Author Topic: How long can we wait while flattening the curve?  (Read 361953 times)

Abe

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Re: How long can we wait while flattening the curve?
« Reply #4900 on: November 23, 2020, 05:34:42 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?

Depends on the facility and situation. Basic ICU care (sepsis, heart failure, stroke) they are definitely qualified. The other situations they could handle in small volumes, but would likely transfer out because outcomes are better at places that deal with the more difficult situations on a regular basis. Not because the low-volume hospitals are less competent, but maybe less experienced as a system. I would say that many nurses and physicians in rural areas are older and have more experience than we give credit for. But when you have a 10-bed ICU, you fill up fast. Thus they avoid biting off more than they can chew.

Jouer

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Re: How long can we wait while flattening the curve?
« Reply #4901 on: November 23, 2020, 08:13:24 AM »
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.

Jeeeeesus. Thank you Abe for the eye-opening insight from someone in the know.

T-Money$

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Re: How long can we wait while flattening the curve?
« Reply #4902 on: November 23, 2020, 09:46:09 AM »
COVID deaths by age in Minnesota and a chart comparing New Mexico (stringent COVID restrictions) vs Utah (significantly less COVID restrictions) with almost identical case numbers.

States that have fully opened up like Georgia and Florida now have lower case numbers per capita then places like NY, NJ and PA.



frugalnacho

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Re: How long can we wait while flattening the curve?
« Reply #4905 on: November 23, 2020, 11:23:29 AM »
You are ignoring this user. Show me the post.

You are ignoring this user. Show me the post.

All his posts are exactly the same for me.

Montecarlo

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Re: How long can we wait while flattening the curve?
« Reply #4906 on: November 23, 2020, 12:09:25 PM »
From my anecdotal experience, I'm not surprised mask mandates don't work.  When I am out in public, which is rare with the recent surge, people are rarely wearing them correctly.

What's interesting is how people interpret that, I think. 
If you're fairly liberal, you highlight the dangers of demagogues promoting fake news and sowing discord as reasons people aren't following the guidelines.
If you're fairly conservative, you suggest that science has run amok, promoting interventions that cannot be justified.
If you're fairly libertarian, you smile inwardly at the thought of a big, diverse population ever being effectively herded with mandates.

Villanelle

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Re: How long can we wait while flattening the curve?
« Reply #4907 on: November 23, 2020, 12:25:42 PM »
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.

Wow.  Thanks for this.  It seems so obvious, but I hadn't pieced this aspect of it together myself.  With a vaccine, compliance isn't an issue.  Someone slipping off their mask in the grocery store for just a moment to let in cool air isn't a problem.  They can't momentarily take out the vaccination like they can take off a mask, or stick a finger under it to scratch, or not wear if while taking out the trash and then running in to a neighbor, or not feeling they need it in their home while the plumber does a quick repair.  Sticking a needle on the arm is essentially forcing 100% compliance with the parameters of the study.  Of course!

I'm annoyed with myself for not making that connection.  Thanks for doing it for me! 

deborah

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Re: How long can we wait while flattening the curve?
« Reply #4908 on: November 23, 2020, 12:43:10 PM »
From my anecdotal experience, I'm not surprised mask mandates don't work.
Depends where you live. They work very well in a lot of countries.

lutorm

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Re: How long can we wait while flattening the curve?
« Reply #4909 on: November 23, 2020, 10:03:15 PM »
I guess this thread should be closed now since we're clearly not flattening the curve any more?

marty998

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Re: How long can we wait while flattening the curve?
« Reply #4910 on: November 24, 2020, 02:19:13 AM »
From my anecdotal experience, I'm not surprised mask mandates don't work.  When I am out in public, which is rare with the recent surge, people are rarely wearing them correctly.

What's interesting is how people interpret that, I think. 
If you're fairly liberal, you highlight the dangers of demagogues promoting fake news and sowing discord as reasons people aren't following the guidelines.
If you're fairly conservative, you suggest that science has run amok, promoting interventions that cannot be justified.
If you're fairly libertarian, you smile inwardly at the thought of a big, diverse population ever being effectively herded with mandates.

Is it too forlorn to hope there is a forth category of "fairly human being" who simply tries to do the right thing?

Paper Chaser

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Re: How long can we wait while flattening the curve?
« Reply #4911 on: November 24, 2020, 04:31:37 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.

Wow.  Thanks for this.  It seems so obvious, but I hadn't pieced this aspect of it together myself.  With a vaccine, compliance isn't an issue.  Someone slipping off their mask in the grocery store for just a moment to let in cool air isn't a problem.  They can't momentarily take out the vaccination like they can take off a mask, or stick a finger under it to scratch, or not wear if while taking out the trash and then running in to a neighbor, or not feeling they need it in their home while the plumber does a quick repair.  Sticking a needle on the arm is essentially forcing 100% compliance with the parameters of the study.  Of course!

I'm annoyed with myself for not making that connection.  Thanks for doing it for me!

According to the US CDC, it takes several minutes of close proximity to make contracting this virus likely. Things like a person lifting their mask in the grocery, or sticking a finger under it to scratch, or taking garbage out without a mask have extremely low risk for transmitting the virus to anybody else. The time/proximity just aren't there. This virus is transferred with close, extended contact. You're most likely to get it from friends and family where you let your guard down, or in confined public spaces where people linger without masks (bars, church, spas, etc).

It doesn't change the overall point that a vaccine is effective all the time, but I think it's important to understand what is/isn't a risky behavior per the CDC.
« Last Edit: November 24, 2020, 06:29:51 AM by Paper Chaser »

habanero

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Re: How long can we wait while flattening the curve?
« Reply #4912 on: November 24, 2020, 10:23:43 AM »

According to the US CDC, it takes several minutes of close proximity to make contracting this virus likely. Things like a person lifting their mask in the grocery, or sticking a finger under it to scratch, or taking garbage out without a mask have extremely low risk for transmitting the virus to anybody else. The time/proximity just aren't there. This virus is transferred with close, extended contact. You're most likely to get it from friends and family where you let your guard down, or in confined public spaces where people linger without masks (bars, church, spas, etc).

It doesn't change the overall point that a vaccine is effective all the time, but I think it's important to understand what is/isn't a risky behavior per the CDC.

We had, at least for a long time, pretty good contact tracing. The attached graph shows assumed place of infection for the last 8 weeks.

From bottom to top:

Unknown (dark purple)
Household (green)
Job/university (dark blue)
public event (the timy orange)
priavte gathering (lighter blue)
bar/restaurant/cafe (red)
daycare / kids school (up to 10th grade I assume) (dark yellow)
health vare insititution (grey)
other (light blue)
data not yet available (beige)

When the red (bars/restaurants/etc) gets really small for the last few weeks is predominantly that they for most practical purposes to a large extent had to close as they couldn't sell alcohol in the most populous areas.  Also, when cases started to climb steeply (total number on top) is pretty much when mask-wearing got widespread due to a sharp rise in infections. Before that it was virtually non-existent in public except for crowded public transport. It would probably be worse with no mask wearing, but it didn't make infections go donw once ppl starting wearing those. And the tinyness of "public events" is largely due to there has hardly been any of the kind.

« Last Edit: November 24, 2020, 10:54:36 AM by habanero »

Villanelle

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Re: How long can we wait while flattening the curve?
« Reply #4913 on: November 24, 2020, 02:11:19 PM »
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.

Wow.  Thanks for this.  It seems so obvious, but I hadn't pieced this aspect of it together myself.  With a vaccine, compliance isn't an issue.  Someone slipping off their mask in the grocery store for just a moment to let in cool air isn't a problem.  They can't momentarily take out the vaccination like they can take off a mask, or stick a finger under it to scratch, or not wear if while taking out the trash and then running in to a neighbor, or not feeling they need it in their home while the plumber does a quick repair.  Sticking a needle on the arm is essentially forcing 100% compliance with the parameters of the study.  Of course!

I'm annoyed with myself for not making that connection.  Thanks for doing it for me!

According to the US CDC, it takes several minutes of close proximity to make contracting this virus likely. Things like a person lifting their mask in the grocery, or sticking a finger under it to scratch, or taking garbage out without a mask have extremely low risk for transmitting the virus to anybody else. The time/proximity just aren't there. This virus is transferred with close, extended contact. You're most likely to get it from friends and family where you let your guard down, or in confined public spaces where people linger without masks (bars, church, spas, etc).

It doesn't change the overall point that a vaccine is effective all the time, but I think it's important to understand what is/isn't a risky behavior per the CDC.

If that finger has virus in it, it could (though still a low probability).  And I specifically mentioned stopping to talk to a neighbor while taking out the trash, for exactly that reason.  And the reason it's a risk is in part because people think that it's a trip out to the trashcan. Very low risk.  But they don't take into account that they might run into the little old lady who lives next door and wants to talk to another human being for a while.  So they don't mask up. 

Montecarlo

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Re: How long can we wait while flattening the curve?
« Reply #4914 on: November 24, 2020, 04:36:57 PM »
A five minute chat outdoors at presumably >arms length is negligible risk

Paper Chaser

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Re: How long can we wait while flattening the curve?
« Reply #4915 on: November 25, 2020, 04:37:29 AM »

According to the US CDC, it takes several minutes of close proximity to make contracting this virus likely. Things like a person lifting their mask in the grocery, or sticking a finger under it to scratch, or taking garbage out without a mask have extremely low risk for transmitting the virus to anybody else. The time/proximity just aren't there. This virus is transferred with close, extended contact. You're most likely to get it from friends and family where you let your guard down, or in confined public spaces where people linger without masks (bars, church, spas, etc).

It doesn't change the overall point that a vaccine is effective all the time, but I think it's important to understand what is/isn't a risky behavior per the CDC.

If that finger has virus in it, it could (though still a low probability).  And I specifically mentioned stopping to talk to a neighbor while taking out the trash, for exactly that reason.  And the reason it's a risk is in part because people think that it's a trip out to the trashcan. Very low risk.  But they don't take into account that they might run into the little old lady who lives next door and wants to talk to another human being for a while.  So they don't mask up.

I'm saying that even if you talk to the little old lady for a few minutes, and neither of you is wearing a mask, it's still probably very low risk. You're outdoors, and presumably several feet apart. The consensus from medical professionals for months has been that being indoors, close together, for several minutes at a time, and maskless are the drivers for spreading this virus. The person that walks past you in the grocery aisle with their mask on their chin is incredibly unlikely to transfer the virus to you. Jogging past somebody on a trail is super low risk. Even being indoors, without masks but more than 6ft apart is pretty low risk because of the distancing. Watch a news program or sports show on TV and the broadcasters are often maskless, indoors, but spaced far enough apart to be considered low risk. You have to have close proximity and some time and poor ventilation and no masks to be high risk of spreading this virus. The risk drops each time one of those ingredients is removed.

For a current example, Being in an airport terminal or a gas station while traveling for Thanksgiving is not the risky part (although it is riskier than staying home); it's the maskless family get together at the end of the trip that's going to spread this virus.
« Last Edit: November 25, 2020, 04:45:04 AM by Paper Chaser »

RetiredAt63

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Re: How long can we wait while flattening the curve?
« Reply #4916 on: November 25, 2020, 06:48:16 AM »
The unmasked person going by you at the grocery store is only momentary exposure, but they are shedding virus the whole time they are in the store.  How many people times how long they are in the store does it take before the air has a significant amount of virus?  And exposure can increase when you are in the checkout line.  Yes we are distancing,  but there is proximity.

DD has a friend, early 30s, with Covid causing neurological issues with short and long term memory.    His odds of surviving are excellent, but it's scary to think the neurological issues could linger.

frugalnacho

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Re: How long can we wait while flattening the curve?
« Reply #4917 on: November 25, 2020, 07:35:41 AM »
I was under the impression it was airborne and social distancing alone was insufficient in poorly ventilated indoor areas. 

RetiredAt63

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Re: How long can we wait while flattening the curve?
« Reply #4918 on: November 25, 2020, 08:21:57 AM »
I was under the impression it was airborne and social distancing alone was insufficient in poorly ventilated indoor areas.

Me too, which is why I get so ticked off at people wearing masks improperly.  And I don't want to get close enough to them to tell them off,  since they don't get the message from 2 M away.

Abe

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Re: How long can we wait while flattening the curve?
« Reply #4919 on: November 25, 2020, 08:43:41 PM »
That’s correct. The dynamics of viral spread in an enclosed space depends on many factors:
Infectors-
density of sources (people with the virus), cumulative time in the store, severity of their infection and percentage of time with the nasal passages unfiltered (number of particles expelled) and force of expulsion (coughing/sneezing vs normal breathing)
 
Infectees-
density of non-immune people, exposure risk of non-infected people (combination of suitable quality face covering, infection risk of the target cells, and time they are in the space).

As you can see, crowded bars and restaurants will be highest risk due to uncovered infectors and infectees, along with cumulative time both are in proximity. The six feet guideline is not well supported and basically is extrapolated from average spread of respiratory droplets with coughing. Airborne virii are not subject to that, and will linger for longer periods such that in an enclosed space the risk of walking into a cloud of particles is higher.

Conversely I have seen some articles saying that hand hygiene is unnecessary but those articles miss the point that the particles do eventually settle onto surfaces.

The underlying problem is that some people want hard and fast rules for 100% avoiding infection, but this is a complex biological interaction that does not have such rules, other than the one they don’t want to hear, which is stay home and don’t go anywhere crowded, ever.
« Last Edit: November 25, 2020, 08:46:25 PM by Abe »

ender

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Re: How long can we wait while flattening the curve?
« Reply #4920 on: November 25, 2020, 09:26:37 PM »
I was under the impression it was airborne and social distancing alone was insufficient in poorly ventilated indoor areas.

Me too, which is why I get so ticked off at people wearing masks improperly.  And I don't want to get close enough to them to tell them off,  since they don't get the message from 2 M away.

This is what gets me, so many people don't wear them correctly at all.

And I have no idea if the new trend for the mini-faceshield mask actually work or not - stuff like https://www.amazon.com/10PCS-Professional-Transparent-Sanitary-Cover/dp/B083P4SZHR - but a significant percentage of people around here wear those. Which seem... pretty pointless. Better than nothing, maybe, but completely missing the point of why you wear a mask.

RetiredAt63

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Re: How long can we wait while flattening the curve?
« Reply #4921 on: November 26, 2020, 06:36:09 AM »
Has anyone seen any recent research on eye exposure versus breathing it in?  I remember back in March there was a lot of emphasis on not touching your face, and especially your eyes.  But as a respiratory virus how likely is transmission that way?  I am guessing low?  I know the lacrimal ducts drain imto the nasal passages, so I would assume something greater than zero, but how much?  Face shields protect eyes somewhat but I can't see them as a substitute for masks.  And seriously, safety glasses with side wings would seem to provide more protection than a face shield.

GuitarStv

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Re: How long can we wait while flattening the curve?
« Reply #4922 on: November 26, 2020, 07:28:24 AM »
I was under the impression it was airborne and social distancing alone was insufficient in poorly ventilated indoor areas.

Me too, which is why I get so ticked off at people wearing masks improperly.  And I don't want to get close enough to them to tell them off,  since they don't get the message from 2 M away.

This is what gets me, so many people don't wear them correctly at all.

And I have no idea if the new trend for the mini-faceshield mask actually work or not - stuff like https://www.amazon.com/10PCS-Professional-Transparent-Sanitary-Cover/dp/B083P4SZHR - but a significant percentage of people around here wear those. Which seem... pretty pointless. Better than nothing, maybe, but completely missing the point of why you wear a mask.

Those are completely useless, and (given the false sense of security) I'd argue worse than nothing.

mm1970

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Re: How long can we wait while flattening the curve?
« Reply #4923 on: November 27, 2020, 10:55:46 AM »
Quote
The underlying problem is that some people want hard and fast rules for 100% avoiding infection, but this is a complex biological interaction that does not have such rules, other than the one they don’t want to hear, which is stay home and don’t go anywhere crowded, ever.

This is very well said.

Also:

https://www.healthline.com/health-news/weather-doesnt-matter-covid-19-can-spread-in-warm-or-cold-temperatures

In short, when it gets cold outside, people spend more time indoors with others.  What do PA, NY, and NJ have in common?  Northern, colder climates and density of people.

FL and GA?  Warmer, less time indoors.

OtherJen

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Re: How long can we wait while flattening the curve?
« Reply #4924 on: November 27, 2020, 02:55:16 PM »
We did pretty well here in Michigan through the summer. Many people got a good scare from the over-capacity hospitals and funeral homes, the FEMA field hospital, and mobile morgues last spring. We also had lots of opportunities to be outdoors, no colleges in session, and the state legislature hadn't yet neutered the governor's ability to issue further executive orders or states of emergency. (The Department of Health stepped up when that happened last month, but their powers are limited.)

Now that 1) we're back indoors and 2) the virus has spread outstate to areas that weren't hit as hard last spring and where people are more likely to take an anti-mask political statement (from today's headlines):

Michigan confirms 17,162 new coronavirus cases, 172 deaths over 2-day period (Detroit Free Press; daily case average is now regularly over 8k)

In the UP, hospitals near a breaking point as COVID surges (Michigan Public Radio)

middo

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Re: How long can we wait while flattening the curve?
« Reply #4925 on: November 27, 2020, 03:07:34 PM »
Victoria, Australia has now eliminated the virus after 28 days of no cases reported and no active cases.  The lockdown was long and at times difficult, but worth it.  We still have to wear masks indoors, and if we cannot socially distance.

Australia has only one state with any local (not acquired overseas and found in quarantine) cases, South Australia.  SA had one case yesterday only.  We are headed for a nationwide elimination sometime about a month away, with only cases in the quarantine from overseas Australians returning home.

I am so happy that our state Premiers decided to eliminate this virus rather than follow our Federal governments initial plans to only "flatten the curve".  We squashed it.

OtherJen

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Re: How long can we wait while flattening the curve?
« Reply #4926 on: November 27, 2020, 04:01:59 PM »
Victoria, Australia has now eliminated the virus after 28 days of no cases reported and no active cases.  The lockdown was long and at times difficult, but worth it.  We still have to wear masks indoors, and if we cannot socially distance.

Australia has only one state with any local (not acquired overseas and found in quarantine) cases, South Australia.  SA had one case yesterday only.  We are headed for a nationwide elimination sometime about a month away, with only cases in the quarantine from overseas Australians returning home.

I am so happy that our state Premiers decided to eliminate this virus rather than follow our Federal governments initial plans to only "flatten the curve".  We squashed it.

I'm envious. Our state's governor took a hard line. It ended up in an assassination plot against her.

marty998

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Re: How long can we wait while flattening the curve?
« Reply #4927 on: November 27, 2020, 05:24:22 PM »
Victoria, Australia has now eliminated the virus after 28 days of no cases reported and no active cases.  The lockdown was long and at times difficult, but worth it.  We still have to wear masks indoors, and if we cannot socially distance.

Australia has only one state with any local (not acquired overseas and found in quarantine) cases, South Australia.  SA had one case yesterday only.  We are headed for a nationwide elimination sometime about a month away, with only cases in the quarantine from overseas Australians returning home.

I am so happy that our state Premiers decided to eliminate this virus rather than follow our Federal governments initial plans to only "flatten the curve".  We squashed it.

It’s amazing isn’t it. We’ve got to the point where just a single case in the entire country makes for breaking/rolling news coverage.

Economically I reckon we* might be in for a bit of a golden age if we can maintain this. The funny thing about capital is that it doesn’t require a large movement of people.

Sure we have our problems, but the instability and excess deaths and long term health effects to populations in other countries are going to make us an attractive destination for capital investment over the next couple of years.

*throw NZ into this equation too.

Bloop Bloop Reloaded

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Re: How long can we wait while flattening the curve?
« Reply #4928 on: November 27, 2020, 06:18:33 PM »
Hopefully that leads to our Aussie dollar going higher - would be a nice reward to those of us who haven't been spending much during the pandemic. Hopefully also leads to our interest rates rising soon because I don't want inflation/wage growth to be going back to 4% anytime soon, and I'm a little worried about our shares/property being inflated due to low interest rates.

RetiredAt63

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v8rx7guy

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Re: How long can we wait while flattening the curve?
« Reply #4930 on: November 27, 2020, 07:15:10 PM »
Victoria, Australia has now eliminated the virus after 28 days of no cases reported and no active cases.  The lockdown was long and at times difficult, but worth it.  We still have to wear masks indoors, and if we cannot socially distance.

Australia has only one state with any local (not acquired overseas and found in quarantine) cases, South Australia.  SA had one case yesterday only.  We are headed for a nationwide elimination sometime about a month away, with only cases in the quarantine from overseas Australians returning home.

I am so happy that our state Premiers decided to eliminate this virus rather than follow our Federal governments initial plans to only "flatten the curve".  We squashed it.

So... now what?  When do you get to stop having to pretend like you're infected and wear masks everywhere?

middo

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Re: How long can we wait while flattening the curve?
« Reply #4931 on: November 27, 2020, 10:31:41 PM »
Victoria, Australia has now eliminated the virus after 28 days of no cases reported and no active cases.  The lockdown was long and at times difficult, but worth it.  We still have to wear masks indoors, and if we cannot socially distance.

Australia has only one state with any local (not acquired overseas and found in quarantine) cases, South Australia.  SA had one case yesterday only.  We are headed for a nationwide elimination sometime about a month away, with only cases in the quarantine from overseas Australians returning home.

I am so happy that our state Premiers decided to eliminate this virus rather than follow our Federal governments initial plans to only "flatten the curve".  We squashed it.

So... now what?  When do you get to stop having to pretend like you're infected and wear masks everywhere?

At the moment masks only have to be worn indoors or where you cannot distance from others, and public transport.  Outside is fresh air again.  There will be more relaxations in about a weeks time.

v8rx7guy

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Re: How long can we wait while flattening the curve?
« Reply #4932 on: November 27, 2020, 11:23:14 PM »
Victoria, Australia has now eliminated the virus after 28 days of no cases reported and no active cases.  The lockdown was long and at times difficult, but worth it.  We still have to wear masks indoors, and if we cannot socially distance.

Australia has only one state with any local (not acquired overseas and found in quarantine) cases, South Australia.  SA had one case yesterday only.  We are headed for a nationwide elimination sometime about a month away, with only cases in the quarantine from overseas Australians returning home.

I am so happy that our state Premiers decided to eliminate this virus rather than follow our Federal governments initial plans to only "flatten the curve".  We squashed it.

So... now what?  When do you get to stop having to pretend like you're infected and wear masks everywhere?

At the moment masks only have to be worn indoors or where you cannot distance from others, and public transport.  Outside is fresh air again.  There will be more relaxations in about a weeks time.

I'll be really curious if your country actually does.  I want to see a county that has zero COVID cases start packing stadiums for sporting events with mask-less people.  Or do we need to wait for a vaccine for that to happen again... or?

deborah

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Re: How long can we wait while flattening the curve?
« Reply #4933 on: November 27, 2020, 11:28:51 PM »
We already have.

https://www.austadiums.com/news/850/origin-decider-set-for-suncorp-sell-out-and-coronavirus-record-crowd

Quote
Wednesday’s attendance is the largest for any sports event in the world since the outbreak of coronavirus.
« Last Edit: November 27, 2020, 11:32:13 PM by deborah »

v8rx7guy

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Re: How long can we wait while flattening the curve?
« Reply #4934 on: November 27, 2020, 11:41:14 PM »
We already have.

https://www.austadiums.com/news/850/origin-decider-set-for-suncorp-sell-out-and-coronavirus-record-crowd

Quote
Wednesday’s attendance is the largest for any sports event in the world since the outbreak of coronavirus.

That is promising to hear.  Masks?  I just would love to know that when cases are under control, things really do get back to normal and people dont even think about it anymore.

deborah

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Re: How long can we wait while flattening the curve?
« Reply #4935 on: November 28, 2020, 12:03:03 AM »
If you look at the pictures there are no masks as most states, including where that was held, don't mandate masks.

Villanelle

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Re: How long can we wait while flattening the curve?
« Reply #4936 on: November 28, 2020, 09:52:13 AM »
We already have.

https://www.austadiums.com/news/850/origin-decider-set-for-suncorp-sell-out-and-coronavirus-record-crowd

Quote
Wednesday’s attendance is the largest for any sports event in the world since the outbreak of coronavirus.

That is promising to hear.  Masks?  I just would love to know that when cases are under control, things really do get back to normal and people dont even think about it anymore.

I suspect some people will continue to wear masks for a long time.   It was already a fairly common practice in parts of Asia.  And since it truly isn't cumbersome in many cases, despite what the whiners say, I think there are people who will continue to mask up in situations like crowded public transport or a packed concert hall.  You mention getting "back to normal", but it's possible that 'normal' will have shifted a bit. 

obstinate

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Re: How long can we wait while flattening the curve?
« Reply #4937 on: November 28, 2020, 01:40:10 PM »
I suspect some people will continue to wear masks for a long time.   It was already a fairly common practice in parts of Asia.  And since it truly isn't cumbersome in many cases, despite what the whiners say, I think there are people who will continue to mask up in situations like crowded public transport or a packed concert hall.  You mention getting "back to normal", but it's possible that 'normal' will have shifted a bit.
It is my intention to continue wearing a mask on mass transit permanently. Just seems like a sensible idea, and who knows how many colds I'll avoid as a result? Even one or two would make it worth it.

mm1970

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Re: How long can we wait while flattening the curve?
« Reply #4938 on: November 28, 2020, 03:02:49 PM »
I suspect some people will continue to wear masks for a long time.   It was already a fairly common practice in parts of Asia.  And since it truly isn't cumbersome in many cases, despite what the whiners say, I think there are people who will continue to mask up in situations like crowded public transport or a packed concert hall.  You mention getting "back to normal", but it's possible that 'normal' will have shifted a bit.
It is my intention to continue wearing a mask on mass transit permanently. Just seems like a sensible idea, and who knows how many colds I'll avoid as a result? Even one or two would make it worth it.
Like others have mentioned, masks are pretty common in Asia.  I have a coworker who is originally from China, and he wears masks at work frequently, and has for years.

Villanelle

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Re: How long can we wait while flattening the curve?
« Reply #4939 on: November 28, 2020, 03:27:56 PM »
I suspect some people will continue to wear masks for a long time.   It was already a fairly common practice in parts of Asia.  And since it truly isn't cumbersome in many cases, despite what the whiners say, I think there are people who will continue to mask up in situations like crowded public transport or a packed concert hall.  You mention getting "back to normal", but it's possible that 'normal' will have shifted a bit.
It is my intention to continue wearing a mask on mass transit permanently. Just seems like a sensible idea, and who knows how many colds I'll avoid as a result? Even one or two would make it worth it.

I'm actually sort of pleased that masks may be somewhat normalized.  I rarely wore them when I lived in Asia, but did on occasion.  I did it once back in the US and removed it quickly because it clearly made people think I was walking around with some sort of plague.  Lots of side eye, maybe people openly avoiding me, etc.  I felt entirely well; I just knew I was going to to be close quarters with many people and it seemed prudent. . 

If in a year or two I can wear a mask on occasion without people thinking I'm on the verge of starting... well, a pandemic, then that would be a positive. 

scottish

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Re: How long can we wait while flattening the curve?
« Reply #4940 on: November 28, 2020, 05:24:35 PM »
Not me.   Once the pandemic is passed, I'll be happy to mothball my masks indefinitely.    Don't see why I'd want a reminder of all this time stuck at home.

ysette9

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Re: How long can we wait while flattening the curve?
« Reply #4941 on: November 28, 2020, 05:42:01 PM »
I found myself wondering about how I will feel once we don’t have to wear masks all the time outside. At this point if I go out and forget one I feel naked and quickly turn back to grab one. Funny how we can get used to all sorts of things.

Villanelle

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Re: How long can we wait while flattening the curve?
« Reply #4942 on: November 28, 2020, 05:57:45 PM »
Not me.   Once the pandemic is passed, I'll be happy to mothball my masks indefinitely.    Don't see why I'd want a reminder of all this time stuck at home.

I won't see it as a reminder.  I'll see it as a way to keep myself and others healthier. 

And that's not a dig against anyone who chooses otherwise.  But masks serve a purpose, and they would serve the same purpose before and after Covid.  Strange that they would only be a reminder of this time, when they existed long before it and function in a way that is relevant if and when Covid is no longer a major issue, or even eradicated entirely.

scottish

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Re: How long can we wait while flattening the curve?
« Reply #4943 on: November 28, 2020, 08:03:00 PM »
Yeah.   Aside from my personal circumstances, they would also remind me of all the folks who lost their lives or suffered long term disabilities as a result of the pandemic.    And to a lesser degree, small businesses pushed to the edge and kids who have lost part of their childhood.

I'll be happy to get back to normal and put masks back where they belong - in our medical facilities.

GuitarStv

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Re: How long can we wait while flattening the curve?
« Reply #4944 on: November 28, 2020, 08:50:06 PM »
Yeah . . . fuck masks.  They suck in the summer, they suck in the winter.  They suck when you need to talk to someone, they really suck if you have a runny nose, they fog your glasses up, they cause the skin around my mouth to break out.  I'll be happy to not wear them anymore.

marty998

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Re: How long can we wait while flattening the curve?
« Reply #4945 on: November 29, 2020, 01:08:42 AM »
Hopefully that leads to our Aussie dollar going higher - would be a nice reward to those of us who haven't been spending much during the pandemic. Hopefully also leads to our interest rates rising soon because I don't want inflation/wage growth to be going back to 4% anytime soon, and I'm a little worried about our shares/property being inflated due to low interest rates.

What’s wrong with wage growth? We were all better off with 4% wage growth and 3% inflation from 2003 to 2007.

I get really annoyed seeing you arguing the “let them eat cake” economic theory of all the benefits going to those who you think are deserving.

There’s a lot of jobs out there that are much more vital to society than lawyers and accountants. Those people are never going to earn the same as you and I but they shouldn’t be left in the dust of negative real wage growth because those of us with much greater economic privilege are happy with the status quo.

If those people don’t have wage growth to keep themselves above water where do you think the economy will be? You think you’re paying too much tax now... wait and see how much tax you’ll be paying to keep the masses from revolting.

Bloop Bloop Reloaded

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Re: How long can we wait while flattening the curve?
« Reply #4946 on: November 29, 2020, 01:43:57 AM »
Marty, there's no difference between 4% wage growth and 3.5% inflation and 1.5% wage growth and 1% inflation.

Except that the former is more likely to trigger an inflation cascade. And the former also rewards people for taking on debt, which I don't think should be something that's encouraged.

I'm not saying all the benefits should go to "who I think are deserving". I'm not the one who controls the market!!

The problem with wage growth (or any growth) derived wholly from stimulus is that you're pushing the barrow of subsidised consumption. It's anti-MMM. If we don't want to buy a new TV (and I've been happy with my TV for a decade!) we shouldn't be given vouchers or handouts to effect another purchase. Particularly when the small, short-term sugar hit of consumer spending then translates into very problematic things like super inflated shares/property prices (due to interest rates being way too low). The stimulatory policies are being directed towards asset prices, which helps old people with lots of assets but doesn't help young people like me trying to buy into the market. If we had higher interest rates that would benefit savers, and I'd much rather our policy benefit savers than the profligate.

We do not currently have negative real wage growth and I doubt we will in future.

fuzzy math

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Re: How long can we wait while flattening the curve?
« Reply #4947 on: November 29, 2020, 09:42:22 AM »
A new study by the CDC confirms what I was theorizing about 15 pages back. The US likely reached 50 million infections by Sept, and 100 million infections in Nov.

This of course, drops the IFR / CFR precipitously, and puts us on the path towards herd immunity much sooner than what official case counts would lead one to believe.

https://www.npr.org/sections/coronavirus-live-updates/2020/11/26/939365087/government-model-suggests-u-s-covid-19-cases-could-be-approaching-100-million

Villanelle

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Re: How long can we wait while flattening the curve?
« Reply #4948 on: November 29, 2020, 10:21:21 AM »
A new study by the CDC confirms what I was theorizing about 15 pages back. The US likely reached 50 million infections by Sept, and 100 million infections in Nov.

This of course, drops the IFR / CFR precipitously, and puts us on the path towards herd immunity much sooner than what official case counts would lead one to believe.

https://www.npr.org/sections/coronavirus-live-updates/2020/11/26/939365087/government-model-suggests-u-s-covid-19-cases-could-be-approaching-100-million

That would assume that having had it means one is and continues to be (for quite some time) immune.  Is that something we know to be true?

ender

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Re: How long can we wait while flattening the curve?
« Reply #4949 on: November 29, 2020, 10:49:59 AM »
A new study by the CDC confirms what I was theorizing about 15 pages back. The US likely reached 50 million infections by Sept, and 100 million infections in Nov.

This of course, drops the IFR / CFR precipitously, and puts us on the path towards herd immunity much sooner than what official case counts would lead one to believe.

https://www.npr.org/sections/coronavirus-live-updates/2020/11/26/939365087/government-model-suggests-u-s-covid-19-cases-could-be-approaching-100-million

Did you read the headline of the article at all?

Quote
Model Suggests


They underlying paper concludes with:

Quote
In summary, we estimated that in the U.S. through September 30, 2020 there were approximately 53 million
total SARS-CoV-2 infections, including 42 million symptomatic illnesses and 2.4 million hospitalizations, with
large variations by age group and geographic area. This indicates that approximately 84% of the U.S. population
has not yet been infected and thus most of the country remains at risk, despite already high rates of
hospitalization. Improved estimates of SARS-CoV-2 infections, symptomatic illnesses, and hospitalizations over
time, are critical to our understanding of the severity and burden of this new virus

It's nice that this paper affirms your beliefs on the matter but it's far from a 100% conclusive article. The entire premise is it's a model/