Author Topic: How long can we wait while flattening the curve?  (Read 675220 times)

Michael in ABQ

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Re: How long can we wait while flattening the curve?
« Reply #2300 on: May 29, 2020, 12:54:35 AM »
Why not let the US military fight covid? We could get the military to set up field hospitals (aka big tents) in all 50 states. The US military already has thousands of medics, nurses and doctors. To supplement the enlisted healthcare personnel, the military could hire thousands of civilian healthcare workers as private contractors. Young, healthy civilian nurses and doctors could volunteer to work temporarily for the US military, exclusively treating covid patients, while most civilian healthcare workers continued doing their regular jobs at nursing homes, hospitals, and urgent care facilities. All the young military personnel and the civilian contractors working on fighting covid could live together in purpose-built temporary housing, right at the site of the field hospitals. Fairly quickly, most of the young healthcare workers, both civilian and military, would get exposed to covid. Some wouldn't get it, others would be asymptomatic. Many would get sick. A few would get really sick. But, because they are all young and healthy, 99.99% would fully recover and be able to resume their work in the fight against covid after a 2-week quarantine. And, since the covid warriors would all be living together in communal barracks-style housing arrangements, they wouldn't be going home to infect their families after work. Seems to me like it would be worth a try. To me, it makes more sense to let the regular healthcare system continue focusing on the important job of delivering babies, treating cancer patients, people who have heart attacks, get into car crashes, etc., and then have a literal army of young, healthy nurses, doctors, and medics who are all working full-time only fighting against covid. In addition to manning the field hospitals, military personnel and private contractors could do contact tracing, make sure sick people quarantine, deliver food and pick up and take away rubbish from sick people's houses, bury people who die from covid, and whatever else needed to be done. What do you think? Would it work? Why or why not?...

The National Guard is involved, about 50,000 Soldiers and Airmen have been activated across all 54 states and territories - more than 1/10 of the force. They're helping to run testing sites, disinfect places, delivering medical supplies, food, water, etc. Almost everyone in a medical job in the Reserves or National Guard are in a similar position in the civilian world. Same thing with a high proportion of first responders. In my unit I have at least 10% that are police officers or firefighters. Most active duty medical personnel in the military work in military treatment facilities and are already caring for million of servicemembers and their families. Our medics are generally trained to the level of an EMT or in some cases a paramedic.

All of the field hospitals that were setup early on never got used because the existing hospital capacity was sufficient. The Navy medical ships sent to NYC and LA were supposed to handle non-COVID-19 cases but of course someone could come in to recover from a heart attack and also be asymptomatic for COVID-19. I believe they're still in place but I don't think they were utilized very heavily.

Abe

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Re: How long can we wait while flattening the curve?
« Reply #2301 on: May 29, 2020, 02:55:20 AM »
One of my patients has covid and will probably not make it. It’s hard telling someone their parent isn't doing well, and I have a lot of experience with it. Luckily I do not have it yet, but was heavily exposed for some time right before their intubation. This is in line with experience in NY: once proper protection is given to healthcare workers the risk of transmission is low. Thus simple measures can limit inter-household spread. It’s much easier to enforce this at hospitals than the rest of society. A case in point is my county:

Cases are rising in my county, and hospitalizations are trending upwards while people are going to parks without any effort at social distancing. Oh well! For context, fatalities from covid in California are ~4K in last two months, equivalent to motor vehicle collision deaths for the year. Death rate has stabilized statewide at about 75 a day now. At this rate we will have about 16,000 deaths in California by the end of the year. For comparison, if we just allowed for “herd immunity” at 50% of the population, it’d be about 80k with IFR of 0.4%. For my county it will be 4m x 0.4% = 16,000. Not enough to make people sit up and notice until one of their family members dies or has a prolonged hospitalization.

I’ve realized this based on two observations in my county: a fraction of people will not tolerate long-term suppression measures that are anything more than minor inconveniences to them (even masks and staying 6ft apart), and a larger fraction can not tolerate economic losses since our government is unable to provide basic subsidies for an extended period. Also, these populations overlap considerably with due at-risk population (elderly and/or obese). Thus we are destined to let this disease burn through our county until there’s a vaccine. My point being that it is incumbent on those of us at high risk to take significant precautions and express dissent by refusing to play the denialists’ game. Avoid unnecessary travel, avoid unnecessary shopping, and make contingencies for your at-risk family. No one else will look out for you and yours. Most importantly, talk with your elderly relatives about their wishes regarding end of life care. Would they want a breathing tube if the chance of survival is 50%? How long are they willing to stay on it? 1 week seems short to try, but 3 weeks? At the at-risk age, they will likely never have a life out of a hospital or nursing home afterwards. That reality is what my patient and his family is facing now. Plan for it, and the decision to let go will be easier for everyone involved.

I normally avoid interjecting anecdotes into a discussion, but I think it’s worth having some insight into this disease and it’s sequelae.

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #2302 on: May 29, 2020, 05:08:09 AM »
Sending you stay-well thoughts

LWYRUP

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Re: How long can we wait while flattening the curve?
« Reply #2303 on: May 29, 2020, 07:05:47 AM »
Most importantly, talk with your elderly relatives about their wishes regarding end of life care. Would they want a breathing tube if the chance of survival is 50%? How long are they willing to stay on it? 1 week seems short to try, but 3 weeks? At the at-risk age, they will likely never have a life out of a hospital or nursing home afterwards. That reality is what my patient and his family is facing now. Plan for it, and the decision to let go will be easier for everyone involved.

I normally avoid interjecting anecdotes into a discussion, but I think it’s worth having some insight into this disease and it’s sequelae.

Thank you for posting this, I find the context very helpful. 

What age would you consider "elderly" for purposes of this post?  My parents are in their mid 60s -- is this something we should be going through?

Also, would you go as far as recommending masks while going on a walk in a suburban area?  We pass by people but never stop and try to step out of everyone's way.  I've been wearing masks on the rare occasion I go to the store but we're mostly locked down... but every so often we need to get out and go on a walk, and I haven't been wearing a mask on my bi-weekly walks...

OtherJen

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Re: How long can we wait while flattening the curve?
« Reply #2304 on: May 29, 2020, 07:33:44 AM »
Most importantly, talk with your elderly relatives about their wishes regarding end of life care. Would they want a breathing tube if the chance of survival is 50%? How long are they willing to stay on it? 1 week seems short to try, but 3 weeks? At the at-risk age, they will likely never have a life out of a hospital or nursing home afterwards. That reality is what my patient and his family is facing now. Plan for it, and the decision to let go will be easier for everyone involved.

I normally avoid interjecting anecdotes into a discussion, but I think it’s worth having some insight into this disease and it’s sequelae.

Thank you for posting this, I find the context very helpful. 

What age would you consider "elderly" for purposes of this post?  My parents are in their mid 60s -- is this something we should be going through?

Also, would you go as far as recommending masks while going on a walk in a suburban area?  We pass by people but never stop and try to step out of everyone's way.  I've been wearing masks on the rare occasion I go to the store but we're mostly locked down... but every so often we need to get out and go on a walk, and I haven't been wearing a mask on my bi-weekly walks...

I can't answer for Abe, but elderly is usually defined as age 65 or older in the medical field.

LightTripper

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Re: How long can we wait while flattening the curve?
« Reply #2305 on: May 29, 2020, 07:43:23 AM »

What age would you consider "elderly" for purposes of this post?  My parents are in their mid 60s -- is this something we should be going through?



I can't answer for Abe, but elderly is usually defined as age 65 or older in the medical field.

Unless you're pregnant for the first time, in which case you get the fun of being referred to as "elderly" (or in my case "geriatric") at anything over 35 :)

In the UK they are asking those over 70 to be particularly careful with Covid - but I don't suppose there is any magic to exactly where you draw the line.

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Re: How long can we wait while flattening the curve?
« Reply #2306 on: May 29, 2020, 07:55:53 AM »
Why not let the US military fight covid? We could get the military to set up field hospitals (aka big tents) in all 50 states. The US military already has thousands of medics, nurses and doctors. To supplement the enlisted healthcare personnel, the military could hire thousands of civilian healthcare workers as private contractors. Young, healthy civilian nurses and doctors could volunteer to work temporarily for the US military, exclusively treating covid patients, while most civilian healthcare workers continued doing their regular jobs at nursing homes, hospitals, and urgent care facilities. All the young military personnel and the civilian contractors working on fighting covid could live together in purpose-built temporary housing, right at the site of the field hospitals. Fairly quickly, most of the young healthcare workers, both civilian and military, would get exposed to covid. Some wouldn't get it, others would be asymptomatic. Many would get sick. A few would get really sick. But, because they are all young and healthy, 99.99% would fully recover and be able to resume their work in the fight against covid after a 2-week quarantine. And, since the covid warriors would all be living together in communal barracks-style housing arrangements, they wouldn't be going home to infect their families after work. Seems to me like it would be worth a try. To me, it makes more sense to let the regular healthcare system continue focusing on the important job of delivering babies, treating cancer patients, people who have heart attacks, get into car crashes, etc., and then have a literal army of young, healthy nurses, doctors, and medics who are all working full-time only fighting against covid. In addition to manning the field hospitals, military personnel and private contractors could do contact tracing, make sure sick people quarantine, deliver food and pick up and take away rubbish from sick people's houses, bury people who die from covid, and whatever else needed to be done. What do you think? Would it work? Why or why not?...

I think my answer would be:  You could do it, but it would cost a lot more than you might think and it probably wouldn't be very effective. 

First of all, I am a big supporter of the US Military.  It is arguably the finest force in the world at its primary mission, which is basically to kill people and blow stuff up, although it costs a lot of money to do it.  In support of its primary mission, the US military does a lot of secondary stuff.  For example, it runs a huge logistical operation and things like hospitals, warehouses, motorpools, and post offices. 

In general, the military isn't more efficient at delivering these services than a good private sector company, but that's ok because they are usually focused on having the capability of delivering their services in places and circumstances where private sector companies wouldn't go.  For example, if the military needs to deliver cargo from the US to Germany, a contracted private sector cargo company will almost certainly be able to do the job for less than the US military.  On the other hand, if you want to deliver ammunition to soldiers under fire at night in Afghanistan, US military tactical airlift is going to be the right tool for the job (at a very high cost, obviously). 

As you get further away you get from the military's primary missions, it is likely to become less efficient.  Our military's medical mission is primarily focused on trauma care and mass casualties (aimed at wounded young soldiers who were previously healthy).  Pandemic response and chronic illnesses haven't really been a big focus.  The military builds a lot of tent hospitals, but they're mostly surgical wards and recovery areas, not ICUs and isolation wards.  It is my understanding this is why the USNS Mercy and USNS Comfort didn't get used much in California and New York --they were never meant to handle a pandemic.

If you ordered the military to build and operate tent hospitals across the USA, they would salute smartly and do their best, but I think you'd be far better off giving civilian hospitals the resources they need to expand their existing facilities to meet demand.  The military might have a role to play in providing additional resources in areas where needs can't be met or in taking over other functions so resources can be focused on Covid (as USNS Mercy and Comfort were used). 

I think one of the attractions of using the military for our government is not that it is necessarily the most effective tool for the job, but that it is to some degree it is already funded.  As they say:  When the only tool you have is a hammer, all your problems will start to look like nails. 



Shane

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Re: How long can we wait while flattening the curve?
« Reply #2307 on: May 29, 2020, 09:45:30 AM »
Why not let the US military fight covid? We could get the military to set up field hospitals (aka big tents) in all 50 states. The US military already has thousands of medics, nurses and doctors. To supplement the enlisted healthcare personnel, the military could hire thousands of civilian healthcare workers as private contractors. Young, healthy civilian nurses and doctors could volunteer to work temporarily for the US military, exclusively treating covid patients, while most civilian healthcare workers continued doing their regular jobs at nursing homes, hospitals, and urgent care facilities. All the young military personnel and the civilian contractors working on fighting covid could live together in purpose-built temporary housing, right at the site of the field hospitals. Fairly quickly, most of the young healthcare workers, both civilian and military, would get exposed to covid. Some wouldn't get it, others would be asymptomatic. Many would get sick. A few would get really sick. But, because they are all young and healthy, 99.99% would fully recover and be able to resume their work in the fight against covid after a 2-week quarantine. And, since the covid warriors would all be living together in communal barracks-style housing arrangements, they wouldn't be going home to infect their families after work. Seems to me like it would be worth a try. To me, it makes more sense to let the regular healthcare system continue focusing on the important job of delivering babies, treating cancer patients, people who have heart attacks, get into car crashes, etc., and then have a literal army of young, healthy nurses, doctors, and medics who are all working full-time only fighting against covid. In addition to manning the field hospitals, military personnel and private contractors could do contact tracing, make sure sick people quarantine, deliver food and pick up and take away rubbish from sick people's houses, bury people who die from covid, and whatever else needed to be done. What do you think? Would it work? Why or why not?...

The National Guard is involved, about 50,000 Soldiers and Airmen have been activated across all 54 states and territories - more than 1/10 of the force. They're helping to run testing sites, disinfect places, delivering medical supplies, food, water, etc. Almost everyone in a medical job in the Reserves or National Guard are in a similar position in the civilian world. Same thing with a high proportion of first responders. In my unit I have at least 10% that are police officers or firefighters. Most active duty medical personnel in the military work in military treatment facilities and are already caring for million of servicemembers and their families. Our medics are generally trained to the level of an EMT or in some cases a paramedic.

All of the field hospitals that were setup early on never got used because the existing hospital capacity was sufficient. The Navy medical ships sent to NYC and LA were supposed to handle non-COVID-19 cases but of course someone could come in to recover from a heart attack and also be asymptomatic for COVID-19. I believe they're still in place but I don't think they were utilized very heavily.
Right, I remember reading about the Navy hospital ships docked at Long Beach, CA and NYC, that they were only treating non-covid patients, and that they were almost completely empty. It just seems to me like it makes more sense to let the military fight the metaphorical "war" against covid, which would free up our civilian healthcare workers to continue doing what they normally do. Since most healthcare workers in the military reserves and national guard are already working full-time in healthcare jobs in the regular healthcare industry, why don't we call up active duty military to treat covid patients? Trump says it's a "war," so why don't we call up the military to fight the war?

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #2308 on: May 29, 2020, 09:51:04 AM »
Most importantly, talk with your elderly relatives about their wishes regarding end of life care. Would they want a breathing tube if the chance of survival is 50%? How long are they willing to stay on it? 1 week seems short to try, but 3 weeks? At the at-risk age, they will likely never have a life out of a hospital or nursing home afterwards. That reality is what my patient and his family is facing now. Plan for it, and the decision to let go will be easier for everyone involved.

I normally avoid interjecting anecdotes into a discussion, but I think it’s worth having some insight into this disease and it’s sequelae.

Thank you for posting this, I find the context very helpful. 

What age would you consider "elderly" for purposes of this post?  My parents are in their mid 60s -- is this something we should be going through?

Also, would you go as far as recommending masks while going on a walk in a suburban area?  We pass by people but never stop and try to step out of everyone's way.  I've been wearing masks on the rare occasion I go to the store but we're mostly locked down... but every so often we need to get out and go on a walk, and I haven't been wearing a mask on my bi-weekly walks...


I think advanced directives are important no matter your age. I’m early 30s and I have one in place. The forms are free on my state government website and my bank didn’t charge to notarize. I have a copy at my primary care doctor, at my local hospital, and a copy in my own records.

Shane

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Re: How long can we wait while flattening the curve?
« Reply #2309 on: May 29, 2020, 09:58:34 AM »
Why not let the US military fight covid? We could get the military to set up field hospitals (aka big tents) in all 50 states. The US military already has thousands of medics, nurses and doctors. To supplement the enlisted healthcare personnel, the military could hire thousands of civilian healthcare workers as private contractors. Young, healthy civilian nurses and doctors could volunteer to work temporarily for the US military, exclusively treating covid patients, while most civilian healthcare workers continued doing their regular jobs at nursing homes, hospitals, and urgent care facilities. All the young military personnel and the civilian contractors working on fighting covid could live together in purpose-built temporary housing, right at the site of the field hospitals. Fairly quickly, most of the young healthcare workers, both civilian and military, would get exposed to covid. Some wouldn't get it, others would be asymptomatic. Many would get sick. A few would get really sick. But, because they are all young and healthy, 99.99% would fully recover and be able to resume their work in the fight against covid after a 2-week quarantine. And, since the covid warriors would all be living together in communal barracks-style housing arrangements, they wouldn't be going home to infect their families after work. Seems to me like it would be worth a try. To me, it makes more sense to let the regular healthcare system continue focusing on the important job of delivering babies, treating cancer patients, people who have heart attacks, get into car crashes, etc., and then have a literal army of young, healthy nurses, doctors, and medics who are all working full-time only fighting against covid. In addition to manning the field hospitals, military personnel and private contractors could do contact tracing, make sure sick people quarantine, deliver food and pick up and take away rubbish from sick people's houses, bury people who die from covid, and whatever else needed to be done. What do you think? Would it work? Why or why not?...

I think my answer would be:  You could do it, but it would cost a lot more than you might think and it probably wouldn't be very effective. 

First of all, I am a big supporter of the US Military.  It is arguably the finest force in the world at its primary mission, which is basically to kill people and blow stuff up, although it costs a lot of money to do it.  In support of its primary mission, the US military does a lot of secondary stuff.  For example, it runs a huge logistical operation and things like hospitals, warehouses, motorpools, and post offices. 

In general, the military isn't more efficient at delivering these services than a good private sector company, but that's ok because they are usually focused on having the capability of delivering their services in places and circumstances where private sector companies wouldn't go.  For example, if the military needs to deliver cargo from the US to Germany, a contracted private sector cargo company will almost certainly be able to do the job for less than the US military.  On the other hand, if you want to deliver ammunition to soldiers under fire at night in Afghanistan, US military tactical airlift is going to be the right tool for the job (at a very high cost, obviously). 

As you get further away you get from the military's primary missions, it is likely to become less efficient.  Our military's medical mission is primarily focused on trauma care and mass casualties (aimed at wounded young soldiers who were previously healthy).  Pandemic response and chronic illnesses haven't really been a big focus.  The military builds a lot of tent hospitals, but they're mostly surgical wards and recovery areas, not ICUs and isolation wards.  It is my understanding this is why the USNS Mercy and USNS Comfort didn't get used much in California and New York --they were never meant to handle a pandemic.

If you ordered the military to build and operate tent hospitals across the USA, they would salute smartly and do their best, but I think you'd be far better off giving civilian hospitals the resources they need to expand their existing facilities to meet demand.  The military might have a role to play in providing additional resources in areas where needs can't be met or in taking over other functions so resources can be focused on Covid (as USNS Mercy and Comfort were used). 

I think one of the attractions of using the military for our government is not that it is necessarily the most effective tool for the job, but that it is to some degree it is already funded.  As they say:  When the only tool you have is a hammer, all your problems will start to look like nails.

My main reason for suggesting using the military to fight covid is because I think that, even if it costs more $$, it would be better to NOT entrust our nation's response to a pandemic to a for profit healthcare system, whose interests are often perpendicular to those of the American people. The US Military, otoh, wouldn't profit in any way off of covid, so, hopefully, their incentives would more closely line up with regular people. Also, as I said earlier, a big benefit of using the military to fight covid would be that active military personnel are generally young and healthy, and they do NOT go home at night after work, at least not while they are deployed, so there would be less chance of their passing the disease on to their families, who then might pass it on to others in the civilian population.

RetiredAt63

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Re: How long can we wait while flattening the curve?
« Reply #2310 on: May 29, 2020, 09:58:55 AM »
I'm getting close to 70.  I don't feel old, people tell me I don't look that old, and am reasonably healthy, but my body has had to deal with all those years of "stuff happening".  I notice I don't heal as fast as I used to.  So yes, technically we are older by 70.  Of course people can have a body that is older than their age, because of their medical history.

And yes, advanced directives and wills are appropriate at any age.  You never know when you will get hit by a bus (or whatever).

GardenerB

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Re: How long can we wait while flattening the curve?
« Reply #2311 on: May 29, 2020, 11:14:20 AM »
This info graphic provides an interesting perspective on the relative lethality of COVID-19 to date:

https://public.flourish.studio/visualisation/2562261/

This is neat, but it selectively excludes the top 7 causes of death.

There are almost too many of those infographics around.

https://www.visualcapitalist.com/how-many-people-die-each-day/

Jon Bon

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Re: How long can we wait while flattening the curve?
« Reply #2312 on: May 29, 2020, 11:24:54 AM »
Just wrote to my Governor today urging him to open up playgrounds for young children. We should really be consistent here, if picnic tables are allowed to be open then surely a playground can be. Most signs point to the outdoors being the safest place. Heck I just went to a funeral with ~300 people there and that was legal. 

I also put in my note that I was simply going to start allowing my children to use the playground equipment. If that means I am breaking the law, then so be it. In my state the Governor has been consistently asking for common sense from the people, I am asking the same from him.

GardenerB

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Re: How long can we wait while flattening the curve?
« Reply #2313 on: May 29, 2020, 11:30:01 AM »
This info graphic provides an interesting perspective on the relative lethality of COVID-19 to date:

https://public.flourish.studio/visualisation/2562261/

This is neat, but it selectively excludes the top 7 causes of death.

There are almost too many of those infographics around.

https://www.visualcapitalist.com/how-many-people-die-each-day/

Also as mentioned earlier there is also the general risk compared to daily life risks.  I haven't seen this for the US yet, but I would assume similar stats as this one done for the UK by Sir David Spiegelhalter:

https://medium.com/wintoncentre/what-are-the-risks-of-covid-and-what-is-meant-by-the-risks-of-covid-c828695aea69

"Over this 5-week period covering the peak of the epidemic-

-Men had roughly double the risk of getting the virus and dying, compared with women of the same age.

-Fatal risks doubled for each 6–7 years extra age: compared to a 20-year-old, an 80-year-old had ~ 500 times the risk of dying from COVID.

-For over 45s, the possibility of catching the virus and then dying from COVID added a fatal risk roughly equivalent to an extra 3 weeks of normal risk to the 5 weeks being considered.

-For those between 15 and 45, the possibility of COVID added a fatal risk roughly equivalent to an extra 1 week of normal risk to the 5 weeks being considered.

-For under 15s, the possibility of COVID added a negligible fatal risk."

Gremlin

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Re: How long can we wait while flattening the curve?
« Reply #2314 on: May 29, 2020, 08:15:08 PM »
Every country has managed to flatten the curve, with or without harsh lockdown measures.

More new cases worldwide today than any other day so far.  Pretty sure that means that not every country has managed to flatten the curve...

https://www.theguardian.com/world/2020/may/20/global-report-coronavirus-pandemic-not-over-warns-the-who

that's because it keeps spreading to other countries. Have a look at the country specific charts - all but the ones that have only been recently affected have managed to flatten the curve.

I call bullshit.  Populous countries like India, Pakistan, Bangladesh, Brazil, Mexico and Indonesia have all been reporting cases since the end of March/start of April.  None of them are even close to flattening their curves.  Plenty of mid-population nations in a similar boat.  As you suggest, have a look at the country specific charts.  Here's India, Brazil and Mexico for starters...
So Bloop Bloop's comment continues to age badly.  New cases reported daily worldwide are now ~20% higher than they were when Bloop Bloop asserted that "every country on earth has managed to flatten the curve" ten days ago.  All of the countries mentioned above have sadly continued to see new "highs" in their new case numbers even as those that can afford to implement social distancing controls are seeing some success in mitigating its insidious reach.

This continues to be a problem that's a long way from being under any degree of control in many, many parts of the world.

HBFIRE

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Re: How long can we wait while flattening the curve?
« Reply #2315 on: May 29, 2020, 09:01:43 PM »


So Bloop Bloop's comment continues to age badly.  New cases reported daily worldwide are now ~20% higher than they were when Bloop Bloop asserted that "every country on earth has managed to flatten the curve" ten days ago.  All of the countries mentioned above have sadly continued to see new "highs" in their new case numbers even as those that can afford to implement social distancing controls are seeing some success in mitigating its insidious reach.

This continues to be a problem that's a long way from being under any degree of control in many, many parts of the world.


Does anyone have the aggregated test volume by day for the world?  This could be a function of increased testing rather than actual infections increasing.  World deaths have been declining for 6 weeks.  The US, in particular, has ramped up its testing massively over the last month.  Case data is not very reliable as an indicator.  Hospitalization rates and death rates are better to watch.

Abe

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Re: How long can we wait while flattening the curve?
« Reply #2316 on: May 30, 2020, 12:22:28 AM »
Most importantly, talk with your elderly relatives about their wishes regarding end of life care. Would they want a breathing tube if the chance of survival is 50%? How long are they willing to stay on it? 1 week seems short to try, but 3 weeks? At the at-risk age, they will likely never have a life out of a hospital or nursing home afterwards. That reality is what my patient and his family is facing now. Plan for it, and the decision to let go will be easier for everyone involved.

I normally avoid interjecting anecdotes into a discussion, but I think it’s worth having some insight into this disease and it’s sequelae.

Thank you for posting this, I find the context very helpful. 

What age would you consider "elderly" for purposes of this post?  My parents are in their mid 60s -- is this something we should be going through?

Also, would you go as far as recommending masks while going on a walk in a suburban area?  We pass by people but never stop and try to step out of everyone's way.  I've been wearing masks on the rare occasion I go to the store but we're mostly locked down... but every so often we need to get out and go on a walk, and I haven't been wearing a mask on my bi-weekly walks...

I’d say over 60 is when there’s a clearly significant risk of death from covid. I’d say any adult with living parents should have a talk about what they would want for common end of life situations, but particularly for covid at this time. Most important is to decide how long one would want to carry on treatment for various scenarios (on a ventilator, on medications to support the heart and blood pressure, in event of ones heart due to an irreversible reason, stroke with significant disability, etc). All of these are pertinent to covid and also for medical care in older people in general.

Anecdotally I have discussed with my parents who are 68, and both are physicianS so have insight into medical care at the end of life. Both clearly do not want prolonged ventilator support due to decreased consciousness, which we defined as more than 3 weeks (somewhat arbitrarily). That’s different than recovering enough to be awake, but still needing a ventilator to breathe. There can be meaningful quality of life in the latter situation. They also made clear that if was a triage situation and a younger person with dependents who had a better chance needed a ventilator, they would rather that person be chosen. This gives you an idea of the major questions surrounding end of life for COVId in particular, but other lung infections in general.


Regarding masks while outside: if you are close contact with other people For prolonged periods, wear one. All of this is poorly defined, but the 6ft distance guideline is reasonable. In general wear a mask if you can. It’s not hurting you and may help others if you are infected but have mild symptoms that may go unrecognized prospectively. If you have any symptoms whatsoever, wear one. Indoors in a store for sure wear a mask.
« Last Edit: May 30, 2020, 12:25:51 AM by Abe »

Abe

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Re: How long can we wait while flattening the curve?
« Reply #2317 on: May 30, 2020, 02:37:08 PM »
Here's the latest graph of cases per state, using a 7-day moving average to smooth out the noise.

Cases rates are continuing to rise in Alabama, Arizona, Arkansas, California, Maryland, Minnesota, Mississippi, North Carolina, South Carolina, Tennessee, Texas, Utah, Virginia, Wisconsin.  Interestingly, the daily death rate has overall stabilized in most of these states. This suggests that overall we are preventing the spread to the highest-risk people.

Iowa, Mississippi, NC, Rhode Island, Utah, Virginia are having increased rates of death. Most other states have plateaued in number of deaths per day.

 

Seadog

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Re: How long can we wait while flattening the curve?
« Reply #2318 on: May 30, 2020, 03:23:56 PM »
This info graphic provides an interesting perspective on the relative lethality of COVID-19 to date:

https://public.flourish.studio/visualisation/2562261/

This is neat, but it selectively excludes the top 7 causes of death.
This info graphic provides an interesting perspective on the relative lethality of COVID-19 to date:

https://public.flourish.studio/visualisation/2562261/

This is neat, but it selectively excludes the top 7 causes of death.
I noticed that after I posted it when I went back to look at it again and I think it’s a fair criticism. I’d like to see it with the remaining top causes of death. 

I still think it gives a nice visual presentation to how quickly COVID-19 arose though. And that was with unprecedented steps taken on a global level to minimize its ability to spread.

It’s also just generally depressing to see numbers that big for all the causes listed. It’s easy to forget that with 7 billion of us there is a lot of death. Numbers that big can be difficult to really grasp and appreciate.

I'd also like to see a year to year example over the last 50 or 100. While obviously this is killing a lot of people, you only get 1-2 of these sorts of things per century. On MMM it's supposed to be about long term thinking. Being fiercely logical, I could never get my head around the inconsistency of why "lumpy" deaths are considered so much worse than garden variety ones. A few thousand dead from terrorism, is somehow considered to be so much worse than millions dead from heart disease and cancer. A few plane crashes per year which kill maybe not even a thousand people are bad, compared to orders of magnitude more from car crashes which are just accepted. And viruses similarly so. Over the last 50 years, the cumulative deaths from viruses are nothing worse than any of the other big killers, no where close.

While it was an interesting infogram, as others mentioned I can't help but feel it was inspired by an agenda.

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #2319 on: May 30, 2020, 03:43:09 PM »
You say “let’s wait and see” about 50-100 years like man isn’t mortal. No shit we’ll all be dead anyway in 100 years. I’d like to finish out my remaining years without getting ko’d early, friendo.

HBFIRE

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Re: How long can we wait while flattening the curve?
« Reply #2320 on: May 30, 2020, 05:14:39 PM »
Interestingly, the daily death rate has overall stabilized in most of these states. This suggests that overall we are preventing the spread to the highest-risk people.



Or we are simply identifying a much higher % of positives than we were before.  It’s possible to identify more positives while overall actual infections  are in decline, through increased testing volume.  This, if true, would explain why deaths are either stabilizing or dropping despite case identifications increasing.

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #2321 on: May 30, 2020, 05:28:36 PM »
In my state at least we are testing somewhat fewer than we were a month ago.

GuitarStv

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Re: How long can we wait while flattening the curve?
« Reply #2322 on: May 30, 2020, 06:28:50 PM »
Interestingly, the daily death rate has overall stabilized in most of these states. This suggests that overall we are preventing the spread to the highest-risk people.



Or we are simply identifying a much higher % of positives than we were before.  It’s possible to identify more positives while overall actual infections  are in decline, through increased testing volume.  This, if true, would explain why deaths are either stabilizing or dropping despite case identifications increasing.

Or you're not identifying all the deaths related to the disease.  There has a been a significant mortality spike ever since coronavirus started spreading that's currently unexplained.

js82

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Re: How long can we wait while flattening the curve?
« Reply #2323 on: May 30, 2020, 06:39:32 PM »
Interestingly, the daily death rate has overall stabilized in most of these states. This suggests that overall we are preventing the spread to the highest-risk people.



Or we are simply identifying a much higher % of positives than we were before.  It’s possible to identify more positives while overall actual infections  are in decline, through increased testing volume.  This, if true, would explain why deaths are either stabilizing or dropping despite case identifications increasing.

One thing I'm also curious about(and haven't seen data on yet) is whether we're getting better at treating the disease.  By my understanding there are best practices that have been more widely adopted for the treatment of severe cases, that are improving outcomes - but it's not clear how much the total impact is.  I'd imagine it's non-neglegible, but just how non-neglegible is an open question.  I'd guess at least 10% reduction in mortality, but almost certainly less than 50%(but again, this is purely a wild guess).
« Last Edit: May 30, 2020, 06:42:49 PM by js82 »

HBFIRE

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Re: How long can we wait while flattening the curve?
« Reply #2324 on: May 30, 2020, 07:05:46 PM »


Or you're not identifying all the deaths related to the disease.  There has a been a significant mortality spike ever since coronavirus started spreading that's currently unexplained.

Definitely, but a very complex problem.  We are seeing increased non covid-19 mortality during this crisis.  We also should consider that we are including "probable" deaths in the totals, which is imprecise at best.  We pre-screen and test "probable" covid-19 cases, but only 5-20% are actual positive cases.  What makes us confident that "probable" deaths are covid-19 and not another respiratory illness?  If we are testing all probable illness, and only 5-20% are positive, this means we are likely misattributing covid-19 as the cause of death with  many deaths that aren't diagnosed.

Results suggest that there are an additional 968 weekly deaths that officially did not
involve covid-19, compared to what would have otherwise been expected. 


All of this is to say, the data can be misleading.
« Last Edit: May 30, 2020, 07:10:35 PM by HBFIRE »

Gin1984

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Re: How long can we wait while flattening the curve?
« Reply #2325 on: May 30, 2020, 08:10:23 PM »
Interestingly, the daily death rate has overall stabilized in most of these states. This suggests that overall we are preventing the spread to the highest-risk people.



Or we are simply identifying a much higher % of positives than we were before.  It’s possible to identify more positives while overall actual infections  are in decline, through increased testing volume.  This, if true, would explain why deaths are either stabilizing or dropping despite case identifications increasing.

One thing I'm also curious about(and haven't seen data on yet) is whether we're getting better at treating the disease.  By my understanding there are best practices that have been more widely adopted for the treatment of severe cases, that are improving outcomes - but it's not clear how much the total impact is.  I'd imagine it's non-neglegible, but just how non-neglegible is an open question.  I'd guess at least 10% reduction in mortality, but almost certainly less than 50%(but again, this is purely a wild guess).
There have been some drugs tested, that seem to decrease time spent in a hospital but once you are in the ICU, we don't have better treatments.  There is a vaccine recruiting in the UK in phase 2 looking for most hospital workers which may help but the problem is, we just don't know enough yet.

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Re: How long can we wait while flattening the curve?
« Reply #2326 on: May 30, 2020, 08:58:56 PM »
You say “let’s wait and see” about 50-100 years like man isn’t mortal. No shit we’ll all be dead anyway in 100 years. I’d like to finish out my remaining years without getting ko’d early, friendo.

Well then you're better off focussing on eliminating risks for heart disease, cancer, and malaria. Make sure you install those mosquito nets

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #2327 on: May 31, 2020, 04:44:33 AM »
Malaria isn’t a concern in my area, and I do take precautions against heart disease and cancer. It’s possible to be proactive against more than one thing, ffs.

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Re: How long can we wait while flattening the curve?
« Reply #2328 on: May 31, 2020, 04:53:47 AM »
Just like malaria is a non-issue for you, Covid-19 is a non-issue for us here.

We are re-opening restaurants and cafes for dine-in as of tomorrow and hopefully in three weeks almost all restrictions will be gone, besides the big ones like international travel and sporting events.

Today the parks were crawling with people celebrating our newfound freedoms!

Seadog

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Re: How long can we wait while flattening the curve?
« Reply #2329 on: May 31, 2020, 05:35:44 AM »
You say “let’s wait and see” about 50-100 years like man isn’t mortal. No shit we’ll all be dead anyway in 100 years. I’d like to finish out my remaining years without getting ko’d early, friendo.

Well then you're better off focussing on eliminating risks for heart disease, cancer, and malaria. Make sure you install those mosquito nets

That's what I truly can't get my head around. Something like 150k (quick googleing) ppl die every day. That means since Jan, something like 22m ppl have died. Covid deaths are like 400k. So if you died in the last 5 months, it's 50x more likely that it was something other than this bug that got you.
Even during the peak week at 7500/day, that means it as 20 times more likely another cause.

Compared to all other causes, especially for people sub 60, this is really just not a big deal. If you all-risks causes of death was .1% before, now it's like .102%. But like terrorism, people have this irrational fear, and are willing to literally spends thousands of dollars on a personal level, and hundreds of billions on a societal to make a tiny non-zero risk, a slightly tinier non-zero risk. I just don't get it.

I've used this example before, but it's like the habitual drunk driver always remembering to buckle up. As if somehow dying from flying out the windshield due to no seatbelt is somehow worse than dying from rear ending someone at speed since you were blitzed out of your skull, the former which is far far more likely. A death is a death and most are sad and tragic. It makes far more sense to concentrate on eliminating all causes of death as best we can.

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #2330 on: May 31, 2020, 05:59:05 AM »
Just like malaria is a non-issue for you, Covid-19 is a non-issue for us here.

We are re-opening restaurants and cafes for dine-in as of tomorrow and hopefully in three weeks almost all restrictions will be gone, besides the big ones like international travel and sporting events.

Today the parks were crawling with people celebrating our newfound freedoms!

Bully for you, but it’s real in the US

js82

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Re: How long can we wait while flattening the curve?
« Reply #2331 on: May 31, 2020, 08:48:44 AM »
That's what I truly can't get my head around. Something like 150k (quick googleing) ppl die every day. That means since Jan, something like 22m ppl have died. Covid deaths are like 400k. So if you died in the last 5 months, it's 50x more likely that it was something other than this bug that got you.
Even during the peak week at 7500/day, that means it as 20 times more likely another cause.

Comparison bias plays a big role here.  since the early 20th century, deaths from infectious diseases have declined by an order of magnitude thanks to vaccines, antibiotics, and other triumphs of modern medicine.  For this reason, our sense of scale is very different when it comes to pandemics than for other causes of deaths that we've had much more limited success treating.

That said, I think a legitimate(and uncomfortable) thought experiment is to ask, for the amount of resources we've spent dealing with this pandemic, could we have done more total good directing the same amount of money towards initiatives likely to benefit a large chunk of society(both public health, and otherwise)?  I think the answer to this question is probably "yes," as 6 trillion dollars funds a whole lot of cancer research, mosquito netting, medical treatment for those who may not be able to afford it, and other things that stand a reasonable chance at saving more lives with a lower price tag.

Davnasty

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Re: How long can we wait while flattening the curve?
« Reply #2332 on: May 31, 2020, 09:51:09 AM »
That's what I truly can't get my head around. Something like 150k (quick googleing) ppl die every day. That means since Jan, something like 22m ppl have died. Covid deaths are like 400k. So if you died in the last 5 months, it's 50x more likely that it was something other than this bug that got you.
Even during the peak week at 7500/day, that means it as 20 times more likely another cause.

Comparison bias plays a big role here.  since the early 20th century, deaths from infectious diseases have declined by an order of magnitude thanks to vaccines, antibiotics, and other triumphs of modern medicine.  For this reason, our sense of scale is very different when it comes to pandemics than for other causes of deaths that we've had much more limited success treating.

That said, I think a legitimate(and uncomfortable) thought experiment is to ask, for the amount of resources we've spent dealing with this pandemic, could we have done more total good directing the same amount of money towards initiatives likely to benefit a large chunk of society(both public health, and otherwise)?  I think the answer to this question is probably "yes," as 6 trillion dollars funds a whole lot of cancer research, mosquito netting, medical treatment for those who may not be able to afford it, and other things that stand a reasonable chance at saving more lives with a lower price tag.

But once again, we need to remember that there would have been economic impacts regardless of the decision to shutdown. At least some portion of that 6 trillion dollars would have gone to relief anyway.

And how do we account for the long term costs of caring for those with lasting damage from the virus? We still don't know much about what those long term effects will be and back in March we knew even less.

And then there's about a thousand other factors to consider, both pros and cons of shutting down, which is why I don't claim to know the answer to your question above, I'm just pointing out that I don't think the comparison is nearly that simple.

Telecaster

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Re: How long can we wait while flattening the curve?
« Reply #2333 on: May 31, 2020, 10:57:46 AM »
That's what I truly can't get my head around. Something like 150k (quick googleing) ppl die every day. That means since Jan, something like 22m ppl have died. Covid deaths are like 400k. So if you died in the last 5 months, it's 50x more likely that it was something other than this bug that got you.
Even during the peak week at 7500/day, that means it as 20 times more likely another cause.

Compared to all other causes, especially for people sub 60, this is really just not a big deal. If you all-risks causes of death was .1% before, now it's like .102%. But like terrorism, people have this irrational fear, and are willing to literally spends thousands of dollars on a personal level, and hundreds of billions on a societal to make a tiny non-zero risk, a slightly tinier non-zero risk. I just don't get it.

I've used this example before, but it's like the habitual drunk driver always remembering to buckle up. As if somehow dying from flying out the windshield due to no seatbelt is somehow worse than dying from rear ending someone at speed since you were blitzed out of your skull, the former which is far far more likely. A death is a death and most are sad and tragic. It makes far more sense to concentrate on eliminating all causes of death as best we can.

That's 400K with aggressive intervention.   Without intervention the total could be easily be an order of magnitude higher. 

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #2334 on: May 31, 2020, 12:04:31 PM »
Hey did you guys know that Australia doesn’t have COVID19 all that bad?

RetiredAt63

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Re: How long can we wait while flattening the curve?
« Reply #2335 on: May 31, 2020, 12:45:43 PM »
Hey did you guys know that Australia doesn’t have COVID19 all that bad?

Bloop Bloop has made sure that we are all aware of that.  You and New Zealand.

former player

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Re: How long can we wait while flattening the curve?
« Reply #2336 on: May 31, 2020, 01:36:27 PM »
[...] It makes far more sense to concentrate on eliminating all causes of death as best we can.
Ambitious.

GuitarStv

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Re: How long can we wait while flattening the curve?
« Reply #2337 on: May 31, 2020, 01:57:45 PM »
[...] It makes far more sense to concentrate on eliminating all causes of death as best we can.
Ambitious.

I like it.  If you set an impossible goal as your target, it makes it an awful lot easier to give up on doing anything at all.  This is the path of least resistance.


:P

Abe

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Re: How long can we wait while flattening the curve?
« Reply #2338 on: May 31, 2020, 02:03:40 PM »
That's what I truly can't get my head around. Something like 150k (quick googleing) ppl die every day. That means since Jan, something like 22m ppl have died. Covid deaths are like 400k. So if you died in the last 5 months, it's 50x more likely that it was something other than this bug that got you.
Even during the peak week at 7500/day, that means it as 20 times more likely another cause.

Compared to all other causes, especially for people sub 60, this is really just not a big deal. If you all-risks causes of death was .1% before, now it's like .102%. But like terrorism, people have this irrational fear, and are willing to literally spends thousands of dollars on a personal level, and hundreds of billions on a societal to make a tiny non-zero risk, a slightly tinier non-zero risk. I just don't get it.

I've used this example before, but it's like the habitual drunk driver always remembering to buckle up. As if somehow dying from flying out the windshield due to no seatbelt is somehow worse than dying from rear ending someone at speed since you were blitzed out of your skull, the former which is far far more likely. A death is a death and most are sad and tragic. It makes far more sense to concentrate on eliminating all causes of death as best we can.

That's 400K with aggressive intervention.   Without intervention the total could be easily be an order of magnitude higher.

Using the US as an example (since I live here and am not familiar with national statistics for other countries, and am NOT discussing mortality in Australia which obviously is very low and you guys can do whatever you feel like at this point, thanks):

Total deaths from all causes in the US in particular is about 2.2 million per year, or approximately 6000 a day. Currently, COVID-19 is adding an extra ~1000 per day. Some fraction of those patients were going to die this year (hard to estimate the number, but on average patients who died of COVID in NYC hospitals were about 1.5x more likely to have a comorbidity (side note: the majority did not have life-threatening comorbidities)). Actuarial 1-year mortality for a 70 year old is 2.3%, 75 year old is 3.6%, and 80 year old is 5.8% based on the Social Security data). If we're generous and say 5.8% x 1.5 = 8.7% of patients who died of COVID were going to die this year because of an underlying comorbidity, that's about 75 per day (and clearly an overestimate since not all patients were 80+ years old).

The first big question will be what is the total number of deaths from COVID for the remainder of the year?
     If we assume the current linear trend in decreased deaths per day continues, by mid-June it should be ~500 a day, and by early July close to 0. Thus the average is 500/day x 30 = an additional 15,000 deaths. This gives a total of ~120,000 in a total of 3.5 months. For comparison, deaths per year from all other causes of pneumonia are estimated to be ~ 55k per year.

The second big question is will the fall result in another epidemic? Most estimates suggest we will not have a widely distributed vaccine for the coronavirus until January at the earliest. Seasonal waves of coronavirus infections are generally similar in magnitude, so if we cut the fall/winter season in half we get an additional 60k deaths.

Sources:
https://www.ssa.gov/oact/STATS/table4c6_2016.html#fn1
https://www.medrxiv.org/content/10.1101/2020.04.19.20062117v2
https://github.com/nytimes/covid-19-data
https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_06-508.pdf

The good news to focus on is that deaths are generally declining except in certain countries. Re-opening seems feasible and it appears conventional anti-infection measures will be sufficient now that the exponential rise has been quelled. I'm not going to argue whether the reaction we had was excessive of not, since none of us can see into the Multiverse and see what happened in the other universes where we just let things run like normal. Also, most people in the US aren't willing to do much activity regardless of what is allowed or not, so it's a somewhat moot point. Even the widely debated Georgia and Texas re-openings have had limited effects for workplaces in general (2nd page for each pdf):

https://www.gstatic.com/covid19/mobility/2020-05-25_US_Georgia_Mobility_Report_en.pdf
https://www.gstatic.com/covid19/mobility/2020-05-25_US_Texas_Mobility_Report_en.pdf
« Last Edit: May 31, 2020, 02:07:37 PM by Abe »

Gremlin

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Re: How long can we wait while flattening the curve?
« Reply #2339 on: May 31, 2020, 03:43:00 PM »
Hey did you guys know that Australia doesn’t have COVID19 all that bad?

Bloop Bloop has made sure that we are all aware of that.  You and New Zealand.
On behalf of the rest of us Australians, I'd like to apologise.

Just as I'm sure that not all Americans are 'Muricans, please understand that not all Australians are Bloop Bloops.

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #2340 on: May 31, 2020, 05:12:56 PM »
not all Australians are Bloop Bloops.

I will never ever stop laughing

RetiredAt63

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Re: How long can we wait while flattening the curve?
« Reply #2341 on: May 31, 2020, 05:13:22 PM »
Hey did you guys know that Australia doesn’t have COVID19 all that bad?

Bloop Bloop has made sure that we are all aware of that.  You and New Zealand.
On behalf of the rest of us Australians, I'd like to apologise.

Just as I'm sure that not all Americans are 'Muricans, please understand that not all Australians are Bloop Bloops.

Oh I do.  I was in Australia this year visiting forum friends, and in New Zealand visiting a close friend.   Canada is not as bad off as the US re Covid, but life would be a lot more fun if I were still in NZ.   ;-) .

Seadog

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Re: How long can we wait while flattening the curve?
« Reply #2342 on: May 31, 2020, 05:14:17 PM »
That's what I truly can't get my head around. Something like 150k (quick googleing) ppl die every day. That means since Jan, something like 22m ppl have died. Covid deaths are like 400k. So if you died in the last 5 months, it's 50x more likely that it was something other than this bug that got you.
Even during the peak week at 7500/day, that means it as 20 times more likely another cause.

Comparison bias plays a big role here.  since the early 20th century, deaths from infectious diseases have declined by an order of magnitude thanks to vaccines, antibiotics, and other triumphs of modern medicine.  For this reason, our sense of scale is very different when it comes to pandemics than for other causes of deaths that we've had much more limited success treating.

That said, I think a legitimate(and uncomfortable) thought experiment is to ask, for the amount of resources we've spent dealing with this pandemic, could we have done more total good directing the same amount of money towards initiatives likely to benefit a large chunk of society(both public health, and otherwise)?  I think the answer to this question is probably "yes," as 6 trillion dollars funds a whole lot of cancer research, mosquito netting, medical treatment for those who may not be able to afford it, and other things that stand a reasonable chance at saving more lives with a lower price tag.

Agree 100%. The whole of the west lacks any real perspective on what real hardship is. I've lived and worked in shithole countries where lots of food wasn't available. Grocery stores with more empty shelves than full. A remote work site where on one day I remember (wasn't common, but still) we got one meal of white rice and fried veggies, because that's all they could get. Obviously that's not going to kill anyone, but certainly adds a bit of perspective when most people think the only thing between them and a 100 types of out of season veggies or a dozen different cuts of beef is a 3 mile trip to the grocery store and a charge card.

This is why all the labour issues is such a big concern for me. Farms can't get the pickers they need. Meat plants are being closed because someone had the bug. My friend couldn't get certain beef sandwiches at Wendy's the other day because they had no patties. Most people don't appreciate the scope, scale and complexity of the west's entire food production, distribution, and sale platforms. How does a tomato grown in Chili get to Northern Alberta? And why does it only cost a dollar?

That lack of hardship and having to think for yourself is why half of (at least Canada) was 1 paycheque away from insolvency,"I'll never lose my job". Many immigrants save like 40% of their income. Why do most ppl suck at most real world skills that the rest of the world learns because they have to? I've seen people lose their shit because their cell phone died in their car, and they can't even read a frigging map. Most people can't even drive a standard car here.  What happens when the water goes out? "That'll never happen". Again in said shit hole countries I've gone like 3 days without was the longest. A dozen 2L pop bottles in an attic, purification tablets for another several hundred liters, knowing where nearest fresh water source is, and you can ride out pretty much any water stoppage. For like $20. How many people do this stuff? It isn't prepper fear mongering, it's a $20 insurance policy that could save your life, and puts you ahead of 98% of the population. As the saying goes, humanity is 9 meals away from anarchy. I have a rotating ~1 month pantry. This literally costs nothing, since it's all food you're constantly eating and resupplying.

When shit gets real, it's far too late. The west's idea of "shit getting real" is when Purell was sold out, and they were limited to 4 cans of soup.
« Last Edit: May 31, 2020, 05:17:07 PM by Seadog »

Bloop Bloop

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Re: How long can we wait while flattening the curve?
« Reply #2343 on: May 31, 2020, 05:34:28 PM »
No need to devolve into personal attacks, folks. It's unnecessary and doesn't move the discussion forward, and a pretty low-rent strategy.

Kyle Schuant

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Re: How long can we wait while flattening the curve?
« Reply #2344 on: May 31, 2020, 06:06:18 PM »
Most of the West doesn't know what real hardship is, and Bloop doesn't know what a real personal attack is. :p

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #2345 on: May 31, 2020, 06:23:39 PM »


I don’t know if Australia had this kid’s show, but in my mind that “not all Australians are bloop bloops” made an image in my mind that bloop bloop is similar to a boohbah and Australia is full of them.

marty998

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Re: How long can we wait while flattening the curve?
« Reply #2346 on: May 31, 2020, 07:20:12 PM »


I don’t know if Australia had this kid’s show, but in my mind that “not all Australians are bloop bloops” made an image in my mind that bloop bloop is similar to a boohbah and Australia is full of them.

If a Vogon fucked a rainbow, this would definitely be the babies 🤣

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #2347 on: May 31, 2020, 07:38:41 PM »
Sorry for my broken brain, bloop

Davnasty

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Re: How long can we wait while flattening the curve?
« Reply #2348 on: May 31, 2020, 08:13:17 PM »
not all Australians are Bloop Bloops.

I will never ever stop laughing

I'm not sure why this is so funny, but it is.

Now I kinda wish it was slang for Australians.

Seadog

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Re: How long can we wait while flattening the curve?
« Reply #2349 on: June 01, 2020, 05:55:52 AM »
[...] It makes far more sense to concentrate on eliminating all causes of death as best we can.
Ambitious.

I like it.  If you set an impossible goal as your target, it makes it an awful lot easier to give up on doing anything at all.  This is the path of least resistance.


:P

No need to be facetious. As JS82 pointed out, we're literally spending trillions of dollars here. There are multiple entire countries where 20+% of the population has AIDS. Many countries in Africa where thousands of people die from Malaria. Across all countries (some worse than others) where addiction/depression/suicide are all real problems claiming thousands more. These things are not "pie in the sky, maybe one day we'll fix them" issues. We know how to treat/reduce these things NOW. Malaria nets, anti-malarial pills, successful anti-virals for AIDS which mean it's not a death sentence (if you can afford them), and addiction specialists/counseling, in-house treatment programs. The exacerbating sad fact for me is that these people are being claimed in the prime of their lives, vs the average age of 85 or whatever for this.

Much like people can't differentiate the difference between the distance to Mars, Another star, or another galaxy because the numbers are just too huge and beyond anything of human scale, the same can be said for trillions of dollars. If we wanted to spend $6t on saving lives, it could have been much better deployed.