Author Topic: How long can we wait while flattening the curve?  (Read 356785 times)

OtherJen

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Re: How long can we wait while flattening the curve?
« Reply #4850 on: November 19, 2020, 05:28:09 AM »
Mask use/compliance is 100% where I live (Utah) - I literally haven't seen anyone in a public indoor setting without one in months. The LDS church has a lot of sway and pushed hard to get people to wear masks, so we're much better at it than most red states.

But cases are spiking here too. If the masks helped, it's hard to tell.

That said, masks certainly aren't going to hurt anything. At the very least they help visually remind everyone to stay the hell away from each other if possible. I think.

Everyone in Utah is going to do a big family get together for Thanksgiving, though (to be clear: my family won't) because I guess that's just what you do. I know people who wear a mask when alone, outdoors, on a walk... who are going to a Thanksgiving get-together with 40 people, indoors, unmasked. Insanity - and probably the end of our in-person school which has thus far been a big/safe success. Doh.

-W

That's the thing: people wear masks in public but not for Sunday or holiday dinner with the extended family. They aren't wearing them in private settings. My friend's son caught it at a house party, where none of the attendees wore masks. Fortunately he's in his 20s and only had flu-like symptoms and lost taste/smell. Several of my cousins got it after a post-funeral get-together at a private house (they also all survived, but long-term effects are a concern because of genetic cardiovascular disorders in the family).

Not doing in-person family Thanksgiving is smart. We aren't either. Unfortunately, many aren't willing to make that sacrifice. I expect things will be even worse a couple of weeks after the holiday.

RetiredAt63

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Re: How long can we wait while flattening the curve?
« Reply #4851 on: November 19, 2020, 06:33:28 AM »

What the pandemic has show is weaknesses in society.  Weaknesses for children.  Weaknesses in the way the job market is structured.  Weaknesses in care homes.  In Ontario most of the nursing home deaths were in private ones, not public ones.  Part time staff who work in more than one place to get close to full time hours. People who care more for their own comfort than the safety of others (masks, social gatherings).

Re sacrifices, we already sacrificed throughout our lives, some more than others, and in various ways.  Those of us who had children prioritized our time and money to the kids instead of other activities.  We are doing the not so obvious sacrifice of not bugging out kids about seeing the grandkids, or getting together for Thanksgiving (last October) or Christmas, or whatever.  And being "Willing to die for our kids/grandkids" doesn't mean a thing, it isn't going to keep them safe.  Being willing to stay in our bubbles and not invade theirs will keep them safer. 

When people first started wearing masks, I noticed that the older people at the grocery store, and the women at the grocery store, started wearing them first.  At that point the accepted wisdom was that we were wearing them for others' protection from us, not to protect ourselves from them. 

In Ontario right now the people getting sick are not just the elderly.  It is kids, young people, middle-aged people.  They aren't catching it from us.  They are catching it from each other.  There is nothing we can do to save them from each other.

Age Group   Cumulative   Active   Resolved   Deaths
            
Under 20       11,238       1914      9323              1
20-29           20,383       2671        17708         4
30-39           15,206       1999        13200          7
40-49           13,636       1874        11733         29
50-59           14,371       1788        12472         111
60-69            9,267       1191        7776            300
70-79            5,182        640           3946        596
80-89            5,338        460           3637        1241
90-99            3,528        281           2121        1126

From https://covid-19.ontario.ca/data
ETA  I edited about 5 times to make the numbers sort of line up, at least the table makes some sense now.

Good post! Thanks. And thanks for the data too. I often watch similar demographics for my area, and while the general numbers vary by location, the rate of infection and death between the demographics is pretty similar in every location I've looked at.
I always like to calculate the survival rate by demographic because it's not something that I see or hear about, and I think it's helpful to focus on any positive that we can when trying to quantify the risks.
With your data I get:
Age Group         Survival rate
            
Under 20             ~100%
20-29             ~100
30-39             ~100
40-49               99.8
50-59               99.3
60-69               96.8
70-79               88.5
80-89               76.8
90-99               68.1

There's a lot of doom and gloom discussed and reported as it relates to this virus but in every location that I've seen, the vast majority of people infected with COVID survive, even in the oldest/most at risk demographics. I think knowing that can and should be accounted for in our individual decision making for any sacrifices we might make.

For me, the odds are good that I would survive.  What I worry about, as much as dying, is the side effects.  I'm not sure my lungs totally recovered from the pneumonia in my 40s, plus I already had so so lung function from growing up with smokers.  Plus, after knowing people who had long term health issues from childhood diseases, I worry about that for the younger groups.

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #4852 on: November 19, 2020, 07:38:27 AM »
Great stuff from @RetiredAt63 !

I had a conversation with my girlfriend yesterday and boy did it make me feel 60 years older than I am. I actually said something like, ďIf WWII were fought today, I donít think Americans would have it in them to sacrifice and get it done.Ē Normally I despise statements like that. :)

Some people have to sacrifice more than others. Namely the unemployed and small businesses who are put at risk. But we can and should bail these people out. Itís easy for me to blame Trump and Congress for not doing that, and lord knows I love blaming Trump for things. But it is completely within our power to unite as citizens and make the failure to pass more relief politically untenable. But instead, so many people simply want to go back to normal* rather than toughing it out and spending their time advocating to get some relief for those who are hurting the most from lockdowns.

*normal in this respect is of course, not normal at all. It is extreme excess mortality that persists for the whole year (above and beyond what weíre already experiencing), itís full ICUs and overworked healthcare employees exposing themselves to even more risk. Normal in this context means ďnormal for meĒ.

Watchmaker

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Re: How long can we wait while flattening the curve?
« Reply #4853 on: November 19, 2020, 08:05:39 AM »
Wisconsin is second on the list, with a mask mandate since July 30.  Second most cases.

Here in Wisconsin most people do wear masks at the grocery store, but they are still going to packed bars, eating at restaurants, having parties at home, etc. And mask use compliance is generally low in small businesses in my area.

With our large number of cases recently, I have seen some change in behavior--several bars are temporarily closed, for example. 

bigblock440

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Re: How long can we wait while flattening the curve?
« Reply #4854 on: November 19, 2020, 09:24:09 AM »
And finally, I think there are arguments to be made on both sides of whether or not research like this should be published right now, so I won't call the authors of the study irresponsible for publishing, however conducting the research at all was irresponsible. Telling 3,000 people to intentionally not wear masks no matter their circumstances when we already know that masks reduce transmission to others is definitely irresponsible. That's why there aren't more studies like this.

I thought they had some juicy stuff given the pre-noise, but now when it's out I kind of see why it was refused by 3(?) journals. The flaws are pretty freakin' obvious to me. I think the only thing you cannot hold against it is the sample size, they claimed it was the largest ever as far as I understood from the pre-noise.

I think asking 3k ppl not to wear masks in Denmark is entirely responsible during this time. It was also in line with Danish health authorities recommendations at the time (they have changed a bit now when infections are more widespread btw) but during the experiment time the risk of getting an infection in Denmark was extremely low and not many people wore masks there in the first place unless you worked in health service which is the only area masks were mandatory in Denmark at that time. Obviously noone in the sample were in a job or other position were masks were mandated.

Largest study of it's kind might be true, but that doesn't mean it's large enough to provide useful results. And to clarify, the number of participants is less important than the number of infections. As an extreme example, a study with a million participants and 100 total infections would still be "too small" to tell us if masks protect the wearer. A study with 1,000 participants and 500 infections would be much more informative.

Your point that people weren't wearing masks anyway at that time is fair so my criticism that this study specifically was irresponsible was misplaced.

If however, a study like this were conducted in a time and place where the virus was spreading, such a study would be unethical. For such a study to be meaningful you would need the virus to be spreading. So this kind of study is necessarily going to be unethical or uninformative.

Honestly both groups have a higher incidence of infection than the Pfizer vaccine study participants had.

Pfizer treatment infections: 9/19000 = 0.04%
Pfizer control infections: 85/19000 = 0.4%

Copenhagen study mask: 42/~2430 = 1.8%
Copenhagen study no-mask: 53/~2430 = 2.1%


Should we deem the Pfizer study results an issue because of the low incidence of infections in each group?

I didn't realize the infection counts in the Pfizer study were so low. That's surprising to me but maybe I'm missing something.


There are reasons why the number of infections in the mask study would need to be much higher than in a vaccine study to be meaningful.

First, someone who is vaccinated remains that way 24/7. Someone who is given a box of 50 masks and told to wear them in certain situations is not.  it's guaranteed that participants had varying degrees of discipline in mask-wearing, especially if mask-wearing was uncommon among the general public at the time. It's difficult to wear a mask when it's not the norm.

Consider a study on the efficacy of condoms. 6,000 sexually active participants, 3,000 are given a box of condoms and told to use them in "certain situations"/ 3000 are told to go without. In a given time period 42 of the test group and 53 of the control group become pregnant. Are these numbers sufficient to claim condoms are ineffective? I'd say not. But in a study on the efficacy of IUDs if 9 in 19,000 with an IUD got pregnant and 85 in 19,000 without got pregnant, that would be more meaningful. (the actual disparity between these groups would be much greater, IUDs are more than 99% effective on an annual basis)

Second, it's likely that a large majority of those transmissions occurred among family and other groups whom the participants weren't told to wear masks around.

When you throw in false positives from transmission that occurs when not wearing a mask, you need a much larger sample size/number of infections to compensate.

Would you risk it with an IUD, or would you just forgo sex entirely since there's only a 99% chance?

SunnyDays

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Re: How long can we wait while flattening the curve?
« Reply #4855 on: November 19, 2020, 09:42:51 AM »

Luckily I live in an area with the lowest infection rate in a relatively low infection rate area, even though a large fraction of the population works in hospitals. Many of us wear masks all day at work even pre-COVID so it's just not a big deal to wear them, and compliance is high indoors. People don't normally wear masks outdoors in low-density locations, and infection rates remain low.
 

So it's possible that the prevalence of mask-wearing is contributing to the low infection rates in your area?

Davnasty

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Re: How long can we wait while flattening the curve?
« Reply #4856 on: November 19, 2020, 09:43:23 AM »
Would you risk it with an IUD, or would you just forgo sex entirely since there's only a 99% chance?

I would risk it. Is this relevant to the discussion?

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #4857 on: November 19, 2020, 10:09:47 AM »
When this is all over, we need to completely rethink, from top to bottom, how we explain public health to people. Something I've been toying around with is a pollution analogy. Most people wouldn't consider it an affront to their personal freedoms if they couldn't dump toxic waste in a river or detonate a nuclear bomb over their city. This is because drinkable water, breathable air, and non-irradiated land are public goods belonging to the commons.

Healthcare capacity should be thought of in the same way. Is it your freedom to get sick during a pandemic and get others sick if that will stress capacity? Maybe not. This argument would be easier to make if we didn't try to pretend like healthcare capacity wasn't a public good in the states. Perhaps jerking the wheel in the other direction would help. Everyone can do what they want, but then hospitals get to start auctioning off beds.

Bloop Bloop Reloaded

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Re: How long can we wait while flattening the curve?
« Reply #4858 on: November 19, 2020, 05:48:34 PM »
When this is all over, we need to completely rethink, from top to bottom, how we explain public health to people. Something I've been toying around with is a pollution analogy. Most people wouldn't consider it an affront to their personal freedoms if they couldn't dump toxic waste in a river or detonate a nuclear bomb over their city. This is because drinkable water, breathable air, and non-irradiated land are public goods belonging to the commons.

Healthcare capacity should be thought of in the same way. Is it your freedom to get sick during a pandemic and get others sick if that will stress capacity? Maybe not. This argument would be easier to make if we didn't try to pretend like healthcare capacity wasn't a public good in the states. Perhaps jerking the wheel in the other direction would help. Everyone can do what they want, but then hospitals get to start auctioning off beds.

People smoke, drink, drink while pregnant, and do all sorts of stupid stuff that directly harms themselves (let alone other people). I think if you want to start a public health debate you're going to have to begin with those elements. It's unlikely someone's going to wear a mask or get a vaccination to protect others if she won't even stop smoking to protect herself.

Ask any doctor how many patients keep smoking despite being told it's a major adverse factor for lots of things...e.g. any sort of surgery.

Would you risk it with an IUD, or would you just forgo sex entirely since there's only a 99% chance?

I would risk it. Is this relevant to the discussion?

It's kinda interesting how the public health discourse stresses the failure rate of certain birth control methods (e.g. withdrawal). Withdrawal + rhythm method when used perfectly has a very, very high safety rate as long as the woman has regular cycles (it is not difficult to track cycles - you just need to keep careful track of your period and carry out blood / ultrasound tests to check hormones. This is free under the public system in Australia). So it's kinda weird reading up about how withdrawal + rhythm is so terrible, etc. If the woman has regular cycles, does the requisite testing, and both partners are disciplined it's very safe.


RetiredAt63

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Re: How long can we wait while flattening the curve?
« Reply #4859 on: November 19, 2020, 07:01:54 PM »
Bloop bloop I don't know whether to laugh or to cry.  Regular cycles are not as common as you may think, and lots of things can throw a cycle off.  Both partners disciplined- seriously, when there are guys out there who don't even want to wear condoms, you think they will be part of a disciplined couple?  And the testing?  How often?  I don't think my provincial health care would be very helpful on that, and you already know from comments here about the American system.

Seriously, if you and a girlfriend were planning to have sex, do you really think she would do all that monitoring?  And trust you to hold off during her (theoretical) fertile time, And a few days either side just in case?   Hypothetical me in that hypothetical situation would be on the pill or an IUD or condom+cervical cap+spermicidal jelly.

Sorry about the semi-rant, got a little distracted there.

I will tell you something that may not be as true today as it was then.  When reliable birth control became available for women, we grabbed it, because we were the ones who got pregnant when our partners were irresponsible, or the condom slipped, or we ovulated early/late.

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #4860 on: November 19, 2020, 07:16:40 PM »
People smoke, drink, drink while pregnant, and do all sorts of stupid stuff that directly harms themselves (let alone other people). I think if you want to start a public health debate you're going to have to begin with those elements. It's unlikely someone's going to wear a mask or get a vaccination to protect others if she won't even stop smoking to protect herself.

Right or wrong, people drinking and smoking and taking silly risks is priced into our healthcare capacity to some extent. Administrators can look at trends for alcohol consumption and vehicle miles driven and come up with a reasonable expectation for how much hospitals will be stressed by drunk driving accidents in a given year.

More broadly, we expect certain levels of morbidity and mortality and our systems are built to accommodate that. We do not have slack capacity sitting around to accommodate the massive increase in morbidity that we've seen in the pandemic. People not abiding by recommendations during a pandemic is a pretty direct stressor on the commons of healthcare.

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #4861 on: November 19, 2020, 07:29:56 PM »
Bloop bloop I don't know whether to laugh or to cry.  Regular cycles are not as common as you may think, and lots of things can throw a cycle off.  Both partners disciplined- seriously, when there are guys out there who don't even want to wear condoms, you think they will be part of a disciplined couple?  And the testing?  How often?  I don't think my provincial health care would be very helpful on that, and you already know from comments here about the American system.

Seriously, if you and a girlfriend were planning to have sex, do you really think she would do all that monitoring?  And trust you to hold off during her (theoretical) fertile time, And a few days either side just in case?   Hypothetical me in that hypothetical situation would be on the pill or an IUD or condom+cervical cap+spermicidal jelly.

Sorry about the semi-rant, got a little distracted there.

I will tell you something that may not be as true today as it was then.  When reliable birth control became available for women, we grabbed it, because we were the ones who got pregnant when our partners were irresponsible, or the condom slipped, or we ovulated early/late.

100%

Any little barrier or difficulty put up is going to reduce overall success rate when measured over a large sample. If you want high success rates for birth control, the goal should be to make it as easy as possible. This is why we see condoms give way to the pill which gives way to IUDs or the patch or injections. You want to make it a no brainer and reduce the number of opportunities for people to mess up. You want to reduce the number of opportunities for someone to say, "Fuck it, it's not worth it."

This approach and logic is applicable to so much more than birth control too. . People will say that voting anywhere in the US is possible. And that's true. But when you mail everyone ballots with prepaid return envelops weeks early, you get higher turnout than if you make them drive 10 miles to a polling location and stand in line for an hour. If you want high turnout, reduce the number of opportunities for someone to say, "Fuck it, it's not worth it."

Bloop Bloop Reloaded

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Re: How long can we wait while flattening the curve?
« Reply #4862 on: November 19, 2020, 07:58:42 PM »
Bloop bloop I don't know whether to laugh or to cry.  Regular cycles are not as common as you may think, and lots of things can throw a cycle off.  Both partners disciplined- seriously, when there are guys out there who don't even want to wear condoms, you think they will be part of a disciplined couple?  And the testing?  How often?  I don't think my provincial health care would be very helpful on that, and you already know from comments here about the American system.

Seriously, if you and a girlfriend were planning to have sex, do you really think she would do all that monitoring?  And trust you to hold off during her (theoretical) fertile time, And a few days either side just in case?   Hypothetical me in that hypothetical situation would be on the pill or an IUD or condom+cervical cap+spermicidal jelly.

Sorry about the semi-rant, got a little distracted there.

I will tell you something that may not be as true today as it was then.  When reliable birth control became available for women, we grabbed it, because we were the ones who got pregnant when our partners were irresponsible, or the condom slipped, or we ovulated early/late.

I know regular cycles are not universal. That's why I said "if" - that's what a conditional means.

My last partner that I used the rhythm method with did get her fertility measured. Like I said, it's free here. It helps with family planning (both ways - in terms of wanting children and/or not wanting children).

A lot of it depends on how well you communicate and how disciplined you are. An understanding of sperm viability periods also helps, as does an understanding of what increases risk. I find that a lot of health resources aren't very transparent about specific risk factors.

And I'm not saying you wouldn't use any other form of birth control, but that there are many gradients and shades of grey that are worthwhile discussing. An absolutist approach is rarely helpful. I suppose if it was a casual encounter and you didn't know your partner very well then an absolutist approach would be prudent.

Bloop Bloop Reloaded

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Re: How long can we wait while flattening the curve?
« Reply #4863 on: November 19, 2020, 10:00:05 PM »
So our South Australian lockdown has been abruptly and prematurely ended. The reason for the lockdown was that authorities felt the strain was spreading rapidly throughout the community because they couldn't otherwise figure out a cogent mechanism of infection among the known carriers. As it turned out, some worker simply lied, and the lie meant that a crucial link the chain was missing.

From the Guardian's transcription of the press conference

Quote
The lie was -the person claimed that they had purchased a pizza from the pizza shop, where in fact they were working there and had been working there for several shifts

That clearly changes the circumstances and had this person been truthful to the contact tracing teams, we would not have gone into a six-day lockdown.

The second consequence of that lie is this person has numerous associates, persons of interest that we are now trying to identify and locate that we would not have had to do so had they been truthful from the beginning. There is an absolute need for us to move quickly over the next 24 36 hours to identify and locate these people so we know we have eliminated the risk of this particular strain spreading further into the community.

So welcome to Australia. Where if you test negative but are bad enough to not wear a mask in public or breach the (earlier) curfew for any reason, you get a $1500 fine. But if you test positive and then mislead contact tracers, you get ignominy in the papers but no fine!

It's kinda like here how if you run a red light you get a $400 fine but if you run a red light and hit someone's vehicle and injure the person you still only get a $400 fine. We don't punish based on objective seriousness but rather "intention" and the South Australian scenario simply shows the limitations of our approach.

Hopefully the worker who lied is identified and dealt with.

Montecarlo

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Re: How long can we wait while flattening the curve?
« Reply #4864 on: November 20, 2020, 04:25:37 AM »
Perhaps jerking the wheel in the other direction would help. Everyone can do what they want, but then hospitals get to start auctioning off beds.

I know youíre being tongue in cheek but youíre not thinking that one through.

Those most unable to afford auctioned off ICU beds are the ones who can least afford to work from home or go without income.

mizzourah2006

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Re: How long can we wait while flattening the curve?
« Reply #4865 on: November 20, 2020, 05:56:44 AM »
Wisconsin is second on the list, with a mask mandate since July 30.  Second most cases.

Here in Wisconsin most people do wear masks at the grocery store, but they are still going to packed bars, eating at restaurants, having parties at home, etc. And mask use compliance is generally low in small businesses in my area.

With our large number of cases recently, I have seen some change in behavior--several bars are temporarily closed, for example.

Where I'm at is seeing a pretty big jump too. The 7 day moving average for  cases has doubled since early October. Admittedly I don't go out much, but whenever I go to the store everyone is wearing a mask, like they have been since the end of June. It doesn't appear restaurants are any more crowded than they were 2 months ago, when I drive by them, etc. Outside of grocery shopping I've been to outdoor breweries about 5x, most recently 2-3 weekends ago and it was just as crowded as it's been every other time and mask compliance was 100% inside. Its hard to explain why there is such a huge jump in my area from what I'm seeing.

Just out of curiosity how do you know bars are packed and that alot of people are having massive parties at home in your area? Is it on the news or something?

RetiredAt63

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Re: How long can we wait while flattening the curve?
« Reply #4866 on: November 20, 2020, 06:15:11 AM »
Bloop bloop I don't know whether to laugh or to cry.  Regular cycles are not as common as you may think, and lots of things can throw a cycle off.  Both partners disciplined- seriously, when there are guys out there who don't even want to wear condoms, you think they will be part of a disciplined couple?  And the testing?  How often?  I don't think my provincial health care would be very helpful on that, and you already know from comments here about the American system.

Seriously, if you and a girlfriend were planning to have sex, do you really think she would do all that monitoring?  And trust you to hold off during her (theoretical) fertile time, And a few days either side just in case?   Hypothetical me in that hypothetical situation would be on the pill or an IUD or condom+cervical cap+spermicidal jelly.

Sorry about the semi-rant, got a little distracted there.

I will tell you something that may not be as true today as it was then.  When reliable birth control became available for women, we grabbed it, because we were the ones who got pregnant when our partners were irresponsible, or the condom slipped, or we ovulated early/late.

I know regular cycles are not universal. That's why I said "if" - that's what a conditional means.

My last partner that I used the rhythm method with did get her fertility measured. Like I said, it's free here. It helps with family planning (both ways - in terms of wanting children and/or not wanting children).

A lot of it depends on how well you communicate and how disciplined you are. An understanding of sperm viability periods also helps, as does an understanding of what increases risk. I find that a lot of health resources aren't very transparent about specific risk factors.

And I'm not saying you wouldn't use any other form of birth control, but that there are many gradients and shades of grey that are worthwhile discussing. An absolutist approach is rarely helpful. I suppose if it was a casual encounter and you didn't know your partner very well then an absolutist approach would be prudent.

I knew my husband pretty well and we still used the pill and IUD.  DD was definitely planned. 
Your presentation had so many "ifs" in it that it just isn't practical.  Planning as if situations are ideal means lots of chances for things to go wrong.

RetiredAt63

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Re: How long can we wait while flattening the curve?
« Reply #4867 on: November 20, 2020, 06:33:18 AM »
Bloop bloop I don't know whether to laugh or to cry.  Regular cycles are not as common as you may think, and lots of things can throw a cycle off.  Both partners disciplined- seriously, when there are guys out there who don't even want to wear condoms, you think they will be part of a disciplined couple?  And the testing?  How often?  I don't think my provincial health care would be very helpful on that, and you already know from comments here about the American system.

Seriously, if you and a girlfriend were planning to have sex, do you really think she would do all that monitoring?  And trust you to hold off during her (theoretical) fertile time, And a few days either side just in case?   Hypothetical me in that hypothetical situation would be on the pill or an IUD or condom+cervical cap+spermicidal jelly.

Sorry about the semi-rant, got a little distracted there.

I will tell you something that may not be as true today as it was then.  When reliable birth control became available for women, we grabbed it, because we were the ones who got pregnant when our partners were irresponsible, or the condom slipped, or we ovulated early/late.

100%

Any little barrier or difficulty put up is going to reduce overall success rate when measured over a large sample. If you want high success rates for birth control, the goal should be to make it as easy as possible. This is why we see condoms give way to the pill which gives way to IUDs or the patch or injections. You want to make it a no brainer and reduce the number of opportunities for people to mess up. You want to reduce the number of opportunities for someone to say, "Fuck it, it's not worth it."

This approach and logic is applicable to so much more than birth control too. . People will say that voting anywhere in the US is possible. And that's true. But when you mail everyone ballots with prepaid return envelops weeks early, you get higher turnout than if you make them drive 10 miles to a polling location and stand in line for an hour. If you want high turnout, reduce the number of opportunities for someone to say, "Fuck it, it's not worth it."

Basic concept emerging here.  If you want something to happen, make it really easy to happen.  If you don't want something to happen, put all sorts of obstacles in the way.

If a society really wants to encourage people to do something, make it an opt-out activity.  If they hope people won't do something, make it an opt in choice.  Organ donation - countries with high levels are opt out, countries with low levels are opt in.  Pensions - here CPP contributions are automatically deducted at source, RRSP and TFSA deductions are not.  Guess where money doesn't go? 
Voting?  Here its easy to register, Elections Canada does ad campaigns to encourage voting, employers have to ensure employees have 4 consecutive hours to vote (not 4 hours off unless you are split shift, just that work has to start 4 hours after polls open or end 4 hours before polls close), lines are short.

 I'm sure others can come up with other examples.  And it gives us a tool to evaluate implementation of social policy.  If a government or other social body (including parents/spouses in here) makes something easy to do, they are encouraging it no matter how much they say they are against it.  If they make something hard to do, then they don't want you to do it even if they say they do.  Watch the actions/rules, not the words.

NotJen

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Re: How long can we wait while flattening the curve?
« Reply #4868 on: November 20, 2020, 06:33:49 AM »
Wisconsin is second on the list, with a mask mandate since July 30.  Second most cases.

Here in Wisconsin most people do wear masks at the grocery store, but they are still going to packed bars, eating at restaurants, having parties at home, etc. And mask use compliance is generally low in small businesses in my area.

With our large number of cases recently, I have seen some change in behavior--several bars are temporarily closed, for example.

Where I'm at is seeing a pretty big jump too. The 7 day moving average for  cases has doubled since early October. Admittedly I don't go out much, but whenever I go to the store everyone is wearing a mask, like they have been since the end of June. It doesn't appear restaurants are any more crowded than they were 2 months ago, when I drive by them, etc. Outside of grocery shopping I've been to outdoor breweries about 5x, most recently 2-3 weekends ago and it was just as crowded as it's been every other time and mask compliance was 100% inside. Its hard to explain why there is such a huge jump in my area from what I'm seeing.

Just out of curiosity how do you know bars are packed and that alot of people are having massive parties at home in your area? Is it on the news or something?

Yes, itís pretty obvious to me that while mask compliance in public is pretty good around here, people are still gathering plenty of places without masks, and thatís whatís driving the spread.

I donít understand indoor dining - people put on a mask to walk through the door, then take it off for the 2 hours theyíre inside. Few people are using the patios - some places donít even open the patios since so many are willing to eat inside.  We sit outside and watch big parties of people from many households eating together indoors.

I know there are private gatherings going on because friends talk about who they are hanging out with, one former coworker got COVID recently from a large wedding he attended, and I saw plenty of pictures on Facebook of adult Halloween parties with no masks (among other gatherings).  The parties donít have to be massive, just widespread, which they seem to be.

mizzourah2006

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Re: How long can we wait while flattening the curve?
« Reply #4869 on: November 20, 2020, 06:45:36 AM »
Wisconsin is second on the list, with a mask mandate since July 30.  Second most cases.

Here in Wisconsin most people do wear masks at the grocery store, but they are still going to packed bars, eating at restaurants, having parties at home, etc. And mask use compliance is generally low in small businesses in my area.

With our large number of cases recently, I have seen some change in behavior--several bars are temporarily closed, for example.

Where I'm at is seeing a pretty big jump too. The 7 day moving average for  cases has doubled since early October. Admittedly I don't go out much, but whenever I go to the store everyone is wearing a mask, like they have been since the end of June. It doesn't appear restaurants are any more crowded than they were 2 months ago, when I drive by them, etc. Outside of grocery shopping I've been to outdoor breweries about 5x, most recently 2-3 weekends ago and it was just as crowded as it's been every other time and mask compliance was 100% inside. Its hard to explain why there is such a huge jump in my area from what I'm seeing.

Just out of curiosity how do you know bars are packed and that alot of people are having massive parties at home in your area? Is it on the news or something?

Yes, itís pretty obvious to me that while mask compliance in public is pretty good around here, people are still gathering plenty of places without masks, and thatís whatís driving the spread.

I donít understand indoor dining - people put on a mask to walk through the door, then take it off for the 2 hours theyíre inside. Few people are using the patios - some places donít even open the patios since so many are willing to eat inside.  We sit outside and watch big parties of people from many households eating together indoors.

I know there are private gatherings going on because friends talk about who they are hanging out with, one former coworker got COVID recently from a large wedding he attended, and I saw plenty of pictures on Facebook of adult Halloween parties with no masks (among other gatherings).  The parties donít have to be massive, just widespread, which they seem to be.

Obviously all of that is possible, it's still warm here, so outdoor seating is still the norm and clearly it's possible people are gathering at home, but I just don't understand why they'd be gathering more in October and November than they would have for say Labor Day or 4th of July. I'm not seeing anything on my FB. It could all be from Halloween gatherings, who knows. Again, outside of a cold rainy weekend the weather has been nicer here in October and November than it was in July, August, and September. I'd imagine more people would prefer to gather outside in 65-75 degree weather than 90+. But perhaps that's just me. I know I've been outside a lot more these past few weeks than I was in August.

NotJen

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Re: How long can we wait while flattening the curve?
« Reply #4870 on: November 20, 2020, 07:06:04 AM »
Obviously all of that is possible, it's still warm here, so outdoor seating is still the norm and clearly it's possible people are gathering at home, but I just don't understand why they'd be gathering more in October and November than they would have for say Labor Day or 4th of July. I'm not seeing anything on my FB. It could all be from Halloween gatherings, who knows. Again, outside of a cold rainy weekend the weather has been nicer here in October and November than it was in July, August, and September. I'd imagine more people would prefer to gather outside in 65-75 degree weather than 90+. But perhaps that's just me. I know I've been outside a lot more these past few weeks than I was in August.

My county saw a massive increase in cases throughout July.  We actually did extremely well through April and May - very low case counts and not many deaths (contrary to the rest of our state because most of our workforce can WFH), then just a small increase in June when people started heading to the beach, then massive increase in July possibly from 4th of July gatherings and people heading indoors when it got oppressive outside.  A local mask ordinance went into effect mid-July, and we saw a pretty good decline in August.  Small increase, but mostly steady rates in Sept and Oct as kids went back to school in person, and now a spike that started at the end of October.  People got complacent.

Longwaytogo

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Re: How long can we wait while flattening the curve?
« Reply #4871 on: November 20, 2020, 07:56:54 AM »
I would guess the election had as much of an effect as Haloween. No real way to know though I guess.

I'm sure complacency and Pandemic fatigue are as much to blame as any single day/event.

Depressing to see it going up so much; gonna be a long winter :(

mizzourah2006

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Re: How long can we wait while flattening the curve?
« Reply #4872 on: November 20, 2020, 08:10:59 AM »
Something is going on. I'm just not sure I'm not fully buying the complacency and pandemic fatigue argument. I feel like you could have made this exact same argument in July or August. After all why would someone not get fatigue after 5-6 months, but suddenly complacency and pandemic fatigue become a huge problem at months 7 & 8. Perhaps it's exacerbated by school, but where I'm at school has been in since mid August and we didn't start to see much of a spike until the end of October, over 2 months after school had already been back in session. I'm honestly thinking weather does have a pretty huge factor in the transmission of the this virus. The only factor that we can be certain has changed in the past 1-1.5 months is the weather becoming cooler.

RetiredAt63

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Re: How long can we wait while flattening the curve?
« Reply #4873 on: November 20, 2020, 08:28:44 AM »
I would guess the election had as much of an effect as Haloween. No real way to know though I guess.

I'm sure complacency and Pandemic fatigue are as much to blame as any single day/event.

Depressing to see it going up so much; gonna be a long winter :(

We are having spikes too, with no federal election.  Colder weather?  More people gathering indoors?  Canadian Thanksgiving and Halloween?  Shorter daylengths affecting our body physiology and immune systems?  We certainly have testing shortages which means contact tracing is useless and basically not happening.

I am taking our national emblem (the beaver) as my model - stock up on food and stay home all winter.

Longwaytogo

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Re: How long can we wait while flattening the curve?
« Reply #4874 on: November 20, 2020, 08:39:53 AM »
Something is going on. I'm just not sure I'm not fully buying the complacency and pandemic fatigue argument. I feel like you could have made this exact same argument in July or August. After all why would someone not get fatigue after 5-6 months, but suddenly complacency and pandemic fatigue become a huge problem at months 7 & 8. Perhaps it's exacerbated by school, but where I'm at school has been in since mid August and we didn't start to see much of a spike until the end of October, over 2 months after school had already been back in session. I'm honestly thinking weather does have a pretty huge factor in the transmission of the this virus. The only factor that we can be certain has changed in the past 1-1.5 months is the weather becoming cooler.

I agree we got fatigue/complacent in July/August for sure and started socializing, and doing more in our area (and addmitingly my own fanily as well).

I think we mostly "got away with it" in part bevause of the Weather and our states comparatively low rate. But....that ship has sailed.

Now the problem is reeling people back in to March-May levels of caution when they've enjoyed a slightly more normal existence for 3-5 months.

I've had multiple conversations with people this week where thier argument is "but we've been seeing them for months" and I'm like yeah but that doesnt matter. Just because we saw 15-20 folks at an outdoor bonfire on Halloween that doesnt mean it's safe to see them now. Anyone of them (or us) could of gotten infected since then with the increased community transmission.

So I don't neccessarily think the fatigue is just setting in; I think it did in the Summer and people dont want to go back.

It certainly does seem the Cold Weather and/or more folks being indoors makes it significantly worse/more transmittable.

NotJen

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Re: How long can we wait while flattening the curve?
« Reply #4875 on: November 20, 2020, 08:40:44 AM »
I feel like you could have made this exact same argument in July or August. After all why would someone not get fatigue after 5-6 months, but suddenly complacency and pandemic fatigue become a huge problem at months 7 & 8.

I did make that argument for July for my locale - people got complacent after doing really well in the initial stage of the pandemic.  My county's first wave was in July.  Our second wave has not yet reached the July peak, but I'm pretty sure it will.

I really think it's the "shock" factor that kicked in locally that made things better in August.  An alarming increase in rates of infection, plus the local mask ordinance shocked some people into being more careful.  Then rates went down, and things relaxed.  There is certainly a segment of people that are never going to comply with any regulations, and another segment who will always be more careful than what local regulations allow.  But there are a bunch in the middle that are swayed by regulations, messaging, what people around them are doing...  I wish we could shock people again, but our governor is currently loosening restrictions and says she'll never close any businesses again.

Maybe there is more going on, but the behavior I observe seems to explain the new spike/2nd wave pretty well in my area.  Your area may be different.

I would guess the election had as much of an effect as Haloween. No real way to know though I guess.

It might have.  We had a lot of in-person voting here.  I was an election worker, and worked 5 elections during the pandemic (we had a municipal election and 2 runoffs in addition to the primary and general)!  I have heard of 0 instances of poll workers in my county getting sick, and it's definitely something they would share with us.  My greatest risk was from my fellow poll workers, since I was around them for 15 hours a day, and around each voter for less than 15 minutes.  The voters' greatest risk was other voters, and for the general we had so many people, I would believe that some could have gotten infected while waiting in line - but yeah - there's really no way to know if that happened.

frugalnacho

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Re: How long can we wait while flattening the curve?
« Reply #4876 on: November 20, 2020, 08:46:11 AM »
Something is going on. I'm just not sure I'm not fully buying the complacency and pandemic fatigue argument. I feel like you could have made this exact same argument in July or August. After all why would someone not get fatigue after 5-6 months, but suddenly complacency and pandemic fatigue become a huge problem at months 7 & 8. Perhaps it's exacerbated by school, but where I'm at school has been in since mid August and we didn't start to see much of a spike until the end of October, over 2 months after school had already been back in session. I'm honestly thinking weather does have a pretty huge factor in the transmission of the this virus. The only factor that we can be certain has changed in the past 1-1.5 months is the weather becoming cooler.

People have been fatigued for months.  The virus never went away, it was just low enough transmission rates that hospitals weren't overwhelmed.  It also takes a couple of weeks to test positive, and the transmission rate is exponential.  Like I've been saying for months, people are spreading it without even being aware they are sick, and then those people are spreading it without being aware they are sick, and so on.  Where do you live that infection rates were not steady or increasing through July and August?

You and many other people have recently commented that the bars and restaurants have had a steady stream of customers all summer, but you haven't had the explosive growth until relatively recently.  But that's how exponential growth works and public health officials have been warning us about that for months.  People getting fatigued, people eating indoors, kids going back to school, weather getting colder, and exponential growth.

The entire argument that things have been going good all summer (they haven't) and bars and restaurants have been serving people indoors for months without a massive explosion in cases sounds like someone saying they've been drinking mt dew for years and are suddenly surprised by an explosion in their diabetes.  I was relatively fine chugging 2 liters of mt dew per day all summer, I wonder why I'm all of a sudden having issues when I haven't changed my irresponsible and destructive behavior? 

mizzourah2006

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Re: How long can we wait while flattening the curve?
« Reply #4877 on: November 20, 2020, 08:52:08 AM »
For my county specifically our first peak was in mid-June at a 7-day average of about 83/day. We hit that again on 11/4 and appear to have peaked on 11/12 at 131 cases/day in the 7-day. Between mid-June and mid October we never got above a 7-day average of 54/day. It's just very interesting to me. I'm not saying anybody here was or wasn't arguing complacency or pandemic fatigue earlier, I'm just speaking in generalities.

Something is going on. I'm just not sure I'm not fully buying the complacency and pandemic fatigue argument. I feel like you could have made this exact same argument in July or August. After all why would someone not get fatigue after 5-6 months, but suddenly complacency and pandemic fatigue become a huge problem at months 7 & 8. Perhaps it's exacerbated by school, but where I'm at school has been in since mid August and we didn't start to see much of a spike until the end of October, over 2 months after school had already been back in session. I'm honestly thinking weather does have a pretty huge factor in the transmission of the this virus. The only factor that we can be certain has changed in the past 1-1.5 months is the weather becoming cooler.

People have been fatigued for months.  The virus never went away, it was just low enough transmission rates that hospitals weren't overwhelmed.  It also takes a couple of weeks to test positive, and the transmission rate is exponential.  Like I've been saying for months, people are spreading it without even being aware they are sick, and then those people are spreading it without being aware they are sick, and so on.  Where do you live that infection rates were not steady or increasing through July and August?

You and many other people have recently commented that the bars and restaurants have had a steady stream of customers all summer, but you haven't had the explosive growth until relatively recently.  But that's how exponential growth works and public health officials have been warning us about that for months.  People getting fatigued, people eating indoors, kids going back to school, weather getting colder, and exponential growth.

The entire argument that things have been going good all summer (they haven't) and bars and restaurants have been serving people indoors for months without a massive explosion in cases sounds like someone saying they've been drinking mt dew for years and are suddenly surprised by an explosion in their diabetes.  I was relatively fine chugging 2 liters of mt dew per day all summer, I wonder why I'm all of a sudden having issues when I haven't changed my irresponsible and destructive behavior?

I've never commented on bars. I haven't been in a bar since this all began. All I've said is when I drive by restaurants they don't appear to be any more or less crowded than they were in all summer. I'm literally just referring to my area and county. I have no clue what's going on in yours and I don't pretend to.

No one is arguing that it can't be spread without awareness and I'm not sure if you meant to or not, but you just talked about exponential growth and then compared it to drinking mountain dew for years and then suddenly having diabetes, that's a pretty poor analogy for exponential growth.

You sure like to get argumentative don't you? What irresponsible behavior have I engaged in? I'm not congregating around unmasked people all day like you are. Just saying.
« Last Edit: November 20, 2020, 09:08:18 AM by mizzourah2006 »

frugalnacho

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Re: How long can we wait while flattening the curve?
« Reply #4878 on: November 20, 2020, 10:09:28 AM »
For my county specifically our first peak was in mid-June at a 7-day average of about 83/day. We hit that again on 11/4 and appear to have peaked on 11/12 at 131 cases/day in the 7-day. Between mid-June and mid October we never got above a 7-day average of 54/day. It's just very interesting to me. I'm not saying anybody here was or wasn't arguing complacency or pandemic fatigue earlier, I'm just speaking in generalities.

Something is going on. I'm just not sure I'm not fully buying the complacency and pandemic fatigue argument. I feel like you could have made this exact same argument in July or August. After all why would someone not get fatigue after 5-6 months, but suddenly complacency and pandemic fatigue become a huge problem at months 7 & 8. Perhaps it's exacerbated by school, but where I'm at school has been in since mid August and we didn't start to see much of a spike until the end of October, over 2 months after school had already been back in session. I'm honestly thinking weather does have a pretty huge factor in the transmission of the this virus. The only factor that we can be certain has changed in the past 1-1.5 months is the weather becoming cooler.

People have been fatigued for months.  The virus never went away, it was just low enough transmission rates that hospitals weren't overwhelmed.  It also takes a couple of weeks to test positive, and the transmission rate is exponential.  Like I've been saying for months, people are spreading it without even being aware they are sick, and then those people are spreading it without being aware they are sick, and so on.  Where do you live that infection rates were not steady or increasing through July and August?

You and many other people have recently commented that the bars and restaurants have had a steady stream of customers all summer, but you haven't had the explosive growth until relatively recently.  But that's how exponential growth works and public health officials have been warning us about that for months.  People getting fatigued, people eating indoors, kids going back to school, weather getting colder, and exponential growth.

The entire argument that things have been going good all summer (they haven't) and bars and restaurants have been serving people indoors for months without a massive explosion in cases sounds like someone saying they've been drinking mt dew for years and are suddenly surprised by an explosion in their diabetes.  I was relatively fine chugging 2 liters of mt dew per day all summer, I wonder why I'm all of a sudden having issues when I haven't changed my irresponsible and destructive behavior?

I've never commented on bars. I haven't been in a bar since this all began. All I've said is when I drive by restaurants they don't appear to be any more or less crowded than they were in all summer. I'm literally just referring to my area and county. I have no clue what's going on in yours and I don't pretend to.

No one is arguing that it can't be spread without awareness and I'm not sure if you meant to or not, but you just talked about exponential growth and then compared it to drinking mountain dew for years and then suddenly having diabetes, that's a pretty poor analogy for exponential growth.

You sure like to get argumentative don't you? What irresponsible behavior have I engaged in? I'm not congregating around unmasked people all day like you are. Just saying.

I'm not singling you out specifically.  Other people have commented on both bars and restaurants.  Not necessarily that they are participating, just making observations that other people are obviously dining indoors and visiting bars.  I've made the same observations.

Maybe it's not the perfect analogy, but society at large has been in the dangerous prediabetic range for months, never fully getting it under control, and just able to limp along because it's not full blown diabetes yet.  But they've continued to indulge themselves along the way, and here we are.

You state that "something is going on" in reference to large uptick in recent cases.  Yeah, a highly infectious pandemic is going on.  It never went away. The USA had its first "wave" or peak, but it looks more like a plateau.  People aren't wearing masks as much as they should.  They aren't social distancing as much as they should.  And they aren't avoiding gatherings, be it public or private, as much as they should.  Now the weather is getting cold and people are moving activities indoors and children are going back to school.  It's not surprising in the least that cases are skyrocketing. 

mm1970

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Re: How long can we wait while flattening the curve?
« Reply #4879 on: November 20, 2020, 10:16:11 AM »
Something is going on. I'm just not sure I'm not fully buying the complacency and pandemic fatigue argument. I feel like you could have made this exact same argument in July or August. After all why would someone not get fatigue after 5-6 months, but suddenly complacency and pandemic fatigue become a huge problem at months 7 & 8. Perhaps it's exacerbated by school, but where I'm at school has been in since mid August and we didn't start to see much of a spike until the end of October, over 2 months after school had already been back in session. I'm honestly thinking weather does have a pretty huge factor in the transmission of the this virus. The only factor that we can be certain has changed in the past 1-1.5 months is the weather becoming cooler.
I mean, it's exactly like July / August.  People WERE feeling the fatigue then, and that's when we peaked (here anyway, and in the state in general). 

Lo and behold, at least our state is BACK up to where we were in July / Aug (my county, at about 2/3 that level).

I don't think it's exacerbated by school.  As others have mentioned:
1.  It's colder.  Aerosols go further in cold dry weather.
2.  It's colder - people are gathering indoors and not outdoors (possibly why we are better off, being in So Cal).

Contact tracing HERE is still finding indoor gatherings to be the culprit - now it's office workers who aren't distancing and are letting their guard down, not masking.

T-Money$

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Re: How long can we wait while flattening the curve?
« Reply #4880 on: November 20, 2020, 02:58:21 PM »
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006207.pub5/full

Key messages

We are uncertain whether wearing masks or N95/P2 respirators helps to slow the spread of respiratory viruses.

Hand hygiene programmes may help to slow the spread of respiratory viruses.

GuitarStv

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Re: How long can we wait while flattening the curve?
« Reply #4881 on: November 20, 2020, 03:11:51 PM »
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006207.pub5/full

Key messages

We are uncertain whether wearing masks or N95/P2 respirators helps to slow the spread of respiratory viruses.

Hand hygiene programmes may help to slow the spread of respiratory viruses.


You seem to be significantly more sure of the findings than the people who wrote the linked study.
Quote
We included 44 new RCTs and cluster‐RCTs in this update, bringing the total number of randomised trials to 67. There were no included studies conducted during the COVID‐19 pandemic. Six ongoing studies were identified, of which three evaluating masks are being conducted concurrent with the COVID pandemic, and one is completed.

Many studies were conducted during non‐epidemic influenza periods, but several studies were conducted during the global H1N1 influenza pandemic in 2009, and others in epidemic influenza seasons up to 2016. Thus, studies were conducted in the context of lower respiratory viral circulation and transmission compared to COVID‐19. The included studies were conducted in heterogeneous settings, ranging from suburban schools to hospital wards in high‐income countries; crowded inner city settings in low‐income countries; and an immigrant neighbourhood in a high‐income country. Compliance with interventions was low in many studies.

The risk of bias for the RCTs and cluster‐RCTs was mostly high or unclear.


Quote
The high risk of bias in the trials, variation in outcome measurement, and relatively low compliance with the interventions during the studies hamper drawing firm conclusions and generalising the findings to the current COVID‐19 pandemic.

simmias

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Re: How long can we wait while flattening the curve?
« Reply #4882 on: November 20, 2020, 03:38:54 PM »
LOL, how does everybody here not have that guy on ignore already.

RetiredAt63

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Re: How long can we wait while flattening the curve?
« Reply #4883 on: November 20, 2020, 03:43:05 PM »
Made a quick stop at Canadian Tire today.  It wasn't crowded and  everyone was wearing a mask and observing distance.  Until the guy in the checkout line who wasn't even pretending to cover his nose with his mask.  At least he observed distance from the person in front of him, and I observed double distance behind him.
« Last Edit: November 21, 2020, 11:03:23 AM by RetiredAt63 »

marty998

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Re: How long can we wait while flattening the curve?
« Reply #4884 on: November 20, 2020, 06:22:47 PM »
That olí curve is going parabolic. 60,000+ Americans over and above the normal mortality rate are not going to see Christmas (based on 2,000 a day dying now).

Particularly saddened to read about the nurse who tweeted in frustration about the people still shouting with their dying breaths that itís all a hoax.

Youíd like to think there is hope for brainwashed people but maybe some people are just too far gone.

Goldielocks

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Re: How long can we wait while flattening the curve?
« Reply #4885 on: November 20, 2020, 11:53:42 PM »
Bloop bloop I don't know whether to laugh or to cry.  Regular cycles are not as common as you may think, and lots of things can throw a cycle off.  Both partners disciplined- seriously, when there are guys out there who don't even want to wear condoms, you think they will be part of a disciplined couple?  And the testing?  How often?  I don't think my provincial health care would be very helpful on that, and you already know from comments here about the American system.

Seriously, if you and a girlfriend were planning to have sex, do you really think she would do all that monitoring?  And trust you to hold off during her (theoretical) fertile time, And a few days either side just in case?   Hypothetical me in that hypothetical situation would be on the pill or an IUD or condom+cervical cap+spermicidal jelly.

Sorry about the semi-rant, got a little distracted there.

I will tell you something that may not be as true today as it was then.  When reliable birth control became available for women, we grabbed it, because we were the ones who got pregnant when our partners were irresponsible, or the condom slipped, or we ovulated early/late.

To be fair, fertile time often means "really want sex time", back then, if I added a bit of alcohol I was not always the responsible one for 2 days of the month... so I went onto birth control based on decision making during my lucid moments.

I bet guys have 90% responsible and 10% "oops" approaches, too.

lemanfan

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Re: How long can we wait while flattening the curve?
« Reply #4886 on: November 21, 2020, 02:55:58 AM »
Even more importantly, just looking at the raw COVID death data is misleading in itself. The only proper metric for this pandemic is excess deaths.

Swedish authorities, Europe's odd men out released some preliminary population stats today due to getting lots of questions. Generally these are released at some point the following year and hardly anyone cares. So far this year Sweden's total deaths is a bit higher than 2016-2019, but lower than 2015 (all for period until November). This is, admittingly a breach with a slightly downward sloping  trend, but not by a lot and you wouldn't really notice there had been a pandemic if you looked at annual data. But if you zoomed in, you would see excess deaths in march/april, then lower mortality than normal afterwards. This at least suggests a lot of the Covid-19 deaths did not have a lot of time left in them under normal circumstances.

You would find exactly zero people who would have guessed this after being bombarded with headlines and high-frequency data for 9 months now - that Im pretty certain of.

I'm sorry but I don't really follow what you said about Sweden there.  Can you elaborate a bit?

I have not looked very deep  in to the numbers here but the official total deaths per year in Sweden the last few years can be seen in the attached file with a single line graph.  (from https://www.scb.se/hitta-statistik/sverige-i-siffror/manniskorna-i-sverige/doda-i-sverige/)

And for a more high resolution of the normal and excess deaths the past five years, these numbers were published yesterday.  The green numbers are the normal average, and the purple is the actual deaths per month that can be seen in the other attached file.
 
(from https://www.folkhalsomyndigheten.se/folkhalsorapportering-statistik/statistik-a-o/sjukdomsstatistik/covid-19-veckorapporter/senaste-covidrapporten/ and more specifically https://www.folkhalsomyndigheten.se/globalassets/statistik-uppfoljning/smittsamma-sjukdomar/veckorapporter-covid-19/2020/covid-19-veckorapport-vecka-46-final.pdf )

2015 seems to be quite average in these numbers.  (population in 2015 was about 9,7 million and is now 10,3 if that matters).

Bloop Bloop Reloaded

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Re: How long can we wait while flattening the curve?
« Reply #4887 on: November 21, 2020, 02:59:08 AM »
Victoria's mask edict seems to be on the line for removal tomorrow. Fingers crossed.

middo

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Re: How long can we wait while flattening the curve?
« Reply #4888 on: November 21, 2020, 04:21:17 AM »
Victoria's mask edict seems to be on the line for removal tomorrow. Fingers crossed.

My prediction is that outside they will go, but inside and on public transport they will be required.  Which means I still need to tell the kids at school to wear their masks as masks, not chin nappies.

Bloop Bloop Reloaded

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Re: How long can we wait while flattening the curve?
« Reply #4889 on: November 21, 2020, 04:46:44 AM »
Victoria's mask edict seems to be on the line for removal tomorrow. Fingers crossed.

My prediction is that outside they will go, but inside and on public transport they will be required.  Which means I still need to tell the kids at school to wear their masks as masks, not chin nappies.

They should definitely still be required inside public indoor spaces and on public transport. It would be unwise to change that.

OtherJen

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Re: How long can we wait while flattening the curve?
« Reply #4890 on: November 21, 2020, 09:00:42 AM »
We are almost at 200K cases per day, and if we keep up this daily death count for the rest of the year (41 days), we'll rack up another 78K COVID deaths by New Year's Day. However, the 50% increase in hospital admissions for COVID nationwide is the really concerning part. In Michigan, 16 counties have maxed out their ICU capacity, and another 11 are at more than 70% ICU occupancy. https://www.covidactnow.org/us/michigan-mi?s=1353339

We haven't even hit Thanksgiving yet.

RetiredAt63

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Re: How long can we wait while flattening the curve?
« Reply #4891 on: November 21, 2020, 11:01:39 AM »
Bloop bloop I don't know whether to laugh or to cry.  Regular cycles are not as common as you may think, and lots of things can throw a cycle off.  Both partners disciplined- seriously, when there are guys out there who don't even want to wear condoms, you think they will be part of a disciplined couple?  And the testing?  How often?  I don't think my provincial health care would be very helpful on that, and you already know from comments here about the American system.

Seriously, if you and a girlfriend were planning to have sex, do you really think she would do all that monitoring?  And trust you to hold off during her (theoretical) fertile time, And a few days either side just in case?   Hypothetical me in that hypothetical situation would be on the pill or an IUD or condom+cervical cap+spermicidal jelly.

Sorry about the semi-rant, got a little distracted there.

I will tell you something that may not be as true today as it was then.  When reliable birth control became available for women, we grabbed it, because we were the ones who got pregnant when our partners were irresponsible, or the condom slipped, or we ovulated early/late.

To be fair, fertile time often means "really want sex time", back then, if I added a bit of alcohol I was not always the responsible one for 2 days of the month... so I went onto birth control based on decision making during my lucid moments.

I bet guys have 90% responsible and 10% "oops" approaches, too.

Oh definitely.  Decisions should be made while brain is in adult mode.  As in, don't grocery shop when you are super hungry, arrange your transport home before you go out drinking, plan your birth control so it isn't sidetracked by "right now" feelings.  And have your mask at the front door so you remember it, not like my neighbour who saw me with my mask on and scurried back to his apartment for his mask.  (Had to get us back on topic somehow).

Watchmaker

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Re: How long can we wait while flattening the curve?
« Reply #4892 on: November 22, 2020, 09:12:57 AM »
Just out of curiosity how do you know bars are packed and that alot of people are having massive parties at home in your area? Is it on the news or something?

I've gotten my information from our county health department, from Facebook, from friends who work in bars and restaurants, and from looking in the windows of the bars I walk my dog past.

At least where I am, it's not that we've suddenly stopped appropriate pandemic behavior--we've never really had appropriate pandemic behavior. Cases have been climbing all year, it's just the nature of exponential growth that it seems slow until it doesn't. Our county's contract tracing people reported the most common transmission event in our area has been small (4-8) gatherings. In the nicer weather a lot of those events were naturally outside anyway-- now those parties and hangouts will be inside, accelerating the spread.

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #4893 on: November 22, 2020, 10:45:10 AM »
Weíre really stumbling at the finish line here in the US. Looking at deaths vs 3 week lagged cases, itís hard to see the next six weeks or so not being the worst weíve seen. The healthcare system is gonna get really stressed. My heart goes out to first line healthcare workers.

frugalnacho

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Re: How long can we wait while flattening the curve?
« Reply #4894 on: November 22, 2020, 11:31:12 AM »
Just out of curiosity how do you know bars are packed and that alot of people are having massive parties at home in your area? Is it on the news or something?

I've gotten my information from our county health department, from Facebook, from friends who work in bars and restaurants, and from looking in the windows of the bars I walk my dog past.

At least where I am, it's not that we've suddenly stopped appropriate pandemic behavior--we've never really had appropriate pandemic behavior. Cases have been climbing all year, it's just the nature of exponential growth that it seems slow until it doesn't. Our county's contract tracing people reported the most common transmission event in our area has been small (4-8) gatherings. In the nicer weather a lot of those events were naturally outside anyway-- now those parties and hangouts will be inside, accelerating the spread.

Exactly.  More cases beget more cases.  Doubling from 40 cases/day to 80 cases/day and no one cares because it's only 40 more cases, but going from 4k/day to 8k/day seems alarming.  It is alarming, but not unexpected at all because the usa as a whole never got anything under control. 

T-Money$

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Re: How long can we wait while flattening the curve?
« Reply #4895 on: November 22, 2020, 11:33:05 AM »
"We consider it is unwise to infer causation based on regional geographical observations as several proponents of masks have done," Heneghan wrote in July. "Spikes in cases can easily refute correlations, compliance with masks and other measures is often variable, and confounders cannot be accounted for in such observational research."

https://www.washingtonexaminer.com/news/researchers-withdraw-study-showing-efficacy-of-mask-mandates-after-increased-virus-cases-in-areas-observed

Researchers withdraw study showing efficacy of mask mandates after increased virus cases in areas observed

scottish

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Re: How long can we wait while flattening the curve?
« Reply #4896 on: November 22, 2020, 12:40:10 PM »
Multi-variate statistics are fun, T-Money$.

Good news - the Ottawa R number has been less than 1 for November and through most of October.   Active cases are down to 367 from a peak of 1500.   If we can do it, so can you!   Mask on!

RetiredAt63

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Re: How long can we wait while flattening the curve?
« Reply #4897 on: November 22, 2020, 02:24:53 PM »
Multi-variate statistics are fun, T-Money$.

Good news - the Ottawa R number has been less than 1 for November and through most of October.   Active cases are down to 367 from a peak of 1500.   If we can do it, so can you!   Mask on!

Except for the nicely suited man at Canadian Tire whose mask stopped right above his mouth, below his nose.  Who very carefully ignored me.  If looks could kill he'd be at the morgue now.  Not sure whether "twit" or "covidiot" was more approptiate.  But yes, really, Ottawans in general are being very mask conscious.

Abe

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Re: How long can we wait while flattening the curve?
« Reply #4898 on: November 22, 2020, 09:22:57 PM »
I think the ultimate result from our current spike will be several mostly rural states with situations similar to Northeast's first spike. States with larger absolute ICU capacity (even if lower per capita) will skate by with using PACU and stepdown units for ICU capacity.

I have been thinking about clinical treatment and triage schemes, since that time is approaching us and I may be put into the COVID call (probably just lines at first, then ICU to relieve the intensivists). I thought it'd be worth sharing with you what my friends in critical care with COVID experience have been talking about:

One triage scheme that we think is the most just is:
Scenario 1: A new unstable (needs intubation) patient arrives in the ER, we will try to rapidly stabilize them but if we can't get to adequate oxygenation in ___ hours, we will have to withdraw care as futile, as that vent will be needed by someone who may have a better outcome.

Scenario 2: A new stable patient arrives in ER, we maintain them on high-flow or non-invasive ventilation. If they deteriorate within __ hours then they are intubated if ventilators and ICU capacity is available.

Scenario 3: A previously stable patient is deteriorating at the same time as a new unstable patient arrives. We probably should intubate the new patient as we don't know their trajectory (and they potentially may recover), but do know the previously stable patient's trajectory is worsening (and high risk of not recovering). The other alternative is using known clinical prognostic factors as a tie-breaker.

Scenario 4: Non-COVID patient (stroke, heart attack, trauma) comes in unstable. They would need to be triaged and probably assessed for survivability. If they can be stabilized and sent to the floor, that's the best even if standard care would be ICU. If they deteriorate rapidly, they'd fall into the above algorithm for recoverability.

This triage scheme doesn't a-priori deny treatment to people based on clinical factors, but does give them a shot to prove their stability. It does assume that failure at early rescue is predictive of death, but I don't know if that's necessarily true with COVID. What we can't afford is to have a bunch of people with anoxic brains taking up ventilators, and the risk of anoxia increases exponentially with time. UCSF has a mean time to stable ventilation of a few hours (compared to >24hrs) with aggressive ventilator adjustments, so this early decision scheme could be done. The problem is that there are a lot of physicians with some critical care experience, but not enough experience to manage ARDS or multi-organ failure. In NYC they had standard protocols that pretty much anyone could follow (until the person fell out of that criteria, then it's just crank everything up and wait until arrest). They did not have standard protocols for triage, though, since those hospitals are huge and had (barely) enough ICU surge capacity. Many rural hospitals face both an over-capacity situation and a high average acuity situation. They will not do well.

I never imagined we would, outside of a mass-casualty incident, ever have to think about these things in the US. But here we are, again, within the space of a year.

MayDay

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Re: How long can we wait while flattening the curve?
« Reply #4899 on: November 23, 2020, 05:07:25 AM »
Abe and other medical personnel, I've read that rural "ICU" nurses and doctors are not really qualified to deal with serious ICU situations as they typically transfer those patients out to a larger facility. Do you think that is accurate?