, the number of Latino cases in San Mateo was about the same as the Asian and white groups. It is now over triple.
https://data.sfgov.org/stories/s/fjki-2fab
https://www.smchealth.org/san-mateo-county-covid-19-and-othe...
why is the latino population seeing large number of cases?
I would venture, insular communities and bad luck. Maybe also something to do with cultural mores around visiting family when sick, or insufficient "how to mask/distance/etc" materials in Spanish.
I think it's like Gay-Related Immune Deficiency (GRID, before it was AIDS). There's no inherent reason that it showed up predominantly in the gay male population, except a) the first superspreader was a gay airline steward (so he had lots of contacts with the gay community all over the country), and b) gay men were enjoying the fruits of their sexual revolution.
If you think about it, monogamy is basically an extreme form of "sexual distancing", and so a non-monogamous community is much more likely to have an outbreak of an STD. Other non-monogamous communities heavily promote wearing masks (condoms), but as this had been viewed primarily as a way to prevent pregnancy, the gay community did not think it was necessary.
I think it's like Gay-Related Immune Deficiency (GRID, before it was AIDS). There's no inherent reason that it showed up predominantly in the gay male population, except a) the first superspreader was a gay airline steward (so he had lots of contacts with the gay community all over the country), and b) gay men were enjoying the fruits of their sexual revolution.
If you think about it, monogamy is basically an extreme form of "sexual distancing", and so a non-monogamous community is much more likely to have an outbreak of an STD. Other non-monogamous communities heavily promote wearing masks (condoms), but as this had been viewed primarily as a way to prevent pregnancy, the gay community did not think it was necessary.
I think it's just because hispanic people are poorer and thus more likely to be essential workers.
In SF, I've heard that a good percentage of the latin population will share rent-controlled places 12 to a room. I think it's more common they are living in tight quarters.
Overcrowding. Multiple families sharing apartments is typical of low income areas in CA.
It's almost like it's spilling over from Mexico into Texas, New Mexico, Arizona, and S California, and moving north from LA.
Many outlying areas of Mexico appear to be out of control. Chihuahua, for example, has a 21% fatality rate.
Many outlying areas of Mexico appear to be out of control. Chihuahua, for example, has a 21% fatality rate.
“Part of what’s driving the soaring case loads in Imperial County is the influx of positive patients from Mexico. State officials say they’re primarily US citizens, hundreds of thousands of whom live in neighboring Baja, crossing back in search of superior health care.
The county has by far the state’s highest case numbers on a per capita basis, 3,414 per 100,000, as well as a positivity rate for tests that’s more than four times the state average.“
https://www.technologyreview.com/2020/06/30/1004696/theres-n...
The county has by far the state’s highest case numbers on a per capita basis, 3,414 per 100,000, as well as a positivity rate for tests that’s more than four times the state average.“
https://www.technologyreview.com/2020/06/30/1004696/theres-n...
The Johns Hopkins database implies that California's overall positivity rate (i.e. the percent of COVID-19 tests of Californians that are positive) remains roughly flat at just under 5%. [1] While that's still a concerning number (and it seems like LA in particular is not doing as well as the rest of CA), California overall is doing reasonably well, as it has been throughout the outbreak, despite our dense cities and massive population. More tests mean more positive results, but doesn't necessarily indicate worsening conditions. Cumulative totals are especially meaningless; of course an area with a large population (e.g. the Bay Area) will have large cumulative totals.
The focus on absolute numbers of positive cases (without normalizing by testing rate or population) pretty dramatically distorts the national discourse on COVID-19. California has been slow to reopen — although it is reopening — and has been criticized by the right as experiencing surging cases regardless. But that's largely inaccurate: CA is just much, much larger than any other state, and it's been reliably ramping up testing. As counterexamples, Florida and Arizona are places where the surge in cases is actually reflective of significantly worsening community spread: Arizona's positivity rate has tripled from a low of 6.5% in May to nearly 20% today [2], and Florida's positivity rate has grown 5x from a low of 2.3% in May to over 12% today [3]. Texas, another state that reopened quickly, had its positivity rate double from a low of 4.7% — approximately similar to the rate CA has managed to keep itself at — to 11% today. [4]
1: https://coronavirus.jhu.edu/testing/individual-states/califo... 2: https://coronavirus.jhu.edu/testing/individual-states/arizon... 3: https://coronavirus.jhu.edu/testing/individual-states/florid... 4: https://coronavirus.jhu.edu/testing/individual-states/texas
The focus on absolute numbers of positive cases (without normalizing by testing rate or population) pretty dramatically distorts the national discourse on COVID-19. California has been slow to reopen — although it is reopening — and has been criticized by the right as experiencing surging cases regardless. But that's largely inaccurate: CA is just much, much larger than any other state, and it's been reliably ramping up testing. As counterexamples, Florida and Arizona are places where the surge in cases is actually reflective of significantly worsening community spread: Arizona's positivity rate has tripled from a low of 6.5% in May to nearly 20% today [2], and Florida's positivity rate has grown 5x from a low of 2.3% in May to over 12% today [3]. Texas, another state that reopened quickly, had its positivity rate double from a low of 4.7% — approximately similar to the rate CA has managed to keep itself at — to 11% today. [4]
1: https://coronavirus.jhu.edu/testing/individual-states/califo... 2: https://coronavirus.jhu.edu/testing/individual-states/arizon... 3: https://coronavirus.jhu.edu/testing/individual-states/florid... 4: https://coronavirus.jhu.edu/testing/individual-states/texas
>despite our dense cities
Californian cities are actually not dense at all, which may explain why it isn't even worse. LA at 7.5k /mi2, San Diego 4.4k/mi2 etc.. compare that to New York at 27k/mi2, or even Paris 54k/mi2, Barcelona 41k/mi2
Californian cities are actually not dense at all, which may explain why it isn't even worse. LA at 7.5k /mi2, San Diego 4.4k/mi2 etc.. compare that to New York at 27k/mi2, or even Paris 54k/mi2, Barcelona 41k/mi2
San Francisco is the fourth-most dense city in America (among cities with >75,000 residents). If you only count cities with >200,000 residents, it's the second-most dense city in America, behind NYC. Its overall density is 17k/mi2.
https://en.wikipedia.org/wiki/List_of_United_States_cities_b...
And if you look at entire metropolitan areas, rather than just cities, LA is actually the second-most dense metropolitan area in the country.
Meanwhile, Phoenix, Arizona has a population density of 2k/mi2, and is having a massive outbreak.
Public policy appears to be the determining factor in flattening the curve of COVID outbreaks, not density.
https://en.wikipedia.org/wiki/List_of_United_States_cities_b...
And if you look at entire metropolitan areas, rather than just cities, LA is actually the second-most dense metropolitan area in the country.
Meanwhile, Phoenix, Arizona has a population density of 2k/mi2, and is having a massive outbreak.
Public policy appears to be the determining factor in flattening the curve of COVID outbreaks, not density.
Only the US and Brazil, and some of the small Gulf states, seem totally unable to get their coronavirus epidemics under control.[1] Remember when Italy had a huge problem? That's over. China? Over.
[1] https://ig.ft.com/coronavirus-chart/?areas=usa&areas=chn&are...
[1] https://ig.ft.com/coronavirus-chart/?areas=usa&areas=chn&are...
When mainstream and social media turned the public health crisis into a political issue it ruined any chance of ending well. Politics destroys everything it touches in this country.
Or put more simply: We would be a lot better off if everyone would just shut the fuck up for 10 minutes.
Or put more simply: We would be a lot better off if everyone would just shut the fuck up for 10 minutes.
There is a popular expression in French that explicits a worthy distinction: “Politique politicienne”.
It literally means politician politics, or politicians' politics (a politician is a political figure, like an elected official), and it very derogatorily qualifies all the noise, the blablabla, the unimportant chatter in politics — Wherein politics speaks of egos, not ideas; the part that seldom leads to actual or worthwhile "policy".
When a leader is said to be making “de la politique politicienne”, it basically means that's degree zero of intelligent discourse, and solely aimed at tackling political opponents. Cue false claims, supporting opinions you provably don't believe yourself (but party line prevails), etc.
It's an old expression, before my time (1980s). It's fallen out of flavor. Probably because 99% of politics has now become de la politique politicienne...
It literally means politician politics, or politicians' politics (a politician is a political figure, like an elected official), and it very derogatorily qualifies all the noise, the blablabla, the unimportant chatter in politics — Wherein politics speaks of egos, not ideas; the part that seldom leads to actual or worthwhile "policy".
When a leader is said to be making “de la politique politicienne”, it basically means that's degree zero of intelligent discourse, and solely aimed at tackling political opponents. Cue false claims, supporting opinions you provably don't believe yourself (but party line prevails), etc.
It's an old expression, before my time (1980s). It's fallen out of flavor. Probably because 99% of politics has now become de la politique politicienne...
Sure, let's just take politics out of things that affect people.
So the current administration botches the response to a pandemic but the media is blame because they politicized it?
Healthcare is a political issue. Pretty much everything is a political issue. To pretend otherwise is to bury your head in the sand.
Healthcare is a political issue. Pretty much everything is a political issue. To pretend otherwise is to bury your head in the sand.
Would you like to live like the Chinese? No.
Would you like to have the same death rates as Italy (much higher than US)? No.
Is the disease eradicated in either country? No.
The story of who did better remains to be written.
If anything California shut down way too soon. That's the problem that no one seems to talk about.
Would you like to have the same death rates as Italy (much higher than US)? No.
Is the disease eradicated in either country? No.
The story of who did better remains to be written.
If anything California shut down way too soon. That's the problem that no one seems to talk about.
Italy was the first western country to be hit with COVID.
Italy is also not the richest country with the highest per capita ICU bed availability with a ridiculously expensive healthcare system which while terrible for general welfare was excellently places for an emergency like the pandemic.
And if California shut down too early, it was still not a bad decision because you did not know what a good decision was at the time.
The fundamental problem in the US has not been shutdowns. It’s been shutdowns which have involved absolutely no planning for the reopenings.
That’s the fundamental disaster in the US handling of the situation. The northeast could maybe be forgiven for not doing planning for reopening because they were actually dealing with a crisis during the shutdown. But the rest of the country had no excuse. And unlike the northeast they weren’t the first to be hit, so they had time to see and prepare.
Instead, they declared it a Northeast problem as if the virus could tell Jersey Shore residents from South beach residents, and decided to go on with their lives without any planning or preparation anyways.
Italy is also not the richest country with the highest per capita ICU bed availability with a ridiculously expensive healthcare system which while terrible for general welfare was excellently places for an emergency like the pandemic.
And if California shut down too early, it was still not a bad decision because you did not know what a good decision was at the time.
The fundamental problem in the US has not been shutdowns. It’s been shutdowns which have involved absolutely no planning for the reopenings.
That’s the fundamental disaster in the US handling of the situation. The northeast could maybe be forgiven for not doing planning for reopening because they were actually dealing with a crisis during the shutdown. But the rest of the country had no excuse. And unlike the northeast they weren’t the first to be hit, so they had time to see and prepare.
Instead, they declared it a Northeast problem as if the virus could tell Jersey Shore residents from South beach residents, and decided to go on with their lives without any planning or preparation anyways.
Countless lives were saved by California shutting down, that’s WHY the death rate isn’t like Italy.
Yet ...
> If anything California shut down way too soon. That's the problem that no one seems to talk about.
What?
What?
> Would you like to live like the Chinese? No.
Don’t know what you guys are seeing on the media but I’ve been in China since February and the response has been pretty reasonable and very effective, at least from where I’m sitting. Before I came back in early Feb I thought about fleeing to the US, but haven’t entertained the idea since.
Don’t know what you guys are seeing on the media but I’ve been in China since February and the response has been pretty reasonable and very effective, at least from where I’m sitting. Before I came back in early Feb I thought about fleeing to the US, but haven’t entertained the idea since.
What is the death rate of Italy given demographics? Is it still "much higher than [the] US"?
Current deaths per million population:
UK: 642
Spain: 576
Italy: 575
France: 441
US: 365
Netherlands 340
EU Average: 208
Germany: 107
I dont have an easy way to adjust for demographics, but the median age of most of the countries listed is 2-3 years greater than the US. Italy is ~ 6.
UK: 642
Spain: 576
Italy: 575
France: 441
US: 365
Netherlands 340
EU Average: 208
Germany: 107
I dont have an easy way to adjust for demographics, but the median age of most of the countries listed is 2-3 years greater than the US. Italy is ~ 6.
See the reply I just posted. You are comparing a Italy to a massive nation. We only had uncontrolled community spread in a few areas in the Mid-Atlantic and New England, MI and LA. Other than that, we had very few cases and locked down burning through all potential goodwill while there was nothing to lock down over.
Compare the states of New York and New Jersey to the country of Italy. That is a more fair comparison. Not USA -> Italy.
One more thing. Italy didn't beat it. As soon as free movement is restored to the EU, it will spread again. The only thing that would prevent that is the ballyhooed theory that there is latent immunity in 40-60% of the population. If that is the case, than yes Lombardy is in the clear.
But if that is the case, then we also ruined the economy over a disease that was only going to infect a quarter of the people feared, and kill even less. Changes the math, doesn't it?
Edit: Fixed my stupidity about regions of my own country.
Compare the states of New York and New Jersey to the country of Italy. That is a more fair comparison. Not USA -> Italy.
One more thing. Italy didn't beat it. As soon as free movement is restored to the EU, it will spread again. The only thing that would prevent that is the ballyhooed theory that there is latent immunity in 40-60% of the population. If that is the case, than yes Lombardy is in the clear.
But if that is the case, then we also ruined the economy over a disease that was only going to infect a quarter of the people feared, and kill even less. Changes the math, doesn't it?
Edit: Fixed my stupidity about regions of my own country.
> We only had uncontrolled community spread in a few areas in New England, MI and LA.
NY/NJ are not part of New England. And what's your definition of "uncontrolled community spread"? [Other places like Louisiana surely qualified. Edit: never mind, I didn't parse LA as Louisiana.] Would you say it's now "uncontrolled" in say Arizona or South Carolina?
NY/NJ are not part of New England. And what's your definition of "uncontrolled community spread"? [Other places like Louisiana surely qualified. Edit: never mind, I didn't parse LA as Louisiana.] Would you say it's now "uncontrolled" in say Arizona or South Carolina?
Yes, NY and NJ are in New England. MI is Michigan, LA is Louisiana. Sorry if I assumed state abbreviations were known. I forget that I am speaking to an international crowd at times.
I lied! NY and NJ are not in New England. The USA is annoying.
I lied! NY and NJ are not in New England. The USA is annoying.
They're not though. New England starts at Massachusetts.
New York and New Jersey are mid Atlantic states.
New York and New Jersey are mid Atlantic states.
Connecticut and Rhode Island are also part of New England. Really the tristate area is what people mean when they say New England or the North East in regards to covid. I definitely wouldn't classify NY or NJ as mid-atlantic though, it's really Maryland to the Carolines imo.
> Really the tristate area is what people mean when they say New England
Maybe they should be more careful with their choice of name, New England has been used for over 400 years to refer to something that definitely doesn’t include Manhattan or New Jersey.
The name even has a precise administrative meaning today, as does Middle Atlantic: https://www2.census.gov/geo/pdfs/maps-data/maps/reference/us...
Maybe they should be more careful with their choice of name, New England has been used for over 400 years to refer to something that definitely doesn’t include Manhattan or New Jersey.
The name even has a precise administrative meaning today, as does Middle Atlantic: https://www2.census.gov/geo/pdfs/maps-data/maps/reference/us...
Yeah, I agree it's technically not correct, but in the context of coronavirus specifically, much like COVID-19 is the disease and SARS-CoV-2 is the virus, but everyone calls it COVID, that's what people are referring to in my experience.
In other contexts New England is usually used correctly, though I have seen people include NY and/or the original 13 colonies as "New England"
That said I didn't know about the mid-atlantic administrative region, thanks for that info. It seems really weird to call NY, which borders Canada, mid-atlantic and have it stop at the south of NJ, especially when east north central goes further south. South atlantic looks about 2-3x bigger than mid and definitely goes way past the north-south halfway point of the east coast.
In other contexts New England is usually used correctly, though I have seen people include NY and/or the original 13 colonies as "New England"
That said I didn't know about the mid-atlantic administrative region, thanks for that info. It seems really weird to call NY, which borders Canada, mid-atlantic and have it stop at the south of NJ, especially when east north central goes further south. South atlantic looks about 2-3x bigger than mid and definitely goes way past the north-south halfway point of the east coast.
Well fuck. I am an idiot. Thanks!
Yes, exactly plotting Lombardy and New York show very similar trends.
To be fair, in my opinion neither region "defeated" the virus - they just ran out of people that could be easily infected.
The seropositivity in NYC is probably pushing 30-40 percent now.
To be fair, in my opinion neither region "defeated" the virus - they just ran out of people that could be easily infected.
The seropositivity in NYC is probably pushing 30-40 percent now.
Ha! I just added the "Italy didn't defeat it" caveat. Great minds or something :)
So 70% that could be infected rather than 100% is "running out of people"?
No infection, in the history of infections has EVER infected 100% of people. So already I can ignore you as an alarmist. But I won't.
I will say that being susceptible is not evenly distributed across a population. This is why prisons, meat packing and old people homes are more likely to have outbreaks. The corollary to that is that R0 is not consistent in a population. The R0 for people who live in old folks home is far higher than a bachelor who works from home.
So when the person said that they ran out of easy people to infect, that is absolutely true.
I will say that being susceptible is not evenly distributed across a population. This is why prisons, meat packing and old people homes are more likely to have outbreaks. The corollary to that is that R0 is not consistent in a population. The R0 for people who live in old folks home is far higher than a bachelor who works from home.
So when the person said that they ran out of easy people to infect, that is absolutely true.
So there will be no more cases in NYC going forward? Good for them!
Nope, that has never been and never will be a goal. Hell, there are still cases of Bubonic plague that occur.
The goal should be to minimize spread among the most vulnerable.
The goal should be to minimize spread among the most vulnerable.
123K and counting.
It didn’t hit “uncontrolled community spread” in the US until at least 3 months after the first US case and until at least a month after it devastated Italy.
For the US to still cry about China is embarrassing.
For the US to still cry about China is embarrassing.
I think you meant to reply to me.
I am not crying about China. It is the truth. The only way to prevent uncontrolled spread would have been to stop it before it became uncontrolled. The fact that the first cases were in Cali. in December shows how impossible that really is for a non-island nation (caveat only because NZ)
The main point I was making is that it isn't possible! By the time China had enough data to detect a novel virus, it was too late. It would have always been too late. China isn't to blame. This could just have easily of jumped species in Canada or the US. The point is that we can't be gods no matter how much we tell ourselves we are just that.
I am not crying about China. It is the truth. The only way to prevent uncontrolled spread would have been to stop it before it became uncontrolled. The fact that the first cases were in Cali. in December shows how impossible that really is for a non-island nation (caveat only because NZ)
The main point I was making is that it isn't possible! By the time China had enough data to detect a novel virus, it was too late. It would have always been too late. China isn't to blame. This could just have easily of jumped species in Canada or the US. The point is that we can't be gods no matter how much we tell ourselves we are just that.
[deleted]
Yep. It sucks. Death sucks. The lie we tell ourselves is that these are preventable deaths. The only thing that would have prevented this would have been for China to detect it ASAP and eliminate the spread. Once it hit uncontrolled community spread we were fucked.
We can minimize it somewhat, but lots of people are going to die. If we locked down completely, lots of people would die of a litany of other things that would have normally been prevented in an open society. Fucked either way.
See my point?
We can minimize it somewhat, but lots of people are going to die. If we locked down completely, lots of people would die of a litany of other things that would have normally been prevented in an open society. Fucked either way.
See my point?
The absolute fascinating thing about this is that for much of the country, they just got bored of Corona virus. Federal leadership is fading away to almost nothing, with getting the economy rolling prior to the election being the main focus. Then on top of that we have people who for whatever reason just want to go back to normal, thinking that its no big deal. There are many more who agree that the sickness is a big deal but it really only kills the elderly or weak and that's not a big deal, the sacrifice is worth it.
We decided that staying home and socially isolating was just to hard. The rest of the world must be looking at us in horror.
We decided that staying home and socially isolating was just to hard. The rest of the world must be looking at us in horror.
I think a lot of us inside our country are looking on in horror too. I for sure am - and terrified. I have lost all confidence and don't know if we can 'right the ship' (beyond just Covid I'm talking about basically everything all of our values)
Honestly have never seen anything like it. I am in shock that so many people are applauding whats going on here. If it happens again, I am not sure what to think.
A lot of commenters here are stating that this is because of increased testing. Which is true compared to April. But I want to point out that at least in southern Callifornia the positive test percentage is actually going up now. https://www.sfchronicle.com/bayarea/article/6-000-plus-Calif...
I live in Palo Alto - last weekend I cycled past some sort of art festival in downtown Los Altos.
There were hundreds of people packed together looking at and touching art.
There was a big sign that 'we'd get through this together'.
They're also opening up farmers markets.
I think we're going to see the number of cases rise again.
There were hundreds of people packed together looking at and touching art.
There was a big sign that 'we'd get through this together'.
They're also opening up farmers markets.
I think we're going to see the number of cases rise again.
>They're also opening up farmers markets.
The one near me in downtown San Jose just re-opened a couple of weeks ago. I walked through to see what it was like. Not too bad, they require masks for patrons and also the people working the vendor stalls. Also, customers aren't allowed to touch produce at all and contactless payment is preferred.
So all of that looked relatively decent. My issue was I would see patrons walking around or about to pay and they'd be lowering their mask to talk, not covering their nose with the mask, wearing their mask on their neck, etc.
I'm not sure how to correct issues like that.
The one near me in downtown San Jose just re-opened a couple of weeks ago. I walked through to see what it was like. Not too bad, they require masks for patrons and also the people working the vendor stalls. Also, customers aren't allowed to touch produce at all and contactless payment is preferred.
So all of that looked relatively decent. My issue was I would see patrons walking around or about to pay and they'd be lowering their mask to talk, not covering their nose with the mask, wearing their mask on their neck, etc.
I'm not sure how to correct issues like that.
Supposedly if it's outside it's not as bad: https://www.youtube.com/watch?v=n6QwnzbRUyA
Farmers' markets never closed here in Alameda County which is a lot more densely populated than Los Altos. I think the risk of transmitting respiratory diseases in the outdoors is wildly overstated. Also, people gotta eat.
Nah, it is not overstated. Last time I checked, Wuhan marke was outdoors.
https://images.says.com/uploads/story_source/source_image/75...
Looks like prime batcave-like conditions for coronavirus spread.
Looks like prime batcave-like conditions for coronavirus spread.
When did you check last?
Nothing about the photographs I have seen of the Huanan Seafood Wholesale Market suggests "outdoors".
Nothing about the photographs I have seen of the Huanan Seafood Wholesale Market suggests "outdoors".
No doors, roof only. I consider it outdoors. Anyways, in my country open markets get disenfected twice a week, and yet they still find infections through contact tracing, originated from the sellers at these markets.
Given that there hasn't been a bump from the protests, it seems like outdoor spread is not super common.
Incorrect, the bump we are seeing now looks like it perfectly correlates to the protest. The initial spread you would see in the beginning few weeks wouldn't be noticeable, but it's laying the seeds. It's about 4-6 weeks after we see the effects of those early sees from exponential growth.
Farmer's markets have been open the whole time in Alameda county.
When people move from more isolation toward more interaction cases of all communicable diseases should rise so I think that's a safe assumption.
Most Bay Area counties still aren’t reporting recoveries distorting the Active Case number, unless you believe 0 people who have had COVID-19 in San Francisco have recovered since the SFDPH started tracking cases.
EDIT: Additional context: https://www.worldometers.info/coronavirus/usa/california/
If a county’s active case number equals Total Cases Minus Deaths, then they’re not reporting recoveries. Los Angeles is the largest county not reporting recoveries. In just the Bay Area, Alameda, Santa Clara, San Francisco, San Mateo are the 4 of the 5 largest counties in the Bay Area by population and are not tracking recoveries. Contra Costa and all the North Bay counties appear to be tracking recoveries.
EDIT: Additional context: https://www.worldometers.info/coronavirus/usa/california/
If a county’s active case number equals Total Cases Minus Deaths, then they’re not reporting recoveries. Los Angeles is the largest county not reporting recoveries. In just the Bay Area, Alameda, Santa Clara, San Francisco, San Mateo are the 4 of the 5 largest counties in the Bay Area by population and are not tracking recoveries. Contra Costa and all the North Bay counties appear to be tracking recoveries.
Could this be due to an increase in testing or better testing strategy rather than an increase in cases? Daily COVID cases have been rising significantly over the last couple months in California, while deaths have been flat or slightly declining. Deaths are probably a more accurate indicator than positive tests, so it seems like positive test results do not match the actual case count very well.
It's both. Hospitalization is up, so it's really unlikely infections aren't also up.
People are getting quarantine fatigue.
I think at some point soon, people are just going to give up.
We could’ve bit the bullet, and did a hard lock down for 4 weeks. This would’ve killed the virus in its tracks. But instead, we didn’t take the hard actions. And now, this virus is going to take its toll.
But, no worries. The stock market is doing all time highs.
I think at some point soon, people are just going to give up.
We could’ve bit the bullet, and did a hard lock down for 4 weeks. This would’ve killed the virus in its tracks. But instead, we didn’t take the hard actions. And now, this virus is going to take its toll.
But, no worries. The stock market is doing all time highs.
Yep. At first it was SHOCKING to see the new cases rise. Then the death tally started rising fast. Then the videos from Italian and US hospitals.
But like most things, once you are accustomed to it, the amount of fear people feel declines. As fear declines, apathy increases.
It's like gang violence, child trafficking, or casualties of war. At first it is shocking, but then people get used to it and go on with their lives.
But like most things, once you are accustomed to it, the amount of fear people feel declines. As fear declines, apathy increases.
It's like gang violence, child trafficking, or casualties of war. At first it is shocking, but then people get used to it and go on with their lives.
From a pandemic standpoint, it seems confusing to group together all of California. The article seems to be saying most of the outbreak is in LA and Riverside counties.
>The article seems to be saying most of the outbreak is in LA and Riverside counties.
LA and Riverside Counties are about 1/3 of California by population, so while it is somewhat disproportional for most of (whatever) to be there, it's not anywhere close to what it might seem when you name 2 out of 58 counties.
LA and Riverside Counties are about 1/3 of California by population, so while it is somewhat disproportional for most of (whatever) to be there, it's not anywhere close to what it might seem when you name 2 out of 58 counties.
Paywall free article: https://beta.trimread.com/articles/22708.
Somewhat related to the OP's post, what really drives me crazy is focusing on cases since beginning of time. California has 174k cases in this case. What really should be looked at is week over week increases and number of new cases, and only of active cases, old cases shouldn't really be included but newspapers love sensationalism. In addition states are combining antibody test positives(person had covid, recovered) with active positive tests(nose swabs, person is infected with covid) [1]. Basically testing and presenting digestible results have been a disaster. In addition finding decent dashboards for this info is surprisingly hard. Local ones like santa clara counties one are good [2], but step up the state and national level and its hit or miss.
[1] - https://www.beckershospitalreview.com/public-health/this-is-...
[2] - https://www.sccgov.org/sites/covid19/Pages/dashboard.aspx
Somewhat related to the OP's post, what really drives me crazy is focusing on cases since beginning of time. California has 174k cases in this case. What really should be looked at is week over week increases and number of new cases, and only of active cases, old cases shouldn't really be included but newspapers love sensationalism. In addition states are combining antibody test positives(person had covid, recovered) with active positive tests(nose swabs, person is infected with covid) [1]. Basically testing and presenting digestible results have been a disaster. In addition finding decent dashboards for this info is surprisingly hard. Local ones like santa clara counties one are good [2], but step up the state and national level and its hit or miss.
[1] - https://www.beckershospitalreview.com/public-health/this-is-...
[2] - https://www.sccgov.org/sites/covid19/Pages/dashboard.aspx
Agreed. The news functions like a monitoring system with an extremely bad alert configuration.
Does anyone know how many health care personnel in percentage of f.ex nyc hospitals that have had the illness. I’ve been wondering if institutional immunity in centers of spread would slow down resurgence as hospitals and health care centers get more immune workers.
From what I've read, it is still far from certain infection gives a usable immunity. So rather than that, it might as well kill off medical personal due to repeated exposure in huge amounts.
In other news .. https://outkick.com/media-ignores-90-coronavirus-death-colla...
In other news social distancing caused a dip in deaths, so we should all go mingle again so we can cause a rise in deaths?
This article is ridiculous, the author is simply upset that many sports are closed for a season, and is looking for any justification to reopen. Yes the media blows things out of proportion, but the author even has a graph in the article that shows covid19 kills old people more effectively than flu and pneumonia!
The last few days have seen global upticks in infections, maybe they'll get their chance to write another article about the media being fearmongers once a few hundred thousand more people die and the death curve hits another flat spot.
Absolutely absurd.
This article is ridiculous, the author is simply upset that many sports are closed for a season, and is looking for any justification to reopen. Yes the media blows things out of proportion, but the author even has a graph in the article that shows covid19 kills old people more effectively than flu and pneumonia!
The last few days have seen global upticks in infections, maybe they'll get their chance to write another article about the media being fearmongers once a few hundred thousand more people die and the death curve hits another flat spot.
Absolutely absurd.
How do you know what caused the dip?
Are you sure it’s not any of these:
1. The most likely to die have already died
2. The virus has mutated to be less lethal
3. We are learning how to treat it better
4. Higher vitamin d levels in the summer
5. A younger population is now getting it
6. Some level of herd immunity especially in Europe and NY.
(Im probably missing some)
Are you sure it’s not any of these:
1. The most likely to die have already died
2. The virus has mutated to be less lethal
3. We are learning how to treat it better
4. Higher vitamin d levels in the summer
5. A younger population is now getting it
6. Some level of herd immunity especially in Europe and NY.
(Im probably missing some)
It's a straight forward leap from my proposed cause. This virus spreads from from person to person, so if you don't expose yourself to people, you are rather unlikely to get or transmit the virus. And if people don't get the virus, they can't die from the virus.
The leaps from your suggested causes are much more complicated.
If the second wave doesn't result in more deaths, then maybe it was one your proposed causes, and it'll be interesting to see how they contributed.
If deaths do spike again, then could you please stop spamming Hacker News with anti covid "skepticism"? Because if you continue to post and share these things in spite of a pile of dead bodies, you'd be complicit in the deaths from the third wave (if any).
The leaps from your suggested causes are much more complicated.
If the second wave doesn't result in more deaths, then maybe it was one your proposed causes, and it'll be interesting to see how they contributed.
If deaths do spike again, then could you please stop spamming Hacker News with anti covid "skepticism"? Because if you continue to post and share these things in spite of a pile of dead bodies, you'd be complicit in the deaths from the third wave (if any).
Good article, reading the news the past few months makes it seem like the apocalypse had landed in the US and we are faring worse off than any other nation on the planet wrt covid-19. The reality is quite different, this article from the economist states such[1]*stats taken from May 27th:
"But seven EU countries (including Belgium, France, Italy, the Netherlands and Spain) currently rank above America in their mortality rate. So does Britain, where the official rate is a shocking 559 per million"
[1] - https://beta.trimread.com/articles/22723.
"But seven EU countries (including Belgium, France, Italy, the Netherlands and Spain) currently rank above America in their mortality rate. So does Britain, where the official rate is a shocking 559 per million"
[1] - https://beta.trimread.com/articles/22723.
Coronavirus deaths lag new cases by about 3 weeks
But it seems like a decline in deaths marks the end of a "wave", which is a good thing.
We could face another wave, which of course would be bad. Lockdown fatigue and protests could easily bring it back. But if we've brought one wave under control, at least we know what it takes to do it and we can try to react a little faster for the next one.
We could face another wave, which of course would be bad. Lockdown fatigue and protests could easily bring it back. But if we've brought one wave under control, at least we know what it takes to do it and we can try to react a little faster for the next one.
That somewhat exaggerates things. There are fewer "deaths" over the weekend due to reporting delays. It's still 500+.
[deleted]
California is still not doing enough. The original criteria for phase II were not met and yet the state decided to reopen anyway. Bay Area is thankfully staying stricter.
I was at a sit-down restaurant packed at capacity with live music a week ago about 100 miles from Bay Area. That should not be possible.
Close the state border to all interstate traffic. Test truck drivers at weigh stations near the state border. There should be sufficient capacity of the 5-minute Abbott test for this. Test other interstate travelers at mandatory checkpoints with a test that shows results no later than 60 minutes.
Close county borders. Mandatory testing at each county border. Issue a photo + ID card to each person tested. Mandatory verification of negative result before public transit boarding. Mandatory door to door testing in resisting areas. Deny all walk-in service to anyone not able to verify current test results with at-door scanner. Assume they are infected and serve them curbside. Have them scanned by a mobile dispatched unit at their if unable to travel to a testing location.
Annoying? That's what "essential" activity means. We are not making it inconvenient enough to not do non-essential activities.
Sounds extreme? That's what EU did to contain Italy and Spain. They closed internal borders and localized efforts.
Sounds expensive? Abbott will make a lot of money. Lives will be saved. The entire state could reopen and resume operations once strict testing protocols are in place and the curve is properly slammed.
We do not have an effective CDC to set national policy. Compare the real guidelines [1] leaked to press to the softened guidelines[2]. There is a reason why schools are rejecting[3] the official guidelines.
Finally. Want to host a church gathering? Your entire congregation is welcome to stay quarantined for 14 days on your premises.
P.S. The current CDC document has been updated. It was far less prescriptive earlier. Some sense prevailed. The entire section related to churches has been deleted.
Counties with zero infections should be allowed to open, but border protocols must be enforced. [1]https://www.documentcloud.org/documents/6889330-Guidance-for... [2]https://www.cdc.gov/coronavirus/2019-ncov/downloads/php/CDC-... [3]https://www.usnews.com/news/education-news/articles/2020-05-...
I was at a sit-down restaurant packed at capacity with live music a week ago about 100 miles from Bay Area. That should not be possible.
Close the state border to all interstate traffic. Test truck drivers at weigh stations near the state border. There should be sufficient capacity of the 5-minute Abbott test for this. Test other interstate travelers at mandatory checkpoints with a test that shows results no later than 60 minutes.
Close county borders. Mandatory testing at each county border. Issue a photo + ID card to each person tested. Mandatory verification of negative result before public transit boarding. Mandatory door to door testing in resisting areas. Deny all walk-in service to anyone not able to verify current test results with at-door scanner. Assume they are infected and serve them curbside. Have them scanned by a mobile dispatched unit at their if unable to travel to a testing location.
Annoying? That's what "essential" activity means. We are not making it inconvenient enough to not do non-essential activities.
Sounds extreme? That's what EU did to contain Italy and Spain. They closed internal borders and localized efforts.
Sounds expensive? Abbott will make a lot of money. Lives will be saved. The entire state could reopen and resume operations once strict testing protocols are in place and the curve is properly slammed.
We do not have an effective CDC to set national policy. Compare the real guidelines [1] leaked to press to the softened guidelines[2]. There is a reason why schools are rejecting[3] the official guidelines.
Finally. Want to host a church gathering? Your entire congregation is welcome to stay quarantined for 14 days on your premises.
P.S. The current CDC document has been updated. It was far less prescriptive earlier. Some sense prevailed. The entire section related to churches has been deleted.
Counties with zero infections should be allowed to open, but border protocols must be enforced. [1]https://www.documentcloud.org/documents/6889330-Guidance-for... [2]https://www.cdc.gov/coronavirus/2019-ncov/downloads/php/CDC-... [3]https://www.usnews.com/news/education-news/articles/2020-05-...
This is pretty much what was done here in Europe - country borders closed for everything except freight and on top of that towns and villages with exceptionally high infection rate were closed off and put under even stricter quarantine rules.
Even now with most of the wide area lockdown lifted, there are local clusters being isolated by locking down towns or whole regions, as at the moment with the German slaughter house cluster and the Czech and Polish coal mine clusters.
Even now with most of the wide area lockdown lifted, there are local clusters being isolated by locking down towns or whole regions, as at the moment with the German slaughter house cluster and the Czech and Polish coal mine clusters.
I'm wondering if this can be attributed to large gatherings associated with protests and demonstrations as well as the "reopening" that's currently on-going?
mysteriously, the protests seem to be completely absent in the reporting. (yes, I'm aware of mask usage) it's blamed on Memorial Day gatherings, graduation parties, etc. or primary voting in Wisconsin.. which did not lead to a spike, and did not lead to a bunch of deaths.
The numbers are crazy in some areas, not in others. Texas has 254 counties, and probably 200 of those counties have had less than 75 cases each. many of them have reported 0 cases, and 0 covid-19 related deaths. Even some of the counties around Dallas are doing just fine.
This whole thing is bizarre.
If masks work this well and protesters aren't spiking, I'm not really seeing a good case for allowing more fans at outdoor sporting events.
The numbers are crazy in some areas, not in others. Texas has 254 counties, and probably 200 of those counties have had less than 75 cases each. many of them have reported 0 cases, and 0 covid-19 related deaths. Even some of the counties around Dallas are doing just fine.
This whole thing is bizarre.
If masks work this well and protesters aren't spiking, I'm not really seeing a good case for allowing more fans at outdoor sporting events.
Re: protests, NYC has had large, extremely dense protests for weeks now. Mask compliance is near 100% at them, and testing is easy, ubiquitous and free. We have not seen a spike in cases.
Masks are only partially efficient. There is actually a spike all over US. The issue of protests is political, and no one wants to kick the wasps nest, because Republicans want unsafe Trump rallies to keep going.
Why specifically call out Republicans? Pretty sure that Democrats/liberals/BLM/antifa want the protests to keep going.
Or are you saying that the ones who would normally call that out are the Republicans, and they won't because they want Trump's rallies to happen? That's quite plausibly true. But putting it the way you did makes your view sound quite slanted.
Or are you saying that the ones who would normally call that out are the Republicans, and they won't because they want Trump's rallies to happen? That's quite plausibly true. But putting it the way you did makes your view sound quite slanted.
Yes, the second statement.
Don't count your chickens before they hatch.
It can take weeks after infection to start showing symptoms, weeks more to be sick enough to need hospitalization, weeks after that to die.
These days, many people won't even go to hospitals, even when they're dying, and when they die at home they may never be tested for the virus at all, so won't necessarily be counted as having died from COVID-19.
The direct repercussions of the highly irresponsible mass gatherings that have been taking place over the last few weeks may not be evident for some time.
All this doesn't even take in to account all the people who did not attend any gathering but got infected by someone who did, and yet further infections from the first-order indirect infections, and so on.
Those later, indirect cases (which will still be the result of infections spread during these gatherings) will take even longer to be noticed.
It can take weeks after infection to start showing symptoms, weeks more to be sick enough to need hospitalization, weeks after that to die.
These days, many people won't even go to hospitals, even when they're dying, and when they die at home they may never be tested for the virus at all, so won't necessarily be counted as having died from COVID-19.
The direct repercussions of the highly irresponsible mass gatherings that have been taking place over the last few weeks may not be evident for some time.
All this doesn't even take in to account all the people who did not attend any gathering but got infected by someone who did, and yet further infections from the first-order indirect infections, and so on.
Those later, indirect cases (which will still be the result of infections spread during these gatherings) will take even longer to be noticed.
Symptoms typically manifest in a week for the majority of cases. Considering the scope of the protests, we'd be seeing spikes in NYC, NJ, MN, etc if they were a primary source of infection.
My theory because the protests happen outside and a lot of people were wearing masks, the total effective exposure is a small fraction of the population total. Bonus the groups protesting probably are otherwise doing a good job protecting themselves.
Masks really do a good job, which is why I'm still irate about the CDC guidelines in March. I think they were a tremendous disservice to the country. Yes, we didn't want to use up our small supply of N95 masks when they were more valuable to healthcare providers etc.
But cloth masks work very well if used by a large percentage of the population. Manufacturing them would have been a very fast win, possibly cutting the infection rate in half, and a corresponding cut in fatalities.
My daughter was sewing cloth masks by March 15 when it was almost impossible to come by an N95 mask. She's made over 20 reusable masks. How hard would it have been for the rest of the country to do something similar, had we been given effective leadership?
But cloth masks work very well if used by a large percentage of the population. Manufacturing them would have been a very fast win, possibly cutting the infection rate in half, and a corresponding cut in fatalities.
My daughter was sewing cloth masks by March 15 when it was almost impossible to come by an N95 mask. She's made over 20 reusable masks. How hard would it have been for the rest of the country to do something similar, had we been given effective leadership?
I read an essay about Mongolia. When China locked down Wuhan they closed their borders, closed schools, and because they also had a shortage of masks simply told people that they had to save the N95 masks for healthcare workers. And had seamstresses sew cloth masks and sell them to pharmacies.
They did this without having any detected cases.
They did this without having any detected cases.
In Minneapolis cases and hospitalizations have been trending down(!) ever since Memorial Day when this all started. To the point that hospitalizations are about half of what they were then. So it can’t just be the protests.
Is there any sign that summer in the northern hemisphere will help us out? UV, heat, outdoors, or other factors?
Major spread is happening in Florida, Arizona, and Texas.
yeah but in those states it is way too hot to be outside thus people spend even far more time inside than during the winter.
then Americans like their rooms numbingly cold so the AC goes full blast
so there, it actually makes perfect sense
these states got few cases in the winter because the weather was warm and sunny and they spent more time outside, now they are inside all the time in the cold, you get more cases
then Americans like their rooms numbingly cold so the AC goes full blast
so there, it actually makes perfect sense
these states got few cases in the winter because the weather was warm and sunny and they spent more time outside, now they are inside all the time in the cold, you get more cases
Places where people concentrate inside during the summer.
The virus doesn't hang around outside at the open bus stop. It goes with the people.
The virus doesn't hang around outside at the open bus stop. It goes with the people.
I just want to point out that the government has not clearly outlined its strategy, and the reason is that the end-goal is to reach herd immunity in 12-18 month. Infections are OK, what's not OK is too-high rates of hospitalization which leads to death that can be prevented.
Is there any evidence that the virus is evolving to change its deadliness?
It seems that nobody dare to say this, so I will do, because I'm an idiot.
This is the expected outcome by the recent "black lives matter" events. Right actions but really bad time choice.
I wonder why people expected other results.
This is the expected outcome by the recent "black lives matter" events. Right actions but really bad time choice.
I wonder why people expected other results.
How many are symptomatic?
In some Italian villages that tested extensively, they found 50-70% asymptomatic
https://www.cebm.net/covid-19/covid-19-what-proportion-are-a...
https://www.cebm.net/covid-19/covid-19-what-proportion-are-a...
asymptomatic =/= free of harm caused by the virus
The question was 'symptomatic'.
Lest you think it's a typo, the number of symptomatic tests is a critical number to know.
It's not about whether the individuals beings tested have been harmed, it's about whether testing shows us the infection rate in the population or not. If 100% of tests were of symptomatic patients, the numbers tell us almost nothing.
Lest you think it's a typo, the number of symptomatic tests is a critical number to know.
It's not about whether the individuals beings tested have been harmed, it's about whether testing shows us the infection rate in the population or not. If 100% of tests were of symptomatic patients, the numbers tell us almost nothing.
ok then how many are positive but free or minimal of harm caused by the virus ?
We know now — definitively — those populations who are at risk from COVID, and those populations which are not.
In general the world is too connected, and populations too mobile, for a virus like SARS-CoV-2 to be contained, save for special case island nations that are willing to keep borders closed or visitors quarantined and ensure compliance until a vaccine becomes available.
For the rest of the world, what is abundantly clear in countries that are willing and able to perform the requisite testing, is that this is a virus that spreads easily and rapidly but thankfully in those under 50 is vanishingly unlikely to kill if it is symptomatic at all.
With over 10 million confirmed cases worldwide, likely in excess of 100 million actual infections, COVID could burn out in it’s own before widespread vaccination is available. Not due to containment measures, but due to enough people gaining immunity.
In my non-expert estimation, the public health response to COVID will ultimately result in about an order of magnitude more deaths, or roughly an order of magnitude more years of life lost, than due to COVID itself. The longer we continue lockdown-type policies, the greater the damage done.
COVID spread anyway, COVID continues to spread, although now it seems to be mostly in less risky populations as case counts surge and hospitalization and death rates remain constant. Some of this is of course simply sampling bias now that testing is more available for lower risk populations. We also see people who know they aren’t at any real risk willing to be exposed in order to live their lives. Most inexcusably is that the most vulnerable populations (e.g. in nursing homes) were not adequately protected and even directly harmed by policies while the general masses bore the economic and social brunt of the involuntary enforcement measures.
In general every person who gets COVID and is asymptomatic or minimally symptomatic is basically someone getting an early access vaccine, and this can only be regarded as a positive in exerting a downward effect on R.
I think that speculating about long term effects in largely asymptomatic populations is an academic exercise which misses the forest for the trees. We need to reopen emergency rooms for the cardiac patients, reopen oncology departments for the chemo patients, reopen primary care clinics for health screenings, and reopen gyms, all to reduce/prevent well known and proven morbidities that cost millions of lives a year, not just continue to incur increase death in our most prevalent causes of death out of fear or politics.
In general the world is too connected, and populations too mobile, for a virus like SARS-CoV-2 to be contained, save for special case island nations that are willing to keep borders closed or visitors quarantined and ensure compliance until a vaccine becomes available.
For the rest of the world, what is abundantly clear in countries that are willing and able to perform the requisite testing, is that this is a virus that spreads easily and rapidly but thankfully in those under 50 is vanishingly unlikely to kill if it is symptomatic at all.
With over 10 million confirmed cases worldwide, likely in excess of 100 million actual infections, COVID could burn out in it’s own before widespread vaccination is available. Not due to containment measures, but due to enough people gaining immunity.
In my non-expert estimation, the public health response to COVID will ultimately result in about an order of magnitude more deaths, or roughly an order of magnitude more years of life lost, than due to COVID itself. The longer we continue lockdown-type policies, the greater the damage done.
COVID spread anyway, COVID continues to spread, although now it seems to be mostly in less risky populations as case counts surge and hospitalization and death rates remain constant. Some of this is of course simply sampling bias now that testing is more available for lower risk populations. We also see people who know they aren’t at any real risk willing to be exposed in order to live their lives. Most inexcusably is that the most vulnerable populations (e.g. in nursing homes) were not adequately protected and even directly harmed by policies while the general masses bore the economic and social brunt of the involuntary enforcement measures.
In general every person who gets COVID and is asymptomatic or minimally symptomatic is basically someone getting an early access vaccine, and this can only be regarded as a positive in exerting a downward effect on R.
I think that speculating about long term effects in largely asymptomatic populations is an academic exercise which misses the forest for the trees. We need to reopen emergency rooms for the cardiac patients, reopen oncology departments for the chemo patients, reopen primary care clinics for health screenings, and reopen gyms, all to reduce/prevent well known and proven morbidities that cost millions of lives a year, not just continue to incur increase death in our most prevalent causes of death out of fear or politics.
There are a lot of comments here essentially saying this is not a problem an we are properly reaching herd immunity.
I am wondering if these commenters are discounting the possibility of a vaccine? There is a strong possibility that we will have a vaccine before we can safely reach herd immunity.
I am wondering if these commenters are discounting the possibility of a vaccine? There is a strong possibility that we will have a vaccine before we can safely reach herd immunity.
Natural herd immunity is a non-starter anyway. If we reach herd immunity before a vaccine arrives, the economic damage would be far worse than any shutdown. If the R0 is 5.7, you need 82.5% (4.7/5.7) of the population either immune or quarantined/locked-down. If everyone stops the lockdown, that means 82.5% of the population infected. No matter how much we want to argue down the IFR, that's catastrophic.
Semi-related note, I think we haven't properly socialized the basic numbers behind the disease. I hear that Covid-19 is more contagious than first thought, with a "natural" R0 of 5.7. I also hear that it has a doubling time of around three days, originally thought to be more like 5-6. I also hear that the contagion period is 8-10 days. These three numbers do not make sense together. The R0 number needs to be reached during the contagion period. The average contagion period is likely far longer, or, it's way more contagious than 5.7 (which would mean the herd immunity threshold goes higher).
Also, if the illness is more contagious than we first thought, it means that the lockdown was even more effective than we first thought.
Here's a fun mental exercise for whoever's reading this. Say that you have a bubble of 100 people, and released a disease that infected 50 people and killed all of them; 100% fatality. Then say you discovered that it actually infected all 100 people, but only 50% of them died. Is the disease less dangerous than you first thought?
Semi-related note, I think we haven't properly socialized the basic numbers behind the disease. I hear that Covid-19 is more contagious than first thought, with a "natural" R0 of 5.7. I also hear that it has a doubling time of around three days, originally thought to be more like 5-6. I also hear that the contagion period is 8-10 days. These three numbers do not make sense together. The R0 number needs to be reached during the contagion period. The average contagion period is likely far longer, or, it's way more contagious than 5.7 (which would mean the herd immunity threshold goes higher).
Also, if the illness is more contagious than we first thought, it means that the lockdown was even more effective than we first thought.
Here's a fun mental exercise for whoever's reading this. Say that you have a bubble of 100 people, and released a disease that infected 50 people and killed all of them; 100% fatality. Then say you discovered that it actually infected all 100 people, but only 50% of them died. Is the disease less dangerous than you first thought?
>the economic damage would be far worse than any shutdown.
Any evidence for this? Singapore has 35k recovered and just 26 deaths, because the vast majority of infections are working-age migrants. A disease that kills less than 1/1000 working age people is not going to have a big effect on the economy.
Any evidence for this? Singapore has 35k recovered and just 26 deaths, because the vast majority of infections are working-age migrants. A disease that kills less than 1/1000 working age people is not going to have a big effect on the economy.
The US is at 121K deaths atm. I made an estimate a while back assuming 60% of the population becomes infected and came up with 350K deaths. Bad, but not catastrophic. And I don't think we will get that high.
Amazing, NYC has already reached twice that death rate so they must have had 120% of their population infected
60% of 330M is 198M.
10% will be hospitalized = 19.8M
10% of those hospitalized will die = 1.98M
Even if the IFR isn't 1%, say it's half that, almost 1M deaths.
And if you think 350k surplus deaths isn't catastrophic, you must have been nodding your head while watching Chernobyl (3.6 Roentgen? Not great, not terrible).
10% will be hospitalized = 19.8M
10% of those hospitalized will die = 1.98M
Even if the IFR isn't 1%, say it's half that, almost 1M deaths.
And if you think 350k surplus deaths isn't catastrophic, you must have been nodding your head while watching Chernobyl (3.6 Roentgen? Not great, not terrible).
60%/350k assumes an R0 of less than 2.5 (2.5 is to get to 60% herd immunity threshold, and then more infections continue to happen as it dies out), and also an IFR of less than 0.2%.
I think those are outside of the range of any recent estimates I've seen. Natural R0 is generally believed to be higher, and IFR is believed to be in the 0.5% - 1% range.
I also hope we won't hit 350k, but if we stay below that number, it will be because of a combination of continued lockdowns and finding an effective treatment/vaccine before we reach herd immunity.
I think those are outside of the range of any recent estimates I've seen. Natural R0 is generally believed to be higher, and IFR is believed to be in the 0.5% - 1% range.
I also hope we won't hit 350k, but if we stay below that number, it will be because of a combination of continued lockdowns and finding an effective treatment/vaccine before we reach herd immunity.
The 1-1/R0 assumes a homogeneous and well-mixed population, and thus overestimates the fraction infected required for herd immunity. For real, people with lots of contacts will get infected and become immune first, with disproportionate benefit. That effect is hard to quantify, but it's near-certainly big, with many papers speculating that herd immunity may occur around 30% recovered:
https://www.medrxiv.org/content/10.1101/2020.02.10.20021725v...
This is before considering overshoot, which can occur just as in the homogeneous case (and is a reason to slow the spread as much as reasonable, even if you expect/fear that the end result will be herd immunity from recovered patients).
Reported IFRs are now calculated from serostudies testing for IgG. The best studies are on the high end of your 0.5-1%, but there's reason to suspect they're significant overestimates. Sensitivity for the blood tests was established from cases severe enough to seek medical help, and may be much lower for mild cases. There's also evidence of mucosal immunity in patients who test negative for IgG, and recently of T cell response in such patients too:
https://www.medrxiv.org/content/10.1101/2020.06.21.20132449v...
And the number of coronavirus deaths is greater than the actual number of excess deaths, since they're disproportionately elderly. All these second-order effects are uncertain, and difficult to incorporate into a final number; but they're real, and to ignore them completely risks a gross overestimate. Maybe people know that, and think of the overestimate as "conservative"; but considering the tremendous costs of both the coronavirus itself and society's response, I strongly disagree.
Finally, since you said "lockdowns"--if you credit lockdowns (which are always vaguely defined; but government-imposed restrictions on movement and assembly, broadly) with all of benefit to the USA, how do you explain Japan? They're sitting at 8 deaths per million, they never significantly locked down, and their contact tracers are missing ~80% of cases. Maybe it's the masks? Even in California, use is waning. No one seems to have the political appetite to enforce the order coercively; NYC just stopped enforcing theirs entirely after an incident.
Maybe it's the contact tracing anyways, since missing 80% of cases might be fine if you catch the 20% who are super-spreaders (which you will disproportionately, since each person they infect is a chance to find them tracing back)? I could imagine big public campaigns to explain the importance of cooperating with contact tracers, or websites to help people anonymously advise their contacts (which have been tried for STDs, which have at least as much stigma). But I've seen almost nothing.
To be clear, I agree that restrictions on movement and assembly were and are a good idea in some cases, and New York and Lombardy surely wish they'd locked down earlier. I just don't like seeing them discussed as if they're responsible for all the difference between our current situation and a first-order model that we know is significantly wrong.
https://www.medrxiv.org/content/10.1101/2020.02.10.20021725v...
This is before considering overshoot, which can occur just as in the homogeneous case (and is a reason to slow the spread as much as reasonable, even if you expect/fear that the end result will be herd immunity from recovered patients).
Reported IFRs are now calculated from serostudies testing for IgG. The best studies are on the high end of your 0.5-1%, but there's reason to suspect they're significant overestimates. Sensitivity for the blood tests was established from cases severe enough to seek medical help, and may be much lower for mild cases. There's also evidence of mucosal immunity in patients who test negative for IgG, and recently of T cell response in such patients too:
https://www.medrxiv.org/content/10.1101/2020.06.21.20132449v...
And the number of coronavirus deaths is greater than the actual number of excess deaths, since they're disproportionately elderly. All these second-order effects are uncertain, and difficult to incorporate into a final number; but they're real, and to ignore them completely risks a gross overestimate. Maybe people know that, and think of the overestimate as "conservative"; but considering the tremendous costs of both the coronavirus itself and society's response, I strongly disagree.
Finally, since you said "lockdowns"--if you credit lockdowns (which are always vaguely defined; but government-imposed restrictions on movement and assembly, broadly) with all of benefit to the USA, how do you explain Japan? They're sitting at 8 deaths per million, they never significantly locked down, and their contact tracers are missing ~80% of cases. Maybe it's the masks? Even in California, use is waning. No one seems to have the political appetite to enforce the order coercively; NYC just stopped enforcing theirs entirely after an incident.
Maybe it's the contact tracing anyways, since missing 80% of cases might be fine if you catch the 20% who are super-spreaders (which you will disproportionately, since each person they infect is a chance to find them tracing back)? I could imagine big public campaigns to explain the importance of cooperating with contact tracers, or websites to help people anonymously advise their contacts (which have been tried for STDs, which have at least as much stigma). But I've seen almost nothing.
To be clear, I agree that restrictions on movement and assembly were and are a good idea in some cases, and New York and Lombardy surely wish they'd locked down earlier. I just don't like seeing them discussed as if they're responsible for all the difference between our current situation and a first-order model that we know is significantly wrong.
Therefore what? Are you arguing in favor of ending all lockdown-ish behavior, letting the chips fall where they may, and relying on herd immunity to save us? Because that's what I'm arguing against. I feel like I just read a template.
In my last paragraph, I said explicitly that I supported lockdown-type interventions in some cases. Further, even if the end result is herd immunity from recovered cases, slowing the spread will limit overshoot--so support for lockdowns and expectation the pandemic will end in herd immunity from recovered cases are not mutually exclusive.
So my suspicion is that you've skimmed my (long) comment, assigned it to some "template" that you've seen before, and made quick and inaccurate assumptions about my beliefs instead of reading what I wrote. I don't see how you could otherwise believe in good faith that I was "arguing in favor of ending all lockdown-ish behavior, letting the chips fall where they may, and relying on herd immunity to save us".
To start, I'm arguing that the first-order death calculations using 1-1/R0 and IFR from IgG are probably significant overestimates. Do you disagree? If yes, why do you think heterogeneity and evidence other than IgG of prior infection are negligible?
And again, how do you explain Japan? They found a way to continue mostly operating society, while American schoolchildren without attentive parents fall behind their classmates a day at a time. Wouldn't we be better off trying to understand and emulate their success instead of arguing about "lockdowns"?
So my suspicion is that you've skimmed my (long) comment, assigned it to some "template" that you've seen before, and made quick and inaccurate assumptions about my beliefs instead of reading what I wrote. I don't see how you could otherwise believe in good faith that I was "arguing in favor of ending all lockdown-ish behavior, letting the chips fall where they may, and relying on herd immunity to save us".
To start, I'm arguing that the first-order death calculations using 1-1/R0 and IFR from IgG are probably significant overestimates. Do you disagree? If yes, why do you think heterogeneity and evidence other than IgG of prior infection are negligible?
And again, how do you explain Japan? They found a way to continue mostly operating society, while American schoolchildren without attentive parents fall behind their classmates a day at a time. Wouldn't we be better off trying to understand and emulate their success instead of arguing about "lockdowns"?
I don't believe you are "arguing in favor of ending all lockdown-ish behavior, letting the chips fall where they may, and relying on herd immunity to save us". My point is, if you aren't, then why are you acting like you are disagreeing with me?
I've seen you ask about Japan in other threads, using much of the same words, without the various counterpoints seeming to register to you, and now you're making the same points here. It just seems weird. Why are you bringing Japan up as if it's some sort of counterpoint, when it's a counterpoint to something that you apparently believe in? Why are you bringing it up if you aren't in favor of ending mitigation and aren't in favor of acting more like... Japan? I don't care if (R0-1)/R0 is off by some negligible percentage - it would still mean there's a huge difference in death depending on whether we do or don't stop mitigation. I'm arguing against the people that don't even seem to have a rough mathematical sense about this, and also the people that seem content to be like Thanos and shrug their shoulders at a million, 350k, or 200k people in the US dying as long as it's not their friends.
I mean, back to your first comment, if you think herd immunity maxes out at 30%, and that IFR of 0.5 - 1% is a "significant overestimate", then you're pretty close to projecting our current death toll anyway. 0.25% IFR at 30% would be like 250k in the US, which we'll probably hit with our half-hearted mitigation. But since you're in favor of mitigation efforts, you clearly don't believe the estimates to be that low. So... again, what is the relevance of what you're saying? Are you just being sophist? What's the syllogistic connective tissue in your points? What's your therefore? You believe the R0 and IFR estimates are overestimates; therefore what?
Why do I need to explain Japan? I mean obviously something must be happening in Japan that is consistent with what is happening elsewhere, it's not like they are an alternate universe. It's not like Japan is a counterpoint to NYC or Lombardy; they're in the same reality somehow. How do you explain Japan? It's probably some mixture of culture and bad stats in a way that doesn't really have any bearing on what we should do - we already have sufficient data to know that mitigation saves lives, and we're stupid enough that we're about to learn it all over again for the first time over the next six weeks.
I've seen you ask about Japan in other threads, using much of the same words, without the various counterpoints seeming to register to you, and now you're making the same points here. It just seems weird. Why are you bringing Japan up as if it's some sort of counterpoint, when it's a counterpoint to something that you apparently believe in? Why are you bringing it up if you aren't in favor of ending mitigation and aren't in favor of acting more like... Japan? I don't care if (R0-1)/R0 is off by some negligible percentage - it would still mean there's a huge difference in death depending on whether we do or don't stop mitigation. I'm arguing against the people that don't even seem to have a rough mathematical sense about this, and also the people that seem content to be like Thanos and shrug their shoulders at a million, 350k, or 200k people in the US dying as long as it's not their friends.
I mean, back to your first comment, if you think herd immunity maxes out at 30%, and that IFR of 0.5 - 1% is a "significant overestimate", then you're pretty close to projecting our current death toll anyway. 0.25% IFR at 30% would be like 250k in the US, which we'll probably hit with our half-hearted mitigation. But since you're in favor of mitigation efforts, you clearly don't believe the estimates to be that low. So... again, what is the relevance of what you're saying? Are you just being sophist? What's the syllogistic connective tissue in your points? What's your therefore? You believe the R0 and IFR estimates are overestimates; therefore what?
Why do I need to explain Japan? I mean obviously something must be happening in Japan that is consistent with what is happening elsewhere, it's not like they are an alternate universe. It's not like Japan is a counterpoint to NYC or Lombardy; they're in the same reality somehow. How do you explain Japan? It's probably some mixture of culture and bad stats in a way that doesn't really have any bearing on what we should do - we already have sufficient data to know that mitigation saves lives, and we're stupid enough that we're about to learn it all over again for the first time over the next six weeks.
1-1/R0 may be off by a factor of two or more due to heterogeneity, which I don't consider negligible. I listed that and other effects because I believe they are real and significant, and not because they fit cleanly into any argument for a preconceived position. I agree that a horrifying number of people have died (and will die) of coronavirus. I also believe that the societal costs of the lockdowns will be huge, and will be paid for years to come. Ten years from now, will social scientists find a significant and permanent divergence in educational attainment between rich and poor schoolchildren starting from the school closures? I don't know, but from other studies of interruptions in education I fear yes.
Both harms seem tremendous to me, neither so obviously larger than the other that we should disregard information that helps make the best estimate possible. Do you disagree? If yes, how did you convince yourself that the costs of the lockdowns were definitely smaller? I agree that some of the people arguing against lockdowns are ignorant of the likely death toll, or indifferent to human life; but some of them just think you're underestimating the cost of the lockdowns, just as you think they're underestimating the cost in human life.
In any case, we certainly both agree that the government should take actions to mitigate the coronavirus. In your reply above, you've switched freely between "lockdown" and "mitigation", when the latter is a broader category. Japan is surely undercounting some (like everywhere), but you can't miss NYC-scale mortality. I see basically no question that Japan has many fewer deaths, despite the near-absence of lockdown-type mitigations there. As you say, the Japanese aren't aliens--so if something in their culture is saving them, why can't we find out what and adopt it? Whatever they're doing, compared to the USA, it let them operate their society almost uninterrupted and avoided about 46,000 deaths. How can you dismiss whatever they did as non-actionable, when we don't even know what it was?
Was it all the masks? I don't know, but maybe. So why haven't we tried actually enforcing their use, and a big public education campaign on how to wear them properly? How many Americans have dismissed masks because they tried a fabric mask made from too many layers of high-thread-count fabric and found it hard to breathe through? Masks made from meltblown material are easier, and back close to normal prices. Do Americans know that? I didn't until recently.
Or maybe it's the contact tracing? I doubted that before because Japan is missing most of its cases, but I read a paper observing that heterogeneity meant the most important cases (super-spreaders) would be found preferentially. So maybe it's their cooperation with contact tracers? You could spend more than Coca Cola does in a year advertising the importance of that, and it would cost less than a day of strict lockdown. Why haven't we tried that? Or hygiene in general? Are Americans just bad at washing their hands? Major ad campaigns for basic public health measures have been successful in Africa. Why couldn't they here?
Or maybe it really is something non-replicable? I liked the humidity theory, though the trend in Florida goes against that (though Japan also tends to run the air conditioning hotter and more humid than American tastes; should we advise people to do that?). Something genetic? But even if it's not replicable, I'm amazed by the incuriosity most people--on either side of the "lockdown" debate--show at this massive unexplained difference.
I'm afraid you're trying to interpret my comments as supporting or opposing a small number of well-known, hardened, binary political positions. The result is confusing, because reality is a poor fit for either side of those positions. To the extent I have any goal in writing this beyond procrastinating, it's to show that, and to encourage people to spend their time exploring all the (messy, uncertain, self-contradictory) information available, instead of just arguing a position.
Both harms seem tremendous to me, neither so obviously larger than the other that we should disregard information that helps make the best estimate possible. Do you disagree? If yes, how did you convince yourself that the costs of the lockdowns were definitely smaller? I agree that some of the people arguing against lockdowns are ignorant of the likely death toll, or indifferent to human life; but some of them just think you're underestimating the cost of the lockdowns, just as you think they're underestimating the cost in human life.
In any case, we certainly both agree that the government should take actions to mitigate the coronavirus. In your reply above, you've switched freely between "lockdown" and "mitigation", when the latter is a broader category. Japan is surely undercounting some (like everywhere), but you can't miss NYC-scale mortality. I see basically no question that Japan has many fewer deaths, despite the near-absence of lockdown-type mitigations there. As you say, the Japanese aren't aliens--so if something in their culture is saving them, why can't we find out what and adopt it? Whatever they're doing, compared to the USA, it let them operate their society almost uninterrupted and avoided about 46,000 deaths. How can you dismiss whatever they did as non-actionable, when we don't even know what it was?
Was it all the masks? I don't know, but maybe. So why haven't we tried actually enforcing their use, and a big public education campaign on how to wear them properly? How many Americans have dismissed masks because they tried a fabric mask made from too many layers of high-thread-count fabric and found it hard to breathe through? Masks made from meltblown material are easier, and back close to normal prices. Do Americans know that? I didn't until recently.
Or maybe it's the contact tracing? I doubted that before because Japan is missing most of its cases, but I read a paper observing that heterogeneity meant the most important cases (super-spreaders) would be found preferentially. So maybe it's their cooperation with contact tracers? You could spend more than Coca Cola does in a year advertising the importance of that, and it would cost less than a day of strict lockdown. Why haven't we tried that? Or hygiene in general? Are Americans just bad at washing their hands? Major ad campaigns for basic public health measures have been successful in Africa. Why couldn't they here?
Or maybe it really is something non-replicable? I liked the humidity theory, though the trend in Florida goes against that (though Japan also tends to run the air conditioning hotter and more humid than American tastes; should we advise people to do that?). Something genetic? But even if it's not replicable, I'm amazed by the incuriosity most people--on either side of the "lockdown" debate--show at this massive unexplained difference.
I'm afraid you're trying to interpret my comments as supporting or opposing a small number of well-known, hardened, binary political positions. The result is confusing, because reality is a poor fit for either side of those positions. To the extent I have any goal in writing this beyond procrastinating, it's to show that, and to encourage people to spend their time exploring all the (messy, uncertain, self-contradictory) information available, instead of just arguing a position.
I don't really want to engage with most of this. I think you need to appreciate that there is very little daylight between your kind of points, which might very well be in good faith, and the approach of someone who just engages in what-about-isms with an intent to occlude debate and distract people from the urgency of implementing blunt solutions that do a lot of good. The latter is a particularly cowardly form of debate, where people suggest various forms of possible counterpoints and allude to certain controversial conclusions that they just never quite say out loud.
Just to highlight one point that I think is often missed. Comparing the "additional cost of covid if lockdown is ended" to the "cost of lockdown" is a frequently abused argument - partly because of bad faith, but in other cases because people legitimately miss that "ending the lockdown" doesn't mean that people will all of a sudden leave home. There is a portion of economic cost, and I won't engage in trying to size it right now, because I tire of this, that will remain just from people being rational self-actors. Restaurants will still close, schools will be reduced attended, etc. Because of the virus. So the comparison is to compare "additional cost of covid if lockdown is ended" (and we know there are sufficient idiots out there to drive spread in this case; it doesn't take a lot to have large effects) to "saved marginal cost if lockdown ends".
Just to highlight one point that I think is often missed. Comparing the "additional cost of covid if lockdown is ended" to the "cost of lockdown" is a frequently abused argument - partly because of bad faith, but in other cases because people legitimately miss that "ending the lockdown" doesn't mean that people will all of a sudden leave home. There is a portion of economic cost, and I won't engage in trying to size it right now, because I tire of this, that will remain just from people being rational self-actors. Restaurants will still close, schools will be reduced attended, etc. Because of the virus. So the comparison is to compare "additional cost of covid if lockdown is ended" (and we know there are sufficient idiots out there to drive spread in this case; it doesn't take a lot to have large effects) to "saved marginal cost if lockdown ends".
I understand the impulse to reveal truths selectively in order to guide people to the correct short-term action. I think it's incredibly dangerous, though. That's basically what policymakers did early in the pandemic when they advised Americans that masks were ineffective. Perhaps they got their short-term action, conserving scarce masks for medical workers; but now the shortage is over, and people (a) still aren't wearing masks, and (b) have lost considerable faith in the public health authorities in general. Hard to judge, but I suspect their noble lie saved hundreds of medical workers or patients at most, and will kill tens of thousands of Americans over the next year.
Those policymakers were trained professionals, so I doubt I'm any better at picking and choosing what truths should be spoken. So especially in a forum of moderately sophisticated readers, I'm not inclined to limit myself. I understand that may sometimes superficially look like things people often say in bad faith, but I hope readers expend the effort to distinguish.
In any case, I certainly agree that the coronavirus has tremendous societal and economic cost independent of the mitigations. That doesn't mean we still can't make it worse, though. I'm perhaps more optimistic than you are that Americans can do the right thing after exhausting all other possibilities, and actually wear masks properly and cooperate with other mitigations short of lockdown, with the right (perhaps coercive) guidance. I hope you weren't too close to the earthquake, continuing the apocalypse bingo.
Those policymakers were trained professionals, so I doubt I'm any better at picking and choosing what truths should be spoken. So especially in a forum of moderately sophisticated readers, I'm not inclined to limit myself. I understand that may sometimes superficially look like things people often say in bad faith, but I hope readers expend the effort to distinguish.
In any case, I certainly agree that the coronavirus has tremendous societal and economic cost independent of the mitigations. That doesn't mean we still can't make it worse, though. I'm perhaps more optimistic than you are that Americans can do the right thing after exhausting all other possibilities, and actually wear masks properly and cooperate with other mitigations short of lockdown, with the right (perhaps coercive) guidance. I hope you weren't too close to the earthquake, continuing the apocalypse bingo.
Not a problem in the sense that, tested positive doesn't mean you are sick, tested positive doesn't mean you are having severe symptom.
The timing and effectiveness of a potential vaccine are still unknown. Hopefully some of the vaccines being tested now will work, but it's quite possible that all will prove to be ineffective or unsafe. So from a public policy standpoint we have to proceed on the assumption that a vaccine isn't going to save us.
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I always thought, based on what I've read/heard, that one of the big reasons, maybe the biggest reason we're doing all this is to flatten the curb so hospitals don't get overwhelmed. For some reason headlines always seem to be number of cases or positive test results, and maybe then the number in the hospital is mentioned. The article does say "hospitalization and deaths are also believed to be a lagging indicator." so maybe that's why, but I don't get why (from what I've seen) hospitalizations don't seem to be all that important when reporting on COVID numbers in general. Could it be the people getting the virus now are less likely to end up in the hospital so that number won't keep going up to the point of causing trouble? Another headline on the site says "17+ students test positive for COVID-19 after beach trip".