Author Topic: How long can we wait while flattening the curve?  (Read 675286 times)

OtherJen

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Re: How long can we wait while flattening the curve?
« Reply #4700 on: November 16, 2020, 06:39:47 AM »
I'm a bit confused by the "better treatment" side of things - our ICUs were never overrun or at capacity as, by international standards, the number of cases were low. Right out of the gate in march/april, if you were admitted to an ICU here (or in Sweden for that matter which had a lot more cases) your survival rate on average was around 80% and it hasn't really moved since. Odds are of course much better for younger patients with no underlying cause, but even the ICU doctors themselves were surprised by - all things considered - how well it had gone.

Just a few weeks ago the head of the largest ICU in the country and his collegues on other ICu wards were asked if there had actually been any major improvement in treatments and they all said no-ish. They had made some very minor adjustments to the treatment procedures, but the former has been pretty clear all the time that it's pretty standard, well established ICU treatment and nothing revolutionary in that department.

Me not being a doctor I obv have no clue what they do or don't, but I am surprised by range in the replies form ours "nothing new, really" to "much better treatment now than earlier". I do of course get the point of a massively strained system will perform worse than one operating safely within its capacity, but the rest I find it bit harder to wrap my head around. Another reason for the high survival rate is partly due to how various systems work - here, if you are in a elderly care facility you are very unlikely to be sent to an ICU under any circumstance. Of the Covid-19 patients in ICU here, just under 7% of those admitted are aged 80 or older. In Sweden it's around 5% of the ICU case load. Haven't really seen the corresponding numbers from anywhere else.


NPR: Advances In ICU Care Are Saving More Patients Who Have COVID-19

habanero

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Re: How long can we wait while flattening the curve?
« Reply #4701 on: November 16, 2020, 07:42:19 AM »

NPR: Advances In ICU Care Are Saving More Patients Who Have COVID-19


I have of course read similar stories a lot of times. I have also read stories about new medications that were supposedly great but turned out to be a bit meh in the end. And I'm not stating treatment isn't better (after all, it's what you would expect - that it got better), I just think it hasen't improved as much as perceived. And that's also what our ICU heads say as well. The idea that treatment is much better now is pretty widespread in the general public, but they say what they do hasn't changed much. I have to take their word for it, I guess. And survival rates have been very high since march.

If you read the study linked to in the NPR article it doesn't say "ICU mortality is down due to better treatment". It does acknowledge rapid learning on a global scale and more experience, but it also lists other factors for higher ICU survival rates as the pandemic progresses. It basically says "this is complex" for several reasons, Some systems were strained in the beginning, but been less so since. Who got treatment in an ICU or outside has not been constant (also a function of capacity). Even how ICU death rate is calculated has not been constant.

When Trump got treated with all sorts of experimental stuff and a lot which has documented no effect it was commented here by the doctors treating critically ill Covid-19 with a variation on  "What the fuck are they doing??" They also said they got a bit perplexed by the medication fetish surrounding Covid-19. Given there is no miracle treatment available, the other, well established ICU techniques are much more important. And this is also the likely reason why Trump recovered, not that they apparently threw everything in existence on the problem. Again, I'm not a doctor, but it does at least show some differences in ICU care culture and public perception of what treatment is and the idea is "Trump got it, recovered, so why can't everyone get it" ?

Plina

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Re: How long can we wait while flattening the curve?
« Reply #4702 on: November 16, 2020, 08:07:59 AM »
I'm a bit confused by the "better treatment" side of things - our ICUs were never overrun or at capacity as, by international standards, the number of cases were low. Right out of the gate in march/april, if you were admitted to an ICU here (or in Sweden for that matter which had a lot more cases) your survival rate on average was around 80% and it hasn't really moved since. Odds are of course much better for younger patients with no underlying cause, but even the ICU doctors themselves were surprised by - all things considered - how well it had gone.

Just a few weeks ago the head of the largest ICU in the country and his collegues on other ICu wards were asked if there had actually been any major improvement in treatments and they all said no-ish. They had made some very minor adjustments to the treatment procedures, but the former has been pretty clear all the time that it's pretty standard, well established ICU treatment and nothing revolutionary in that department.

Me not being a doctor I obv have no clue what they do or don't, but I am surprised by range in the replies form ours "nothing new, really" to "much better treatment now than earlier". I do of course get the point of a massively strained system will perform worse than one operating safely within its capacity, but the rest I find it bit harder to wrap my head around. Another reason for the high survival rate is partly due to how various systems work - here, if you are in a elderly care facility you are very unlikely to be sent to an ICU under any circumstance. Of the Covid-19 patients in ICU here, just under 7% of those admitted are aged 80 or older. In Sweden it's around 5% of the ICU case load. Haven't really seen the corresponding numbers from anywhere else.

According to the doctors in swedish newspapers, they now have a better understanding of what works and not so it is less trial and error then in the beginning. Which medicins are helping and not and which positions aids patients in breathing. That has led to shorter stays in hospitals for the patients. It was also stated that even though they have been able to deal with the patient load, they have had to spread the staff in a way they would not normally. Now, there is a lot of talk how it will work staffwise due to lack of ICU staff and a real tired personell that only got 2-3 weeks of vacation instead of the standard 4 weeks.

bigblock440

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Re: How long can we wait while flattening the curve?
« Reply #4703 on: November 16, 2020, 09:12:37 AM »
Putting aside the self-evident lack of need for a mask when working outside on a job site alone or bushwalking alone (masks still required to be worn if you are outside - at the very least, a modification should be made so that you only have to carry a mask, and wear it only when another person comes within range), there are many further views, and also scientific evidence discussed, in this Guardian Australia article about the efficacy of mask wearing in outdoor situations generally:

https://www.theguardian.com/australia-news/2020/nov/15/face-value-are-masks-still-needed-to-combat-coronavirus-in-nsw-and-victoria

Bloop, in Australia are police actually physically enforcing mask mandates on people "bushwalking alone" or "working outside on a jobsite"?

A few months back, our governor issued a mask mandate stating, "Pennsylvania's mask mandate specifically requires people wear a face covering when outdoors and unable to consistently maintain a distance of 6 feet from people who are not members of the same household. It also applies to indoor locations where members of the public are generally permitted."

My family and I have been mostly doing as you suggest, carrying masks around with us in our pockets. Just before we arrive at the farmers market or some business we are planning on entering, we put our masks on. afaik, that's totally fine here. If I'm walking outside with my wife and we see a group of strangers coming towards us on the sidewalk, we just cross the street and keep going. Seems to me like we're following the spirit of our state's mask mandate, while maybe not necessarily always adhering strictly to the letter of the law, e.g., we may sometimes pass other maskless people on the sidewalk in places where it's not easy to cross the street when we're only 4' or 5' apart, instead of 6', but here there aren't cops lurking around waiting to cite people for technical infractions like that.

You're a cold-blooded murderer according to some posters.

ixtap

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Re: How long can we wait while flattening the curve?
« Reply #4704 on: November 16, 2020, 09:16:08 AM »
Putting aside the self-evident lack of need for a mask when working outside on a job site alone or bushwalking alone (masks still required to be worn if you are outside - at the very least, a modification should be made so that you only have to carry a mask, and wear it only when another person comes within range), there are many further views, and also scientific evidence discussed, in this Guardian Australia article about the efficacy of mask wearing in outdoor situations generally:

https://www.theguardian.com/australia-news/2020/nov/15/face-value-are-masks-still-needed-to-combat-coronavirus-in-nsw-and-victoria

Bloop, in Australia are police actually physically enforcing mask mandates on people "bushwalking alone" or "working outside on a jobsite"?

A few months back, our governor issued a mask mandate stating, "Pennsylvania's mask mandate specifically requires people wear a face covering when outdoors and unable to consistently maintain a distance of 6 feet from people who are not members of the same household. It also applies to indoor locations where members of the public are generally permitted."

My family and I have been mostly doing as you suggest, carrying masks around with us in our pockets. Just before we arrive at the farmers market or some business we are planning on entering, we put our masks on. afaik, that's totally fine here. If I'm walking outside with my wife and we see a group of strangers coming towards us on the sidewalk, we just cross the street and keep going. Seems to me like we're following the spirit of our state's mask mandate, while maybe not necessarily always adhering strictly to the letter of the law, e.g., we may sometimes pass other maskless people on the sidewalk in places where it's not easy to cross the street when we're only 4' or 5' apart, instead of 6', but here there aren't cops lurking around waiting to cite people for technical infractions like that.

Why not just put the mask on when approaching other people?

OtherJen

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Re: How long can we wait while flattening the curve?
« Reply #4705 on: November 16, 2020, 09:31:41 AM »
And now our governor will most likely get impeached by our GOP majority legislature because people are BIG MAD that they have to get take-out from Applebee's for the next 3 weeks.

I mean, 11 counties in the state are already at 100% ICU capacity and another 10 have reached at least 70% ICU capacity, but sure, let's impeach the governor for announcing the Department of Health's orders. That seems like a good use of state resources during a public health emergency.

WXYZ Detroit: Michigan Republican state rep. calls for House to impeach Gov. Whitmer

Strangely, they weren't calling to impeach the previous GOP governor after the Flint water crisis. But then, that governor wasn't trying to save lives, he was trying to cover his own ass.

GuitarStv

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Re: How long can we wait while flattening the curve?
« Reply #4706 on: November 16, 2020, 09:32:25 AM »
Is Applebee's food particularly good or something?

OtherJen

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Re: How long can we wait while flattening the curve?
« Reply #4707 on: November 16, 2020, 09:33:47 AM »
Is Applebee's food particularly good or something?

No. It's terrible. It's a catchphrase for shitty corporate-chain Americana.

jrhampt

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Re: How long can we wait while flattening the curve?
« Reply #4708 on: November 16, 2020, 09:52:29 AM »
It's otherwise known as "Crapplebee's".

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #4709 on: November 16, 2020, 10:01:43 AM »
It's the punching bag here, but FWIW I have a ton of great college memories at Applebees. Cheap drinks and apps. It's an institution.

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #4710 on: November 16, 2020, 10:08:04 AM »
I feel for governors here because unlike the Feds, they don't have the ability to print and spend unlimited amounts of money to pay people to stay home. It's more clear now than ever that this should be the path forward. Publicly traded companies and white collar workers who can WFH are doing fine. Even some blue collar workers are doing fine. Small businesses and hospitality are getting creamed though. Bail these people out. Give them a permission slip to stay at home and control the spread. Things are getting real bad, real fast.

Laserjet3051

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Re: How long can we wait while flattening the curve?
« Reply #4711 on: November 16, 2020, 10:16:09 AM »
And now our governor will most likely get impeached by our GOP majority legislature because people are BIG MAD that they have to get take-out from Applebee's for the next 3 weeks.

I mean, 11 counties in the state are already at 100% ICU capacity and another 10 have reached at least 70% ICU capacity, but sure, let's impeach the governor for announcing the Department of Health's orders. That seems like a good use of state resources during a public health emergency.

WXYZ Detroit: Michigan Republican state rep. calls for House to impeach Gov. Whitmer

Strangely, they weren't calling to impeach the previous GOP governor after the Flint water crisis. But then, that governor wasn't trying to save lives, he was trying to cover his own ass.

Your applebees comment misdirects and trivializes the real nontrivial harm done to michiganders by whitmer across the state. Your lack of acknowledgement to this fact is beyond repugnant. The social isolation caused by 8 months of school closures has been pivotal in the degradation of my young daughters mental health. Catapulting her, along with whitmers other closures, to feelings of suicide and self harm.

This michigander toxicologist is overjoyed that i put fred upton back in the mi house of reps who hopefully WILL inpeach whitmer before it is too late, for many of those suffering due to ill advised policies.

OtherJen

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Re: How long can we wait while flattening the curve?
« Reply #4712 on: November 16, 2020, 10:31:10 AM »
And now our governor will most likely get impeached by our GOP majority legislature because people are BIG MAD that they have to get take-out from Applebee's for the next 3 weeks.

I mean, 11 counties in the state are already at 100% ICU capacity and another 10 have reached at least 70% ICU capacity, but sure, let's impeach the governor for announcing the Department of Health's orders. That seems like a good use of state resources during a public health emergency.

WXYZ Detroit: Michigan Republican state rep. calls for House to impeach Gov. Whitmer

Strangely, they weren't calling to impeach the previous GOP governor after the Flint water crisis. But then, that governor wasn't trying to save lives, he was trying to cover his own ass.

Your applebees comment misdirects and trivializes the real nontrivial harm done to michiganders by whitmer across the state. Your lack of acknowledgement to this fact is beyond repugnant. The social isolation caused by 8 months of school closures has been pivotal in the degradation of my young daughters mental health. Catapulting her, along with whitmers other closures, to feelings of suicide and self harm.

This michigander toxicologist is overjoyed that i put fred upton back in the mi house of reps who hopefully WILL inpeach whitmer before it is too late, for many of those suffering due to ill advised policies.

This Michigander immunologist thinks that your attitude toward the the health of people in our state is equally repugnant, and your unwillingness to accept the real suffering experienced by overwhelmed school officials and healthcare workers is unbelievably selfish and self-serving.

I'm truly sorry about your daughter. My SIL is a school psychologist in West Michigan and is trying to serve kids like your daughter while dealing with the fact that schools in her district keep having to close due to a lack of staff but the district won't close because politics, and if one of her own kids has a medical emergency then she's a bit screwed if the rumors are true that her local hospital is being converted to COVID only.

But seriously, dude, my father waited for months to even be able to see a radiology specialist here in Metro Detroit. He was diagnosed with cancer in January and wasn't able to start treatment until September because our local medical systems were overloaded through the spring. He couldn't even get imaging done until July. How many people in GR-Muskegon are going to miss a cancer diagnosis or get a treatment delay because Spectrum Health is almost at max capacity?

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #4713 on: November 16, 2020, 10:38:47 AM »
Everyone is trying their best. Nobody wants at risk pre-teens to go without the attention they need and nobody wants ICUs turning away patients. It's a tough needle to thread.

Montecarlo

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Re: How long can we wait while flattening the curve?
« Reply #4714 on: November 16, 2020, 10:50:17 AM »
What are reasonable timelines to get these vaccines mass produced and distributed?  Sign me up.  I want to get this shit behind us

mm1970

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Re: How long can we wait while flattening the curve?
« Reply #4715 on: November 16, 2020, 10:59:54 AM »
It's the punching bag here, but FWIW I have a ton of great college memories at Applebees. Cheap drinks and apps. It's an institution.
Both my niece and nephew worked at Applebees in high school (and nephew still does in college).

bigblock440

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Re: How long can we wait while flattening the curve?
« Reply #4716 on: November 16, 2020, 11:00:28 AM »
What are reasonable timelines to get these vaccines mass produced and distributed?  Sign me up.  I want to get this shit behind us

Moderna said 20 million doses by the end of the year

OtherJen

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Re: How long can we wait while flattening the curve?
« Reply #4717 on: November 16, 2020, 11:01:47 AM »
It's the punching bag here, but FWIW I have a ton of great college memories at Applebees. Cheap drinks and apps. It's an institution.
Both my niece and nephew worked at Applebees in high school (and nephew still does in college).

I retract the comment about Applebee's. That was unfair. I worked at TGI Friday's in college, which was an absolutely terrible workplace, and it's not fair to assume that all similar chain restaurants are terrible. (Although I truly don't like the food at Applebee's.)

mm1970

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Re: How long can we wait while flattening the curve?
« Reply #4718 on: November 16, 2020, 11:03:37 AM »
Quote
This Michigander immunologist thinks that your attitude toward the the health of people in our state is equally repugnant, and your unwillingness to accept the real suffering experienced by overwhelmed school officials and healthcare workers is unbelievably selfish and self-serving.

I'm truly sorry about your daughter. My SIL is a school psychologist in West Michigan and is trying to serve kids like your daughter while dealing with the fact that schools in her district keep having to close due to a lack of staff but the district won't close because politics, and if one of her own kids has a medical emergency then she's a bit screwed if the rumors are true that her local hospital is being converted to COVID only.

But seriously, dude, my father waited for months to even be able to see a radiology specialist here in Metro Detroit. He was diagnosed with cancer in January and wasn't able to start treatment until September because our local medical systems were overloaded through the spring. He couldn't even get imaging done until July. How many people in GR-Muskegon are going to miss a cancer diagnosis or get a treatment delay because Spectrum Health is almost at max capacity?
+1

My stepfather has basically been a shut in for 8 months, and even worse now. COVID is spiking so much he cannot even safely go grocery shopping.  He's a cancer patient, getting regular treatment and chemo.  Even going to the hospital for treatment is risky for him.

Villanelle

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Re: How long can we wait while flattening the curve?
« Reply #4719 on: November 16, 2020, 11:07:07 AM »
What are reasonable timelines to get these vaccines mass produced and distributed?  Sign me up.  I want to get this shit behind us

I see this sentiment a lot, and I think it demonstrates that there is a clear misunderstanding about the vaccination.  it is not a cure for this disease.  First, remember that we have vaccinated our way out of exactly 1 disease, ever--Smallpox.  Getting rid of a disease is juuuust shy of impossible. 

Second, we have no idea how long immunity lasts.  Naturally-gained (aka getting sick) immunity seems to last not long at all, as multiple people have had the disease twice in the less-than-a-year it has even existed. At least one died from a second infection, I recall reading.   So if this vaccination is similar, we'd need to be vaccinating a vast majority of the population every ~6 months.  There is simply no way to do that.

Distribution is also complicated. The Pfizer vax has to be stored at something like -95*.  Getting it to small rural communities and distributing it will be no small feat.  And that's after production has ramped up enough that we even have enough of it to do so.

Then there will be the people who refuse to get it.  Because this was so politicized, there seems to be even more skepticism and fear about this than just the normal anti-vax crap.  If people won't wear a mask, are they going to get jabbed with a needle filled with a substance for which we have no long term data on effects?  And who is going to pay for them to get it?  Then of course there are the people whose health means they can't get the vaccination, even if they want it.

An effective vaccine is an incredibly development.  But it doesn't mean we will be done with this any time soon.  The biggest concern for me is how long the immunity lasts, and secondarily I worry about mutations in the virus that mean a new vaccination needs to be made and distributed every year, much like the flu.

So I don't think this shit will be completely behind us any time soon, if at all.


dandarc

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Re: How long can we wait while flattening the curve?
« Reply #4720 on: November 16, 2020, 11:17:15 AM »
Distribution isn't as complicated as it sounds at first - "must have super freezer" isn't really true - Pfizer has said they load vaccine + dry ice into container to ship via air, then once at destination you can keep it 6 months in a super freezer, like 5 days in a regular freezer, and something like 15 days by following the "replace dry ice in the box it was shipped in" procedure. Not as easy as pills that can store for years on a shelf at room temp, but sure doesn't read quite as difficult as I first thought when they said "-80 degrees celsius" or what have you. Moderna's vaccine is supposed to be easier to handle on this front than Pfizer's.

Most aggressive timeline I saw was "high priority folks can start receiving vaccine in December, begin widespread distribution in March".
« Last Edit: November 16, 2020, 02:23:15 PM by dandarc »

waltworks

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Re: How long can we wait while flattening the curve?
« Reply #4721 on: November 16, 2020, 11:23:15 AM »
You can vaccinate everyone every 6 months if you have to. I mean, it would cost money and be annoying. But it's not some impossible task.

I'm not worried about the reinfection stuff. I mean, we've had ~55 million *known* cases worldwide. I'd guess there are *at least* 10 times that many that have gone undetected/unreported. Someone dying from reinfection out of that pool of people is meaningless. Hell, thousands of people dying from reinfection from a pool of that size is meaningless for public health purposes.

-W

Montecarlo

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Re: How long can we wait while flattening the curve?
« Reply #4722 on: November 16, 2020, 11:24:58 AM »
What are reasonable timelines to get these vaccines mass produced and distributed?  Sign me up.  I want to get this shit behind us

I see this sentiment a lot, and I think it demonstrates that there is a clear misunderstanding about the vaccination.  it is not a cure for this disease.  First, remember that we have vaccinated our way out of exactly 1 disease, ever--Smallpox.  Getting rid of a disease is juuuust shy of impossible. 

Second, we have no idea how long immunity lasts.  Naturally-gained (aka getting sick) immunity seems to last not long at all, as multiple people have had the disease twice in the less-than-a-year it has even existed. At least one died from a second infection, I recall reading.   So if this vaccination is similar, we'd need to be vaccinating a vast majority of the population every ~6 months.  There is simply no way to do that.

Distribution is also complicated. The Pfizer vax has to be stored at something like -95*.  Getting it to small rural communities and distributing it will be no small feat.  And that's after production has ramped up enough that we even have enough of it to do so.

Then there will be the people who refuse to get it.  Because this was so politicized, there seems to be even more skepticism and fear about this than just the normal anti-vax crap.  If people won't wear a mask, are they going to get jabbed with a needle filled with a substance for which we have no long term data on effects?  And who is going to pay for them to get it?  Then of course there are the people whose health means they can't get the vaccination, even if they want it.

An effective vaccine is an incredibly development.  But it doesn't mean we will be done with this any time soon.  The biggest concern for me is how long the immunity lasts, and secondarily I worry about mutations in the virus that mean a new vaccination needs to be made and distributed every year, much like the flu.

So I don't think this shit will be completely behind us any time soon, if at all.
,
man, you and your facts are a wet blanket.

I do agree that this disease will almost certainly be endemic, and never truly behind us, but I'm not sure we know enough about reinfections to be that pessimistic. 

obstinate

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Re: How long can we wait while flattening the curve?
« Reply #4723 on: November 16, 2020, 12:59:52 PM »
What are reasonable timelines to get these vaccines mass produced and distributed?  Sign me up.  I want to get this shit behind us

I see this sentiment a lot, and I think it demonstrates that there is a clear misunderstanding about the vaccination.  it is not a cure for this disease.  First, remember that we have vaccinated our way out of exactly 1 disease, ever--Smallpox.  Getting rid of a disease is juuuust shy of impossible. 
Eh. We also basically eradicated polio -- it's only found in Afghanistan and Pakistan now. And there are a number of other diseases that are very rarely acquired in industrialized countries.

The main metric that concerns me is when I'm able to go out and do the things I'm used to. I don't really care that much if some anti-vaxxer idiot gets the 'rona, as long as it does not have a high probability of affecting me or my family.

rocketpj

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Re: How long can we wait while flattening the curve?
« Reply #4724 on: November 16, 2020, 01:29:21 PM »
Yup, bring on the vaccines, I'll take them all if I can.

My workplace (homeless shelter), if corona gets to it, will be a morgue, probably including some of the staff.  There have been some exposures so far but no cases that we know of.

Where I live we are back into a semi-lockdown for the next couple of weeks.  Kids sports are cancelled, visiting is out, etc. etc.  Some of my neighbours are mad about it, but if it keeps my family safe then I am all for it.  This sucks and I can't wait for it to end.

I cannot believe how the use of medical masks to slow the spread of a deadly pandemic has become a tribal political issue.  It has to be the stupidest fucking thing I've ever seen.  Literal, willful self defeating idiocy on an international scale.  People will look back on it as the most obvious symptom of a broken educational system. 

Villanelle

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Re: How long can we wait while flattening the curve?
« Reply #4725 on: November 16, 2020, 02:49:30 PM »
You can vaccinate everyone every 6 months if you have to. I mean, it would cost money and be annoying. But it's not some impossible task.

I'm not worried about the reinfection stuff. I mean, we've had ~55 million *known* cases worldwide. I'd guess there are *at least* 10 times that many that have gone undetected/unreported. Someone dying from reinfection out of that pool of people is meaningless. Hell, thousands of people dying from reinfection from a pool of that size is meaningless for public health purposes.

-W

I think it's an impossible task when you factor in compliance.  Sure, it is technically possible, but I think it is socially impossible. 

And frankly, 6 months may be optimistic if we are talking about trying to reach a point where a vast majority of the world's population has immunity at the same time.

I'm not sure what you mean by your last paragraph.  My point was that it is very clear that immunity is not long-lasting *at all*.  I pointed out that someone died so show that we also can't count on subsequent infections being less severe.  How is any of that meaningless?  It seems fairly clear that immunity in at least many (if not most) people, only lasts a matter of months.  While we can't automatically extrapolate that the same will be true for immunity from vaccination, it's not a promising sign for long-term immunity from a vaccine.  That seems far from "meaningless".

waltworks

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Re: How long can we wait while flattening the curve?
« Reply #4726 on: November 16, 2020, 03:41:51 PM »
Look, if immunity only lasted a few months, we'd see millions and millions of reinfections. We aren't seeing that. Quite the opposite. Research says *at least* 5-7 months, and quite likely longer.

https://www.cell.com/immunity/fulltext/S1074-7613(20)30445-3
https://www.npr.org/sections/health-shots/2020/07/23/894670842/how-long-will-immunity-to-the-coronavirus-last

But hey, some people just want to watch the world burn, or root for it, I guess? I wonder where all the "humanity has never made a coronavirus vaccine!!!!!1!!" people went?

-W

Villanelle

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Re: How long can we wait while flattening the curve?
« Reply #4727 on: November 16, 2020, 05:14:16 PM »
Look, if immunity only lasted a few months, we'd see millions and millions of reinfections. We aren't seeing that. Quite the opposite. Research says *at least* 5-7 months, and quite likely longer.

https://www.cell.com/immunity/fulltext/S1074-7613(20)30445-3
https://www.npr.org/sections/health-shots/2020/07/23/894670842/how-long-will-immunity-to-the-coronavirus-last

But hey, some people just want to watch the world burn, or root for it, I guess? I wonder where all the "humanity has never made a coronavirus vaccine!!!!!1!!" people went?

-W

I'm not sure why you have such an adversarial tone.  The notion that I want to watch the world burn or root for it is asinine.  I'm simply not optimistic that this is some fix-all like many people seem to think, and that pessimism is based on more than just "ZOMG;Scary stuff!".  You can certainly disagree with my conclusions, but there's no need to be salty and rude about it. 

Your own article says, "It finds that 90% of those people had antibody responses that lasted at least three months. And these antibodies neutralized the virus, at least in the lab."  So 9 in 10 have antibody responses for three months.  Um, that's not super awesome, if the vaccine is similar.  Now your article also says ""We know from many other infections, the vaccine response can be much more durable than the natural infection response," says Adrian Hill, who is the principal investigator for this vaccine study. That's partly because people get a strong dose with a vaccine, which stimulates strong immunity. "I'm pretty confident that in COVID we're going to see the vaccines are more durable than a natural COVID infection," Hill says. "But again, we don't know yet. We need to wait and see," which is certainly more optimistic, but far from conclusive.

Again, feel free to disagree with my worries or their foundation.  But don't be an unpleasant misanthrope about it or make baseless accusations about how I must want this to fail, please.   

waltworks

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Re: How long can we wait while flattening the curve?
« Reply #4728 on: November 16, 2020, 05:45:27 PM »
Um, antibodies are great. But B and T cells deal with long term stuff. The fact that antibodies last that long is great, it's likely immunity lasts a LOT longer than detectable antibodies, though.

Nobody said the vaccine is perfect or that we'll all get a free pony. But it's extremely good news. We already have 2 effective vaccines, with more in the pipeline. Humanity solves shit sometimes.

-W

OtherJen

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Re: How long can we wait while flattening the curve?
« Reply #4729 on: November 16, 2020, 06:47:22 PM »
Um, antibodies are great. But B and T cells deal with long term stuff. The fact that antibodies last that long is great, it's likely immunity lasts a LOT longer than detectable antibodies, though.

Nobody said the vaccine is perfect or that we'll all get a free pony. But it's extremely good news. We already have 2 effective vaccines, with more in the pipeline. Humanity solves shit sometimes.

-W

B cells produce antibodies. You need to induce a strong enough B cell response to have memory B cells (i.e., plasma cells) left after the initial response is left. That process required a specific T cell response. If specific IgG antibodies aren't detectable after a few months or they aren't able to recognize epitopes on a mutated virus, then there's not a useful memory immune response.
« Last Edit: November 16, 2020, 06:52:36 PM by OtherJen »

Villanelle

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Re: How long can we wait while flattening the curve?
« Reply #4730 on: November 16, 2020, 06:55:43 PM »
Um, antibodies are great. But B and T cells deal with long term stuff. The fact that antibodies last that long is great, it's likely immunity lasts a LOT longer than detectable antibodies, though.

Nobody said the vaccine is perfect or that we'll all get a free pony. But it's extremely good news. We already have 2 effective vaccines, with more in the pipeline. Humanity solves shit sometimes.

-W

LOLZ.  I hope someone gives you a much-needed hug.  (Masked, of course!) 

waltworks

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Re: How long can we wait while flattening the curve?
« Reply #4731 on: November 16, 2020, 07:21:42 PM »
LOLZ.  I hope someone gives you a much-needed hug.  (Masked, of course!)

Thanks! Humorously enough, that's probably how I got Covid back in March - hugging and high fiving homeless guys while running the food pantry.

I'm a big hugger/backslapper/etc, so that's definitely one of the things I've missed most during Covid, and one of the reasons I'm so happy about the good vaccine news.

-W

Abe

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Re: How long can we wait while flattening the curve?
« Reply #4732 on: November 16, 2020, 07:56:58 PM »
A 2011 study from China showed that an anti-SARS-CoV-1 memory T cell response could be triggered 6 years out despite IgG antibody titers waning in the first 3 years after infection (found in prior studies, which raised concerns about recurrent CoV-1 pandemics). This data suggests (though cannot be proven) that immunity lasts longer than anticipated.
https://www.jimmunol.org/content/jimmunol/186/12/7264.full.pdf

Reinfection of select people is well within the expected realm of events even if natural immunity persisted longer than it did in these patients. No infection or immunization has 100% efficacy in preventing reinfections. I don't think we can say with that data what the long-term efficacy of the immune response in previously exposed patients will be, nor make any extrapolation to the vaccines. We do know that immunity against endemic coranavirii is limited to ~12-18 months, and generally due to transient immunity rather than mutations in the particles themselves. Even with that, we have far too little data to argue either side regarding vaccine schedules since CoV-1 immunity appears to last longer. It's just a matter of seeing what happens at this point.

Another point previously raised by others, and which I didn't appreciate at the time was that herd immunity calculations are based on fairly static assumptions regarding exposure and transmission rates. Dynamic transmission models suggest herd immunity rates can be achieved with reasonable non-vaccine precautions at lower levels. Whoever pointed that out, could you explain in further detail? The point being that the total vaccination rate may need to be as high as anticipated to bring deaths down to an acceptable level, especially if we can target vaccinations for high-risk groups. This is one of the reasons that not everyone gets a pneumonia vaccine.

obstinate

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Re: How long can we wait while flattening the curve?
« Reply #4733 on: November 16, 2020, 10:01:46 PM »
Another point previously raised by others, and which I didn't appreciate at the time was that herd immunity calculations are based on fairly static assumptions regarding exposure and transmission rates. Dynamic transmission models suggest herd immunity rates can be achieved with reasonable non-vaccine precautions at lower levels. Whoever pointed that out, could you explain in further detail? The point being that the total vaccination rate may need to be as high as anticipated to bring deaths down to an acceptable level, especially if we can target vaccinations for high-risk groups. This is one of the reasons that not everyone gets a pneumonia vaccine.
I'm not going to take the time to find the paper, but assuming a random distribution of vaccinated people, a naive model would expect to see transmissions lowered by the fraction of vaccinated or otherwise immune folks. So if 25% are vaccinated and 15% have had it then the basic reproduction number should fall to about 60% of its original value (from 2.2-2.7 to 1.3-1.6). That is still enough for the pandemic to spread, but that's without additional precautions like masking. It's also worth noting that this assumes a random distribution of infection risk, but in practice those who get the vaccine will probably be correlated both with who is at risk and with who has already had it. The reproduction number could therefore fall below one in the communities where the virus spreads the most.

RetiredAt63

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Re: How long can we wait while flattening the curve?
« Reply #4734 on: November 17, 2020, 08:23:23 AM »
We almost need a new thread of stupid Covid behaviour.  As in, police in Toronto (which is not doing well) busted a birthday party with over 100 people.  In a storage unit. That is not meant to host a gathering of any sort.  No idea who these people are.   Potential fines are big but who knows what they will actually get hit with.  Not to mention the fines under the building code and fire code.  To go with the Ontario idiots, we have the Quebec idiots who had a huge party in Chelsea (near Ottawa) a short while ago.  I'm sure people in other provinces could provide similar stories.

So most of us observe all the precautions, and every so often the idiots hold a super spreader event. 

It's a miracle Canada's numbers are as low as they are (not all that low).

OtherJen

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Re: How long can we wait while flattening the curve?
« Reply #4735 on: November 17, 2020, 01:03:13 PM »
I can't crack a joke about this: The Hill: North Dakota records world's highest COVID-19 mortality rate.

Quote
North Dakota’s coronavirus mortality rate is the highest of any U.S. state or country, according to an analysis of data from last week conducted by the Federation of American Scientists.

The analysis, first reported by HuffPost, shows that North Dakota has a rate of 18.2 deaths per 1 million people. South Dakota, meanwhile, has 17.4 deaths per million, the third-worst rate in the world. The states have a total population of under 2 million.

This didn't have to happen. What gross negligence by both state leaders and residents.

habanero

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Re: How long can we wait while flattening the curve?
« Reply #4736 on: November 17, 2020, 01:29:38 PM »
I can't crack a joke about this: The Hill: North Dakota records world's highest COVID-19 mortality rate.

Quote
North Dakota’s coronavirus mortality rate is the highest of any U.S. state or country, according to an analysis of data from last week conducted by the Federation of American Scientists.

The analysis, first reported by HuffPost, shows that North Dakota has a rate of 18.2 deaths per 1 million people. South Dakota, meanwhile, has 17.4 deaths per million, the third-worst rate in the world. The states have a total population of under 2 million.

This didn't have to happen. What gross negligence by both state leaders and residents.

Even if you don't just count last week's rate (which is what the article refers to with 18.2 / million / week) it would be near the world top if it was a nation with just over 1000 / million deaths so far. The list is currently topped by Belgium with 1259 / million. 1000 / million would place 4th according to official numbers which are bit hard to compare across countries as counting methodology differs.

ReadySetMillionaire

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Re: How long can we wait while flattening the curve?
« Reply #4737 on: November 17, 2020, 01:58:34 PM »
I can't crack a joke about this: The Hill: North Dakota records world's highest COVID-19 mortality rate.

Quote
North Dakota’s coronavirus mortality rate is the highest of any U.S. state or country, according to an analysis of data from last week conducted by the Federation of American Scientists.

The analysis, first reported by HuffPost, shows that North Dakota has a rate of 18.2 deaths per 1 million people. South Dakota, meanwhile, has 17.4 deaths per million, the third-worst rate in the world. The states have a total population of under 2 million.

This didn't have to happen. What gross negligence by both state leaders and residents.

I am frankly tired of taking snapshots in time and using them to criticize or reward politicians. COVID-19 has been here for seven months; to look at a single rolling seven-day average and declare "this is working" or "this is not working" is just ridiculous.

Look at the Midwest right now. You have varying degrees of lockdowns and mask policies and closures and curfews and stay at home orders. You'd be hard-pressed to come up with any sort of common theme except "these states did not get hit yet."

Taking everything into account, seven states have higher deaths/million than North Dakota. Nineteen states have higher deaths/million than South Dakota. To the above comment, NY and NJ have over 1,750 deaths per million. Now, you still can't really compare these, because we are basically in the 5th inning of a baseball game.

***

Even more importantly, just looking at the raw COVID death data is misleading in itself. The only proper metric for this pandemic is excess deaths.

I was just curious and looked at the South Dakota data. 644 total deaths. 362 of those were older than 80 (56%). Another 129 were between 70-79 (20%). So three-fourths of deaths were above 70.

That's the governor's fault? Seriously, how long are we going to blame old people dying on politicians?

The Dakotas might experience a per capita excess death rate of a a couple-hundred people per million, and we apparently are going to pretend that the governors are mass murderers because they didn't shut their states down.

dandarc

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Re: How long can we wait while flattening the curve?
« Reply #4738 on: November 17, 2020, 02:01:33 PM »
I think that might be 18.2 per million per day - New York Times dashboard is reporting 1.9 per 100,000 per day averaged over the last week.

Very bad situation in North Dakota no matter how you slice it.

habanero

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Re: How long can we wait while flattening the curve?
« Reply #4739 on: November 17, 2020, 02:19:14 PM »
Even more importantly, just looking at the raw COVID death data is misleading in itself. The only proper metric for this pandemic is excess deaths.

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

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

mm1970

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Re: How long can we wait while flattening the curve?
« Reply #4740 on: November 17, 2020, 02:43:35 PM »
Quote
So three-fourths of deaths were above 70.
Oh, come talk to me when you are 69.5 and tell me if "meh, sure, I can die today."

Life expectancy is 79 years.  76 for men, 81 for women.  But hey, who cares if people lose 5-10 years of their lives to COVID, no biggie.

A significant number of my coworkers are over 60, and at least 3 or 4 are over 70.  My MIL is 77, and women in her family live to be well into their 90s.  Spry and healthy with all their faculties too!

dandarc

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Re: How long can we wait while flattening the curve?
« Reply #4741 on: November 17, 2020, 03:00:22 PM »
I've got a feeling that is going to turn out to be a suspect statistical analysis on Sweden. Graph of the data certainly does not tell the story habanero proposes. https://www.statista.com/statistics/1115707/sweden-number-of-deaths-per-week/

All cause mortality was actually most notably below the 2015-19 average before the pandemic hit.

ETA: forgot to explain the graph - deaths per day by week in Sweden, all causes, by date of death. A dot for each week, but the number shown is "deaths per day" during that week if that wasn't clear. Light blue line = 2020 to date. Dark blue line = 2015-2019 average.

This is also a good demonstration of the "incomplete data cliff" on the right side - saying that dramatic decline in the most recent few weeks shown means anything at all will be forever known as a "Don Jr.".
« Last Edit: November 17, 2020, 03:38:47 PM by dandarc »

ReadySetMillionaire

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Re: How long can we wait while flattening the curve?
« Reply #4742 on: November 17, 2020, 03:02:31 PM »
Even more importantly, just looking at the raw COVID death data is misleading in itself. The only proper metric for this pandemic is excess deaths.

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

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

In addition to this, David Spiegelhalter of the University of Cambridge published a statistical analysis in the British Medical Journal stating that the risk of excess death in Britain right now is basically equal to five weeks of life:

Quote
The relation of covid-19 mortality risk with age is slightly steeper than it is for normal actuarial risk, but for ages over 45 the lines are fairly parallel, indicating that the average risk of catching and then dying from the virus were roughly proportional to the average normal risk over the same period.

***

For the general population, the risk of catching and then dying from covid-19 during 16 weeks of the pandemic was equivalent to experiencing around 5 weeks extra “normal” risk for those over 55, decreasing steadily with age, to just 2 extra days for schoolchildren.

For those over 55 who are infected with covid-19, the additional risk of dying is slightly more than the “normal” risk of death from all other causes over one year, and less for under 55s.

https://www.bmj.com/content/370/bmj.m3259

ReadySetMillionaire

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Re: How long can we wait while flattening the curve?
« Reply #4743 on: November 17, 2020, 03:04:30 PM »
Quote
So three-fourths of deaths were above 70.
Oh, come talk to me when you are 69.5 and tell me if "meh, sure, I can die today."

Life expectancy is 79 years.  76 for men, 81 for women.  But hey, who cares if people lose 5-10 years of their lives to COVID, no biggie.

A significant number of my coworkers are over 60, and at least 3 or 4 are over 70.  My MIL is 77, and women in her family live to be well into their 90s.  Spry and healthy with all their faculties too!

See above link. Their odds of dying from COVID are basically just slightly more than dying from anything else.

dandarc

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Re: How long can we wait while flattening the curve?
« Reply #4744 on: November 17, 2020, 03:10:38 PM »
Just a friendly reminder that RSM has been misinterpreting Covid statistics since March. I assume today's installment is no different.

scottish

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Re: How long can we wait while flattening the curve?
« Reply #4745 on: November 17, 2020, 03:23:53 PM »
We almost need a new thread of stupid Covid behaviour.  As in, police in Toronto (which is not doing well) busted a birthday party with over 100 people.  In a storage unit. That is not meant to host a gathering of any sort.  No idea who these people are.   Potential fines are big but who knows what they will actually get hit with.  Not to mention the fines under the building code and fire code.  To go with the Ontario idiots, we have the Quebec idiots who had a huge party in Chelsea (near Ottawa) a short while ago.  I'm sure people in other provinces could provide similar stories.

So most of us observe all the precautions, and every so often the idiots hold a super spreader event. 

It's a miracle Canada's numbers are as low as they are (not all that low).

Don't forget the kids in London with their minimum $10,000 fines!

RetiredAt63

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Re: How long can we wait while flattening the curve?
« Reply #4746 on: November 17, 2020, 03:29:41 PM »
Quote
So three-fourths of deaths were above 70.
Oh, come talk to me when you are 69.5 and tell me if "meh, sure, I can die today."

Life expectancy is 79 years.  76 for men, 81 for women.  But hey, who cares if people lose 5-10 years of their lives to COVID, no biggie.

A significant number of my coworkers are over 60, and at least 3 or 4 are over 70.  My MIL is 77, and women in her family live to be well into their 90s.  Spry and healthy with all their faculties too!

Thanks for posting this.  Based on family history I've got a good 20+ years ahead of me.  I know lots of active vital people in their 70s and 80s and a few in their 90s.  It pisses me off to hear my age group thought of as throw-aways.  Even if someone has health issues that mean the need for assisted living, life is still worth living.

Let's also remember that dying of Covid is a lot nastier death than a lot of ways we die of old age.  And if you were really sick and survive you are going to be a long time getting better.  When I had pneumonia in my mid forties it was 4 months from start to finish.  Being a "never smoked in my life" person didn't save me from 4 months of lung damage, and my lungs were never the same after.  So many people discuss Covid as if it isn't the life changing disease it is.

When people discuss mortality numbers, please remember that every one of those numbers was a living person who most likely enjoyed life and wasn't ready to die.  Whether they had 20 years or 2 months of prospective life left, this was not how they wanted to die.

Rant over.

RetiredAt63

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Re: How long can we wait while flattening the curve?
« Reply #4747 on: November 17, 2020, 03:35:23 PM »
We almost need a new thread of stupid Covid behaviour.  As in, police in Toronto (which is not doing well) busted a birthday party with over 100 people.  In a storage unit. That is not meant to host a gathering of any sort.  No idea who these people are.   Potential fines are big but who knows what they will actually get hit with.  Not to mention the fines under the building code and fire code.  To go with the Ontario idiots, we have the Quebec idiots who had a huge party in Chelsea (near Ottawa) a short while ago.  I'm sure people in other provinces could provide similar stories.

So most of us observe all the precautions, and every so often the idiots hold a super spreader event. 

It's a miracle Canada's numbers are as low as they are (not all that low).

Don't forget the kids in London with their minimum $10,000 fines!

And the protest in Aylmer (Ontario, not Quebec).  And the anti-mask protest in Montreal.  And and and.  As I said, we could fill a thread.  The sad thing is, the vast majority of people are being really good.  The way the virus spreads, it just takes a few stupid ones to keep it going.  If I were a public health doctor I would be on tranquilizers by now. 

Bloop Bloop Reloaded

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Re: How long can we wait while flattening the curve?
« Reply #4748 on: November 17, 2020, 05:10:36 PM »
Our South Australian cluster has grown to 34 cases.

It all started off with a quarantine hotel worker in his 60s who passed it on to his family - there was an "extended family of 15" (yikes).

The first person to get tested was a woman in her 80s, part of the family, who went to hospital. A quick-thinking emergency doctor insisted on a covid test. If that had not happened, we probably would have been in for a third wave.

The objective risk factors (working in a high risk occupation, having a huge extended family) are not being taken into account in our covid rules, yet objective non-risk factors (wearing your mask outside while solo, travelling for work, travelling for recreation in a family unit) are, or were, previously being enforced. I can understand that some arbitrary things like curfews and travel limits are there to help contact tracing...but the least our governments can do, next time around, is to be honest and hit the objective risk factors first, hard, instead of issuing 'moderate' constraints for the entire population.

mrsnamemustache

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Re: How long can we wait while flattening the curve?
« Reply #4749 on: November 17, 2020, 06:03:15 PM »
Good news today on the likelihood of long lasting immunity, relevant to @Villanelle earlier posts https://www.nytimes.com/2020/11/17/health/coronavirus-immunity.html#click=https://t.co/ntTmKxKjbm