Author Topic: How long can we wait while flattening the curve?  (Read 253746 times)

ROF Expat

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Re: How long can we wait while flattening the curve?
« Reply #1300 on: April 28, 2020, 12:42:41 PM »
The government might not do it but it's sensible public policy to value lives unequally.

Depends upon what the public thinks IMO. And the US Government value of a statistical life attempts to quantify how much the public values life. If there's enough push back, then that says something about the value of life, and the government should rethink the lockdown and the calculation.

Even so, that's a little problematic from a civil liberties perspective. I've seen a lot of argument on the anti-lockdown side regarding civil liberties. But life is also a civil liberty, and in the Declaration of Independence, one of my country's most cited documents, it's actually listed before liberty, and the pursuit of happiness.

People trade their own life for liberty and the pursuit of happiness all the time when they take up smoking or skydiving. But since this is a public health crisis, we're talking about trading others lives for our liberty and pursuit of happiness. Or the other way around.

We're talking bout a large number of lives and an even larger number of persons having their pursuit of happiness impacted. It's a tricky situation and we gotta be careful and get it right. Having studied this for months, I think the US response is decently close to "getting it right". And this is coming from someone with absolute contempt for the person in charge right now. No matter how many mind-numblingly stupid things he says though, it's clear to me that really smart people on both the public health side and the economics side are driving the discourse.

Trading other people's lives for the liberty and pursuit of happiness has obvious precedent in the US doesn't it? Didn't the draft send tens of millions of young people into harm's way, with hundreds of thousands dying and many, many more suffering life-long repercussions as a result? All to protect the opportunities for the majority of the population to enjoy liberty and pursue happiness.

People are protesting their businesses being shut down, or being unable to plant seeds to grow food on their own property (see: Michigan). If you think they are protesting some nebulous concept of "lockdown" you're being willfully ignorant. "It's the economy, stupid." And boy it there a lot of stupid on this forum.

Once you see someone calling those who disagree with them "stupid" you can safely ignore them;  their opinions are garbage.

fattest_foot

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Re: How long can we wait while flattening the curve?
« Reply #1301 on: April 28, 2020, 01:52:14 PM »
Should be change the title of this from "Flatten the Curve" to "Controlled Heard Immunity"

Don't we want to slowly infect our healthy low risk folks while protecting our older high risk folks? We were able to protect our hospitals, they were not overwhelmed. So not is it not a focus on keeping the level of infections at a manageable level. I feel like that was basically the plan from day 1. Opening up slowly as to prevent a spike but allow a manageable number of new cases.

No way we can eliminate the disease the US, so its time to focus on limiting health and economic damage. We dont have any easy choices left, just between bad and worse.

Something no one seems to be addressing is our healthcare system. The goal was to not overwhelm it, but what if we're on the verge of a healthcare catastrophe because they have to close? News came out yesterday that Mayo Clinic is furloughing 30,000 workers.

It's time to face it that we had a severe overreaction, or maybe wrong reaction, to this virus. I don't fault the initial reaction because of the unknowns, but now that we have more information, it seems like we should course correct. Instead we're just doubling down on bad decisions.

Jon Bon

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Re: How long can we wait while flattening the curve?
« Reply #1302 on: April 28, 2020, 01:53:33 PM »
Applying a little math to the CDC numbers.

I assumed a 2% mortality rate, which I think is a reasonable assumption. I have seen much higher and much lower so I grabbed something in the middle.

Then I backed into total cases by saying 27k deaths/.02 giving me the 1.38 million cases.  Then I applied those 1.38 million cases proportionally across the population groups.  So now I have assumed cases by age group, and actual deaths.  So now its a function of deaths/assumed cases give you a mortality rate.

This is a model, like all models it is subject to assumptions. But it does show that covid, like most respiratory diseases is more deadly the older you get.

I am happy to run it at different IFR if folks are curious. Also feel free to check my math if I fat fingered anything.








obstinate

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Re: How long can we wait while flattening the curve?
« Reply #1303 on: April 28, 2020, 01:53:49 PM »
People are protesting their businesses being shut down, or being unable to plant seeds to grow food on their own property (see: Michigan). If you think they are protesting some nebulous concept of "lockdown" you're being willfully ignorant. "It's the economy, stupid." And boy it there a lot of stupid on this forum.

Once you see someone calling those who disagree with them "stupid" you can safely ignore them;  their opinions are garbage.
So are you saying we can safely ignore the garbage opinions of user deathpanels, or the people they are talking about? Because both have called people they disagree with stupid, apparently?

kei te pai

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Re: How long can we wait while flattening the curve?
« Reply #1304 on: April 28, 2020, 02:02:01 PM »
Or maybe its time to reflect on a social and health care system which was not robust enough to support the timely necessary steps to control this disease. A society which is affluent but struggles with collective action for the common good. A bitterly divided political landscape. Instead of saying this or that is wrong, look at why the known and necessary actions have not been taken.

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #1305 on: April 28, 2020, 02:06:28 PM »
Should be change the title of this from "Flatten the Curve" to "Controlled Heard Immunity"

Don't we want to slowly infect our healthy low risk folks while protecting our older high risk folks? We were able to protect our hospitals, they were not overwhelmed. So not is it not a focus on keeping the level of infections at a manageable level. I feel like that was basically the plan from day 1. Opening up slowly as to prevent a spike but allow a manageable number of new cases.

No way we can eliminate the disease the US, so its time to focus on limiting health and economic damage. We dont have any easy choices left, just between bad and worse.

Something no one seems to be addressing is our healthcare system. The goal was to not overwhelm it, but what if we're on the verge of a healthcare catastrophe because they have to close? News came out yesterday that Mayo Clinic is furloughing 30,000 workers.

It's time to face it that we had a severe overreaction, or maybe wrong reaction, to this virus. I don't fault the initial reaction because of the unknowns, but now that we have more information, it seems like we should course correct. Instead we're just doubling down on bad decisions.


Those people are typically involved in the "extras" that are not needed or safe to do right now. My orgs, for instance gave most OR nurses the option to orient to work acute medicine or to take leave, since no nonemergent surgeries were being performed.

js82

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Re: How long can we wait while flattening the curve?
« Reply #1306 on: April 28, 2020, 02:16:06 PM »
Should be change the title of this from "Flatten the Curve" to "Controlled Heard Immunity"

Don't we want to slowly infect our healthy low risk folks while protecting our older high risk folks? We were able to protect our hospitals, they were not overwhelmed. So not is it not a focus on keeping the level of infections at a manageable level. I feel like that was basically the plan from day 1. Opening up slowly as to prevent a spike but allow a manageable number of new cases.

No way we can eliminate the disease the US, so its time to focus on limiting health and economic damage. We dont have any easy choices left, just between bad and worse.

Something no one seems to be addressing is our healthcare system. The goal was to not overwhelm it, but what if we're on the verge of a healthcare catastrophe because they have to close? News came out yesterday that Mayo Clinic is furloughing 30,000 workers.

It's time to face it that we had a severe overreaction, or maybe wrong reaction, to this virus. I don't fault the initial reaction because of the unknowns, but now that we have more information, it seems like we should course correct. Instead we're just doubling down on bad decisions.

I've said it elsewhere, and I'll say it again:  Part of the problem is one of resolution: the state level (and that's to say nothing of the federal level) is too coarse a level to enact a uniform set of policies that don't account for local conditions on the ground.  The needs of a large, dense city are very different from the needs of smaller towns.

Lots of hospitals canceled non-emergency procedures because of decisions at the state level, or because of decisions made at the top of a broad network.  In practice there should have been more accounting for local conditions.

Hospitals are a glaring example, but this doesn't just apply to them - it also applies to the broader question of designing policy that balances public health and economic outcomes as effectively as possible.

ROF Expat

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Re: How long can we wait while flattening the curve?
« Reply #1307 on: April 28, 2020, 02:30:03 PM »
People are protesting their businesses being shut down, or being unable to plant seeds to grow food on their own property (see: Michigan). If you think they are protesting some nebulous concept of "lockdown" you're being willfully ignorant. "It's the economy, stupid." And boy it there a lot of stupid on this forum.

Once you see someone calling those who disagree with them "stupid" you can safely ignore them;  their opinions are garbage.
So are you saying we can safely ignore the garbage opinions of user deathpanels, or the people they are talking about? Because both have called people they disagree with stupid, apparently?
[/quot

I was referring to the reference I happened to see and quoted.  Did I miss one?  If another post made a similar reference I would feel the same way. I am all in favor of people expressing their opinions, whether or not I happen to agree with them.  In fact, this thread has pushed me to rethink my own views.  But regardless of one's opinion, stooping to calling people stupid is offensive and lowers one's credibility. 

Midwest

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Re: How long can we wait while flattening the curve?
« Reply #1308 on: April 28, 2020, 03:17:42 PM »
Applying a little math to the CDC numbers.

I assumed a 2% mortality rate, which I think is a reasonable assumption. I have seen much higher and much lower so I grabbed something in the middle.

Then I backed into total cases by saying 27k deaths/.02 giving me the 1.38 million cases.  Then I applied those 1.38 million cases proportionally across the population groups.  So now I have assumed cases by age group, and actual deaths.  So now its a function of deaths/assumed cases give you a mortality rate

This is a model, like all models it is subject to assumptions. But it does show that covid, like most respiratory diseases is more deadly the older you get.

I am happy to run it at different IFR if folks are curious. Also feel free to check my math if I fat fingered anything.

Every IFR I've seen lately is below 1% (closer to 1/2%).  How are you coming up with 27k deaths?  We have 58k deaths across the US and a little over a million reported cases (which is obviously way low).

fattest_foot

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Re: How long can we wait while flattening the curve?
« Reply #1309 on: April 28, 2020, 04:00:38 PM »
Something no one seems to be addressing is our healthcare system. The goal was to not overwhelm it, but what if we're on the verge of a healthcare catastrophe because they have to close? News came out yesterday that Mayo Clinic is furloughing 30,000 workers.

It's time to face it that we had a severe overreaction, or maybe wrong reaction, to this virus. I don't fault the initial reaction because of the unknowns, but now that we have more information, it seems like we should course correct. Instead we're just doubling down on bad decisions.


Those people are typically involved in the "extras" that are not needed or safe to do right now. My orgs, for instance gave most OR nurses the option to orient to work acute medicine or to take leave, since no nonemergent surgeries were being performed.

What does this have to do with the question I posited? Aren't we at risk of doing serious damage to our ability to treat people in the future? Ignore emergency and ICU medicine, which currently "have work" (and I use quotations here because they have work in NYC and a few other hot spots; I'm not sure about the rest of the country). If we're furloughing all of our other medical staff, and potentially closing hospitals because they go bankrupt, we now have massive gaps in our healthcare system.

This is the whole "cure is worse than the disease" syndrome. We're also starting to see our food supply at risk, and other potential areas of society that we can't let fail. And yet, we are.

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #1310 on: April 28, 2020, 04:26:57 PM »
Why do you believe it’s gaps? And if the hospitals get overwhelmed with COVID patients, more people die, and dead people can’t pay their outstanding medical bills. Same results, more dead people.

In my area we have work. Our hospitals aren’t particularly empty. We have fewer patients recovering from elective/non urgent procedures but the COVID and rule out COVID patients have taken their place.

Gremlin

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Re: How long can we wait while flattening the curve?
« Reply #1311 on: April 28, 2020, 04:42:58 PM »
Should be change the title of this from "Flatten the Curve" to "Controlled Heard Immunity"

Don't we want to slowly infect our healthy low risk folks while protecting our older high risk folks? We were able to protect our hospitals, they were not overwhelmed. So not is it not a focus on keeping the level of infections at a manageable level. I feel like that was basically the plan from day 1. Opening up slowly as to prevent a spike but allow a manageable number of new cases.

No way we can eliminate the disease the US, so its time to focus on limiting health and economic damage. We dont have any easy choices left, just between bad and worse.

Something no one seems to be addressing is our healthcare system. The goal was to not overwhelm it, but what if we're on the verge of a healthcare catastrophe because they have to close? News came out yesterday that Mayo Clinic is furloughing 30,000 workers.

It's time to face it that we had a severe overreaction, or maybe wrong reaction, to this virus. I don't fault the initial reaction because of the unknowns, but now that we have more information, it seems like we should course correct. Instead we're just doubling down on bad decisions.

I've said it elsewhere, and I'll say it again:  Part of the problem is one of resolution: the state level (and that's to say nothing of the federal level) is too coarse a level to enact a uniform set of policies that don't account for local conditions on the ground.  The needs of a large, dense city are very different from the needs of smaller towns.

Lots of hospitals canceled non-emergency procedures because of decisions at the state level, or because of decisions made at the top of a broad network.  In practice there should have been more accounting for local conditions.

Hospitals are a glaring example, but this doesn't just apply to them - it also applies to the broader question of designing policy that balances public health and economic outcomes as effectively as possible.

This may be different in the US, but I understand that one of the drivers for the cancellation of elective surgery in Australia was to prioritise the availability of PPE for emergency procedures.  As I understand it, many general dentists etc also had their PPE supply disrupted.  Now appropriate levels of PPE have been secured, we are seeing elective surgery and other similar services starting to re-emerge here. 

Abe

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Re: How long can we wait while flattening the curve?
« Reply #1312 on: April 28, 2020, 04:50:21 PM »
Should be change the title of this from "Flatten the Curve" to "Controlled Heard Immunity"

Don't we want to slowly infect our healthy low risk folks while protecting our older high risk folks? We were able to protect our hospitals, they were not overwhelmed. So not is it not a focus on keeping the level of infections at a manageable level. I feel like that was basically the plan from day 1. Opening up slowly as to prevent a spike but allow a manageable number of new cases.

No way we can eliminate the disease the US, so its time to focus on limiting health and economic damage. We dont have any easy choices left, just between bad and worse.

Something no one seems to be addressing is our healthcare system. The goal was to not overwhelm it, but what if we're on the verge of a healthcare catastrophe because they have to close? News came out yesterday that Mayo Clinic is furloughing 30,000 workers.

It's time to face it that we had a severe overreaction, or maybe wrong reaction, to this virus. I don't fault the initial reaction because of the unknowns, but now that we have more information, it seems like we should course correct. Instead we're just doubling down on bad decisions.

I've said it elsewhere, and I'll say it again:  Part of the problem is one of resolution: the state level (and that's to say nothing of the federal level) is too coarse a level to enact a uniform set of policies that don't account for local conditions on the ground.  The needs of a large, dense city are very different from the needs of smaller towns.

Lots of hospitals canceled non-emergency procedures because of decisions at the state level, or because of decisions made at the top of a broad network.  In practice there should have been more accounting for local conditions.

Hospitals are a glaring example, but this doesn't just apply to them - it also applies to the broader question of designing policy that balances public health and economic outcomes as effectively as possible.

This may be different in the US, but I understand that one of the drivers for the cancellation of elective surgery in Australia was to prioritise the availability of PPE for emergency procedures.  As I understand it, many general dentists etc also had their PPE supply disrupted.  Now appropriate levels of PPE have been secured, we are seeing elective surgery and other similar services starting to re-emerge here.

That’s correct. Also to ensure enough hospital beds (up to half the patients in a large hospital at any given time are there to recover after non-emergency surgery), and enough ventilators or ICU rooms (ORd can be converted an ICU room if needed, and many OR or recovery nurses have ICU experience - Columbia and other hospitals in NY, Italy, Spain, Wuhan at one point had all the ORs except two occupied by critically ill covid patients).

fattest_foot

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Re: How long can we wait while flattening the curve?
« Reply #1313 on: April 28, 2020, 07:06:38 PM »
Why do you believe it’s gaps? And if the hospitals get overwhelmed with COVID patients, more people die, and dead people can’t pay their outstanding medical bills. Same results, more dead people.

In my area we have work. Our hospitals aren’t particularly empty. We have fewer patients recovering from elective/non urgent procedures but the COVID and rule out COVID patients have taken their place.

Cool, so one is a hypothetical (hospitals may eventually get overwhelmed) and the other is actually happening (hospitals are furloughing employees and siphoning money).

Honestly, all I see is a bunch of people scared of worst case scenarios and completely ignoring the massive problems 10 feet in front of the country.

Maybe covid-19 comes back in a second wave and wipes out humanity, but more than likely it won't based on the data we have. It's becoming more and more probable that we do irreparable damage to many vital industries in our country though. Seems like the chicken littles only want to worry about the one the media has worked them up about.

For a community that I thought was pretty analytical, I've been pretty disappointed by the posts here. It's a lot of regurgitating media talking points and very little actual thinking.

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #1314 on: April 28, 2020, 07:26:55 PM »
I’m a frontline worker, idk what to tell you

DaMa

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Re: How long can we wait while flattening the curve?
« Reply #1315 on: April 28, 2020, 07:37:43 PM »
Very little actual thinking?

If we had not gone into lockdown, the disease would have continued it's exponential spread.  Eventually people would have stopped going to public places, so by now most restaurants, bars, gyms, etc. would be closed down.  The hospitals would be overwhelmed with COVID cases, so all the layoffs of people not working would be happening anyway.  The food distribution system would be in worst shape, because absenteeism would be across the board. 

Millions of people would be too sick to go to work by now and these same economic impacts would be happening, but with a HIGHER death count.  You and others don't see this, but I and others do.  The economic impacts could not be avoided.

It's not about which news we watch.  It's about understanding the science of exponential growth. 

dang1

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Re: How long can we wait while flattening the curve?
« Reply #1316 on: April 28, 2020, 07:47:22 PM »
actually, there are some very analytical people in here.
getting to FIRE: as suggested by MMM, etc., do the hard work/ savings/ investments now, for a better early retirement, hopefully, not that long from now.
lessen effects of corona: as suggested by epidemiologists, do the shelter in place / distancing now, to lessen the spread of the virus, and bend the curve, hopefully, not that long from now.

Gremlin

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Re: How long can we wait while flattening the curve?
« Reply #1317 on: April 28, 2020, 07:49:32 PM »
Today, a multidisciplinary group of more than 100 leading academics from Australia's Group of Eight universities released their report entitled "Roadmap to Recovery".  This report was commissioned by the Federal Health Minister and the AHPPC and will feed into the decisions made by the National Cabinet on easing restrictions.

https://www.brisbanetimes.com.au/politics/federal/australian-leaders-given-two-strategies-for-rebounding-from-covid-19-20200428-p54nwh.html

One of the interesting elements is the recommendation that, in order to achieve the fastest and strongest economic recovery, an elimination strategy, rather than suppression strategy, be pursued.  This strategy recommends retaining the lockdown for at least a further month into June.  The economic modelling showed a 5% higher level of economic activity from August onwards under the elimination strategy than the suppression strategy and a 50% increase in economic growth over the coming 18 months with elimination compared to suppression.  The conclusion being that if elimination is achieved then Australian consumer and business confidence will rebound much faster than if there is ongoing pockets of disease popping up within the community.

fattest_foot

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Re: How long can we wait while flattening the curve?
« Reply #1318 on: April 28, 2020, 07:53:08 PM »
Very little actual thinking?

If we had not gone into lockdown, the disease would have continued it's exponential spread.  Eventually people would have stopped going to public places, so by now most restaurants, bars, gyms, etc. would be closed down.  The hospitals would be overwhelmed with COVID cases, so all the layoffs of people not working would be happening anyway.  The food distribution system would be in worst shape, because absenteeism would be across the board. 

Millions of people would be too sick to go to work by now and these same economic impacts would be happening, but with a HIGHER death count.  You and others don't see this, but I and others do.  The economic impacts could not be avoided.

It's not about which news we watch.  It's about understanding the science of exponential growth.

This is all conjecture. We have NO IDEA if any of that would have happened. We don't even know if staying at home actually slowed the virus. We THINK it did, but the reality is we have no idea. Up until a week ago everyone thought our first case was in late January and our first death in March. Turns out that wasn't even remotely true.

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #1319 on: April 28, 2020, 07:57:02 PM »
Mustacians: “economic downturn? You mean stocks on FIRE sale!!”

Also (some) mustacians: “stock market make a doo doo this year, Bette fleece some grandparents on a windswept cliff for the Greater Good”

fattest_foot

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Re: How long can we wait while flattening the curve?
« Reply #1320 on: April 28, 2020, 08:05:12 PM »
Mustacians: “economic downturn? You mean stocks on FIRE sale!!”

Also (some) mustacians: “stock market make a doo doo this year, Bette fleece some grandparents on a windswept cliff for the Greater Good”

This is exactly what I'm talking about. No ability to analyze, just spout dumb partisan talking points.

26 million people unemployed in just over a month. We'll be pushing Great Depression numbers in another 1-2 weeks.

All because "it might be worse than the data we have currently supports."

Like I said, I'm fine with the initial reaction. It was a lot, and fast, and might should've been gradually done, but that's in the past. But the fact is that the majority of the country isn't facing a crisis on the level of NYC, and never will just due to population differences. But let's use the broadest brush we can, on the entire population (instead of the populations we know are susceptible), because that seems wise.

dang1

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Re: How long can we wait while flattening the curve?
« Reply #1321 on: April 28, 2020, 08:28:37 PM »
https://www.idse.net/Emerging-Diseases/Article/02-20/Climate-Change-Threatens-to-Unleash-New-Infectious-Diseases/57367
"Climate Change Threatens to Unleash New Infectious Diseases"

there might be more nasty germs out there coming

Kyle Schuant

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Re: How long can we wait while flattening the curve?
« Reply #1322 on: April 28, 2020, 09:06:35 PM »

Today, a multidisciplinary group of more than 100 leading academics from Australia's Group of Eight universities released their report entitled "Roadmap to Recovery". 
I would suggest that people who have well-paying tenured positions, who during a lockdown will continue to receive an income and have regular professional and social contact, have a perspective which is different to those in other circumstances.


My oldest daughter is a paramedic. Recently she went to a callout for a coughing infant, she had a mild case of croup but the practice is to take them all in if they present with such symptoms. That part's fine - but the mother was a single mother, with a primary school-aged child as well, and the house was lit by candles, as her electricity had been cut off.

With things locked down the single mother had lost her casual part-time job. This meant she was no longer eligible for childcare benefits, so her infant couldn't go. Then the schools closed so her other child couldn't go to school. And without an income, her electricity was shut off.

She is going to less car accidents, but a lot more drug overdoses and suicides.

For my household, like many of the middle-class readers of this newspaper, the shutdown is not a serious threat to our financial, physical or mental health. For many others it is.

I would be interested in that now-unemployed single mother being a contributing authour to a Roadmap to Recovery.

Bloop Bloop

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Re: How long can we wait while flattening the curve?
« Reply #1323 on: April 28, 2020, 09:09:03 PM »
Mustacians: “economic downturn? You mean stocks on FIRE sale!!”

Also (some) mustacians: “stock market make a doo doo this year, Bette fleece some grandparents on a windswept cliff for the Greater Good”

This is exactly what I'm talking about. No ability to analyze, just spout dumb partisan talking points.

26 million people unemployed in just over a month. We'll be pushing Great Depression numbers in another 1-2 weeks.

All because "it might be worse than the data we have currently supports."

Like I said, I'm fine with the initial reaction. It was a lot, and fast, and might should've been gradually done, but that's in the past. But the fact is that the majority of the country isn't facing a crisis on the level of NYC, and never will just due to population differences. But let's use the broadest brush we can, on the entire population (instead of the populations we know are susceptible), because that seems wise.

I really just want to see what value of human life we are looking at when balancing economic disruption with lockdown measures and how panels (such as that panel which just released the Australian recommendations) are factoring in the reduced QALY of most covid patients.

It would be nice to have an honest discussion about utilitarian ethics and money/life conversion but I feel like that is almost impossible in our current blinkered society.

People can focus on saving lives etc but it is not the be all and end all of a functioning society - but I guess it is the be all and end all of political/medical image-management.

Easy to advocate for a longer lockdown when your job isn't on the line and you can just work remotely from home.

The reporting of the "Roadmap to Recovery" that I've seen doesn't even attempt to start talking about the actuarial cost of lockdown etc. I'm not sure if it's been factored into the Roadmap but I suspect the evaluations have been made without specific reference to the economic cost of saving lives and the economic value of letting a few more people die.

The Roadmap talks about elimination (i.e. longer lockdown) allowing for greater economic recovery/confidence but I think that is a circular argument. Yes, elimination = faster removal of lockdown stages = faster recovery but that presupposes that we shouldn't remove lockdown stages even without the virus being fully eliminated. It may well be for example that if we followed the "fast removal" strategy on the current case numbers (<10 nationwide per day) we would only have a few more deaths. Or none at all. We'll know in 10 days when we can analyse the 3 states that have eased lockdown early versus those that haven't.
« Last Edit: April 28, 2020, 09:17:03 PM by Bloop Bloop »

Spud

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Re: How long can we wait while flattening the curve?
« Reply #1324 on: April 28, 2020, 09:11:58 PM »
COVID-19, in a few months, has killed more Americans than nearly a decade of war.

https://www.nationalgeographic.com/history/2020/04/coronavirus-death-toll-vietnam-war-cvd/

fattest_foot

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Re: How long can we wait while flattening the curve?
« Reply #1325 on: April 28, 2020, 09:16:00 PM »
COVID-19, in a few months, has killed more Americans than nearly a decade of war.

https://www.nationalgeographic.com/history/2020/04/coronavirus-death-toll-vietnam-war-cvd/

That's a completely disingenuous comparison to make. Tons of things kill more than wars. Annually.

Spud

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Re: How long can we wait while flattening the curve?
« Reply #1326 on: April 28, 2020, 09:26:24 PM »
COVID-19, in a few months, has killed more Americans than nearly a decade of war.

https://www.nationalgeographic.com/history/2020/04/coronavirus-death-toll-vietnam-war-cvd/

That's a completely disingenuous comparison to make. Tons of things kill more than wars. Annually.

It's nearly the end of April now. For arguments sake let's say that this thing first killed an American on February 1st. How many "Tons of things" kill 58,000 people in just 3 months every year?

Road traffic accidents? Accidents in the home? Industrial accidents? Cancer? School shootings? Gun violence in general? Suicides? Accidental drug overdoses? Bog standard seasonal flu?

Remember, we're not talking about a year. We're talking about a 3 month period thus far. That's only quarter of a year.

I know the virus might not continue slaying people at the rate it currently is, but it's still been moving faster than MOST other things in the last 3 months.

waltworks

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Re: How long can we wait while flattening the curve?
« Reply #1327 on: April 28, 2020, 09:39:24 PM »
Heart disease does about 55k/month.

Cancer kills about 50k/month.

So it's quite a ways behind that. Relatively on par with accidents (15k/mo) or so. Not insignificant, but not a leading cause of death.

Given the demographics, you could make an argument that it's mostly hastening the deaths of people who had very low (ie nursing home) life expectancies to begin with, so from the QALY standpoint it's not comparable necessarily.

-W

Missy B

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Re: How long can we wait while flattening the curve?
« Reply #1328 on: April 28, 2020, 09:59:25 PM »

Today, a multidisciplinary group of more than 100 leading academics from Australia's Group of Eight universities released their report entitled "Roadmap to Recovery". 
I would suggest that people who have well-paying tenured positions, who during a lockdown will continue to receive an income and have regular professional and social contact, have a perspective which is different to those in other circumstances.


My oldest daughter is a paramedic. Recently she went to a callout for a coughing infant, she had a mild case of croup but the practice is to take them all in if they present with such symptoms. That part's fine - but the mother was a single mother, with a primary school-aged child as well, and the house was lit by candles, as her electricity had been cut off.

With things locked down the single mother had lost her casual part-time job. This meant she was no longer eligible for childcare benefits, so her infant couldn't go. Then the schools closed so her other child couldn't go to school. And without an income, her electricity was shut off.

She is going to less car accidents, but a lot more drug overdoses and suicides.

For my household, like many of the middle-class readers of this newspaper, the shutdown is not a serious threat to our financial, physical or mental health. For many others it is.

I would be interested in that now-unemployed single mother being a contributing authour to a Roadmap to Recovery.

Apparently there are places in the US experiencing huge increases in suicides. My bf heard on a Joe Rogen podcast (some guest with a friend in county govt) that the friend's county used to get one suicide a week, and they now get 5 a day. Didn't identify the county to spare his friend the sh*itstorm that would follow if the county was known.

Normally the lack of parties, bars and drunken stupidity results in way less ambulance calls in my part of downtown Vancouver, but I'm hearing just as many sirens as usual. Our at-home OD's are up a lot, because people aren't going to the safe-injection sites.

But to your original point, the key to an elimination strategy is making sure basic needs of the vulnerable are met while you're under quarantine. I think Australia could pull that off but I don't think the US can.

For example, in my province of BC, no one is getting their power cut off because they lost their job from COVID. If you did, you can also get 3 months at your normal rate completely gratis.


YttriumNitrate

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Re: How long can we wait while flattening the curve?
« Reply #1330 on: April 29, 2020, 06:22:17 AM »
My oldest daughter is a paramedic. Recently she went to a callout for a coughing infant, she had a mild case of croup but the practice is to take them all in if they present with such symptoms. That part's fine - but the mother was a single mother, with a primary school-aged child as well, and the house was lit by candles, as her electricity had been cut off.

With things locked down the single mother had lost her casual part-time job. This meant she was no longer eligible for childcare benefits, so her infant couldn't go. Then the schools closed so her other child couldn't go to school. And without an income, her electricity was shut off.

Where abouts was this? It seems like most electric utilities stopped disconnecting people for non-payment.

Quote
Large retailers that go onto payment plans or hardship arrangements will have their network charges deferred.
No residential or small business customers in financial distress will be disconnected without their consent until at least July 31.
https://7news.com.au/lifestyle/health-wellbeing/energy-bill-relief-during-virus-outbreak-c-947948

Jon Bon

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Re: How long can we wait while flattening the curve?
« Reply #1331 on: April 29, 2020, 06:31:43 AM »
Applying a little math to the CDC numbers.

I assumed a 2% mortality rate, which I think is a reasonable assumption. I have seen much higher and much lower so I grabbed something in the middle.

Then I backed into total cases by saying 27k deaths/.02 giving me the 1.38 million cases.  Then I applied those 1.38 million cases proportionally across the population groups.  So now I have assumed cases by age group, and actual deaths.  So now its a function of deaths/assumed cases give you a mortality rate

*Edit*
On the 27k cases I would think that is a statistically significant number of deaths. SO if it was 10x higher I would not expect the age distribution or the fatality rate to change, just the number of cases.

This is a model, like all models it is subject to assumptions. But it does show that covid, like most respiratory diseases is more deadly the older you get.

I am happy to run it at different IFR if folks are curious. Also feel free to check my math if I fat fingered anything.

Every IFR I've seen lately is below 1% (closer to 1/2%).  How are you coming up with 27k deaths?  We have 58k deaths across the US and a little over a million reported cases (which is obviously way low).

I don't work at the CDC, but I assume it takes a while for the data to be cataloged. It takes time from 1 covid death to be transferred to "one 79 year old adult male dying in the hospital in Trenton NJ" type thing.

I ran it at this 1% obviously increases the cases dramatically. But also reduces the chances of dying with it. I by no means am claiming it is right or have any medical training/authority on such matters. But I would bet it is directionally right and does have some basis in real world application.

if anyone knows how to paste excel data better into MMM please let me know!

*Edit*
I would think that 27k deaths is a statistically significant number, so that if deaths were increased to 50k, or even 500k (god help us) the distribution of deaths would not change, just the number of cases.

« Last Edit: April 29, 2020, 06:39:36 AM by Jon Bon »

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #1332 on: April 29, 2020, 07:06:32 AM »
Mustacians: “economic downturn? You mean stocks on FIRE sale!!”

Also (some) mustacians: “stock market make a doo doo this year, Bette fleece some grandparents on a windswept cliff for the Greater Good”

This is exactly what I'm talking about. No ability to analyze, just spout dumb partisan talking points.

26 million people unemployed in just over a month. We'll be pushing Great Depression numbers in another 1-2 weeks.

All because "it might be worse than the data we have currently supports."

Like I said, I'm fine with the initial reaction. It was a lot, and fast, and might should've been gradually done, but that's in the past. But the fact is that the majority of the country isn't facing a crisis on the level of NYC, and never will just due to population differences. But let's use the broadest brush we can, on the entire population (instead of the populations we know are susceptible), because that seems wise.

It's not in the past in a LOT of areas, though. Many areas haven't seen a sustained decline in deaths per day. Even my area, which is doing great with resources and testing compared to lots of places, hasn't had a significant dip that's held up over 2 weeks. We are in a phased opening that started this week. Looking at the weekly numbers we need to have waited another week for that statewide and some of the larger cities likely need a yet another week.

All states ARE doing things differently. West Virginia is probably okay to phase in now. Some other states are probably okay to phase in now. This isn't just about "well not everyone is as bad as new york" because the north east in general is an outlier right now. They won't be okay for a long time. Some states that neighbor mine have significantly higher infection rates, worse access to testing, and are playing faster and looser with reopening.  At what point do you look at some states' approaches and see that they're reckless?

ender

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Re: How long can we wait while flattening the curve?
« Reply #1333 on: April 29, 2020, 07:46:14 AM »
I wish anytime someone says "exponential growth" they were required to list the assumptions that go into that statement.

It's pretty clear to me at this point the only way to contain/sustain the next year is to have extensive testing as well as some level of accurate antibody test to really understand the current spread of the illness.

The lack of meaningful data means it's nearly impossible to make definitive statements about what is happening or what could have happened. It's frustrating to me to see politicians making policy off of educated guesswork. I can only hope politicians are more informed than they seem to be from public statements and hope they making better decisions about this pandemic than things I know well which they tend to make completely stupid policies around (I'm in tech; nearly anytime politicians end up making policies around tech the policies are completely stupid and naive. I am hopeful this doesn't mean they make similarly stupid decisions around topics I know much less about, but I'm... not optimistic).

I would suggest that people who have well-paying tenured positions, who during a lockdown will continue to receive an income and have regular professional and social contact, have a perspective which is different to those in other circumstances.


My oldest daughter is a paramedic. Recently she went to a callout for a coughing infant, she had a mild case of croup but the practice is to take them all in if they present with such symptoms. That part's fine - but the mother was a single mother, with a primary school-aged child as well, and the house was lit by candles, as her electricity had been cut off.

With things locked down the single mother had lost her casual part-time job. This meant she was no longer eligible for childcare benefits, so her infant couldn't go. Then the schools closed so her other child couldn't go to school. And without an income, her electricity was shut off.

She is going to less car accidents, but a lot more drug overdoses and suicides.

For my household, like many of the middle-class readers of this newspaper, the shutdown is not a serious threat to our financial, physical or mental health. For many others it is.

I would be interested in that now-unemployed single mother being a contributing authour to a Roadmap to Recovery.

Something I keep thinking is how disproportionate the economic and health impact are demographically. The venn diagram has minimal overlap from those who are being significantly impacted economically and those at risk.

Time will tell how long people can voluntarily make that tradeoff.

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #1334 on: April 29, 2020, 01:13:44 PM »
The lack of meaningful data means it's nearly impossible to make definitive statements about what is happening or what could have happened. It's frustrating to me to see politicians making policy off of educated guesswork.

I think the bold is pretty fantastic. Would we rather they shoot from the hip? I don't think we lack meaningful data. We have a lot of really good data. It's incomplete, but if we waited for it to be complete, then it'd be too late.

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #1335 on: April 29, 2020, 01:22:57 PM »
At the highest levels, it's not about testing, or CFRs, or flattening the curve, or the percentage of mild and asymptomatic cases.

It's about defensible heuristics and a rational decision making process. Everything else is largely cheap second-guessing. I asked this of folks earlier in this thread, but if you've gotten evidence supported conclusions that we're suffering trillion dollar contractions for not that great of results, then I implore you to get into the rooms that matter.

It's telling to me that almost from the very beginning, much of the dissent came from media personalities like Dr. Drew or Dr. Phil. That doesn't 100% mean that the lockdown is/was the best thing to do. But it does mean that if you want to fight for the contrarian opinion, you should pick less shitty champions.

Davnasty

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Re: How long can we wait while flattening the curve?
« Reply #1336 on: April 29, 2020, 01:40:28 PM »
It's telling to me that almost from the very beginning, much of the dissent came from media personalities like Dr. Drew or Dr. Phil. That doesn't 100% mean that the lockdown is/was the best thing to do. But it does mean that if you want to fight for the contrarian opinion, you should pick less shitty champions.

Very true. Even if I was previously confident in my opinion, I'd start to question myself if Dr Drew jumped in to back me up. That's the kind of endorsement I'd rather not have.

GuitarStv

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Re: How long can we wait while flattening the curve?
« Reply #1337 on: April 29, 2020, 01:44:05 PM »
It's telling to me that almost from the very beginning, much of the dissent came from media personalities like Dr. Drew or Dr. Phil. That doesn't 100% mean that the lockdown is/was the best thing to do. But it does mean that if you want to fight for the contrarian opinion, you should pick less shitty champions.

Very true. Even if I was previously confident in my opinion, I'd start to question myself if Dr Drew jumped in to back me up. That's the kind of endorsement I'd rather not have.

"Dr." Phil isn't even a doctor.

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #1338 on: April 29, 2020, 01:46:58 PM »
For what it's worth I think Dr. Phil and Dr. Drew are perfectly good at what they do. I'd just rather not seem them pontificate on epidemiology with any sort of authority.

The good news is that since so much GDP growth is at stake, I can pretty much guarantee you that more qualified people than those two have consistently been "in the room" arguing for loosening up. World leaders, hell, people in general, myself included, are desperate for good arguments that support getting back to normal, or at least moving in that direction.

Michael in ABQ

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Re: How long can we wait while flattening the curve?
« Reply #1339 on: April 29, 2020, 02:07:56 PM »

The lack of meaningful data means it's nearly impossible to make definitive statements about what is happening or what could have happened. It's frustrating to me to see politicians making policy off of educated guesswork. I can only hope politicians are more informed than they seem to be from public statements and hope they making better decisions about this pandemic than things I know well which they tend to make completely stupid policies around (I'm in tech; nearly anytime politicians end up making policies around tech the policies are completely stupid and naive. I am hopeful this doesn't mean they make similarly stupid decisions around topics I know much less about, but I'm... not optimistic).


Nope, I can guarantee your pessimism is duly warranted. Most politicians are lawyers and while they probably have a good understanding of the law, they are mostly ignorant of technology, business, science, etc. It's kind of like when you read a news article about something you have personal knowledge of and you see how many things they got wrong. You realize that it's probably true for everything.

I will say though, I watched a couple of recent testimonies of the AFRICOM commander in front of Congress and it was actually pretty good. The questions were usually meaningful and there were only a couple of people who were making obvious political statements that they hoped would turn into sound bites. It was frankly hard to tell the Democrats from the Republicans. It just goes to show the difference between what they'll say on C-SPAN versus what they'll say in a highly publicized forum where there are political points to be scored.

T-Money$

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Re: How long can we wait while flattening the curve?
« Reply #1340 on: April 29, 2020, 02:50:53 PM »
COVID-19, in a few months, has killed more Americans than nearly a decade of war.

https://www.nationalgeographic.com/history/2020/04/coronavirus-death-toll-vietnam-war-cvd/

That's a completely disingenuous comparison to make. Tons of things kill more than wars. Annually.

It's nearly the end of April now. For arguments sake let's say that this thing first killed an American on February 1st. How many "Tons of things" kill 58,000 people in just 3 months every year?

Road traffic accidents? Accidents in the home? Industrial accidents? Cancer? School shootings? Gun violence in general? Suicides? Accidental drug overdoses? Bog standard seasonal flu?

Remember, we're not talking about a year. We're talking about a 3 month period thus far. That's only quarter of a year.

I know the virus might not continue slaying people at the rate it currently is, but it's still been moving faster than MOST other things in the last 3 months.

When Neil Ferguson was interviewed by the UK Parliament last month, he said:

"By the end of the year, what proportion of those people who've died from COVID-19 would have died anyhow?" Ferguson asked. "It might be as much as half to two-thirds of the deaths we're seeing from COVID-19, because it's affecting people who are either at the end of their lives or in poor health conditions. So I think these considerations are very valid."

It's possible that most lives we saved from COVID-19 would have died this year anyway, at least I think that is the argument Ferguson was attempting to make. 

I think it is a bit disingenuous to make comparisons to total deaths, part of increase in death rate is likely from COVID-19, but many could be because of heart attacks, strokes, cancer, accidents, etc. that are no longer being treated properly.  Hospitals and ERs are empty you know...other diseases haven't stopped.

While some think it's inhumane or immoral to consider the distribution of death (age and health) from COVID-19, the analysis is done for every other disease I can think of, and the life-years lost due to COVID is definitely worthy of discussion, no matter how insecure it makes people feel.

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #1341 on: April 29, 2020, 02:55:04 PM »
None of the ERs in my orgs are empty, fwiw.

nereo

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Re: How long can we wait while flattening the curve?
« Reply #1342 on: April 29, 2020, 03:02:55 PM »
COVID-19, in a few months, has killed more Americans than nearly a decade of war.

https://www.nationalgeographic.com/history/2020/04/coronavirus-death-toll-vietnam-war-cvd/

That's a completely disingenuous comparison to make. Tons of things kill more than wars. Annually.

It's nearly the end of April now. For arguments sake let's say that this thing first killed an American on February 1st. How many "Tons of things" kill 58,000 people in just 3 months every year?

Road traffic accidents? Accidents in the home? Industrial accidents? Cancer? School shootings? Gun violence in general? Suicides? Accidental drug overdoses? Bog standard seasonal flu?

Remember, we're not talking about a year. We're talking about a 3 month period thus far. That's only quarter of a year.

I know the virus might not continue slaying people at the rate it currently is, but it's still been moving faster than MOST other things in the last 3 months.

When Neil Ferguson was interviewed by the UK Parliament last month, he said:

"By the end of the year, what proportion of those people who've died from COVID-19 would have died anyhow?" Ferguson asked. "It might be as much as half to two-thirds of the deaths we're seeing from COVID-19, because it's affecting people who are either at the end of their lives or in poor health conditions. So I think these considerations are very valid."

It's possible that most lives we saved from COVID-19 would have died this year anyway, at least I think that is the argument Ferguson was attempting to make. 

I think it is a bit disingenuous to make comparisons to total deaths, part of increase in death rate is likely from COVID-19, but many could be because of heart attacks, strokes, cancer, accidents, etc. that are no longer being treated properly.  Hospitals and ERs are empty you know...other diseases haven't stopped.

While some think it's inhumane or immoral to consider the distribution of death (age and health) from COVID-19, the analysis is done for every other disease I can think of, and the life-years lost due to COVID is definitely worthy of discussion, no matter how insecure it makes people feel.
Is he saying most of the people who have died so far would likely have died anyway, or that most of the people who have died and will die later on this year would likely die regardless?  There is a big difference and it’s not clear to me which he is arguing.

dang1

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Re: How long can we wait while flattening the curve?
« Reply #1343 on: April 29, 2020, 04:07:07 PM »
ah, Neil Ferguson, conservative propagandist spouting right-wing garbage.

T-Money$

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Re: How long can we wait while flattening the curve?
« Reply #1344 on: April 29, 2020, 04:29:42 PM »
ah, Neil Ferguson, conservative propagandist spouting right-wing garbage.

Can you elaborate on that a bit?

Cranky

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Re: How long can we wait while flattening the curve?
« Reply #1345 on: April 29, 2020, 04:43:18 PM »
Well, realistically, we’re all going to die.

The person I know who has died of COVID19 is a college friend of my dd’s, and she was 33yo.

If 5% of the US population has had the disease(a generous estimate) and there have been 50,000 fatalities, this suggests that if 50% of the population gets the disease there will be 500,000 fatalities which is a pretty darned big number.

I’m good with doing whatever it takes to slow that down until there are effective treatments and a vaccine.

GuitarStv

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Re: How long can we wait while flattening the curve?
« Reply #1346 on: April 29, 2020, 04:45:29 PM »
I certainly wouldn't expect a vaccine this year.

Kris

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Re: How long can we wait while flattening the curve?
« Reply #1347 on: April 29, 2020, 04:48:44 PM »
I certainly wouldn't expect a vaccine this year.

Interestingly, this is one area where I am cautiously optimistic.

I know “they” have said a vaccine is 12-18 months away. But there are so many labs working on this with such intensity, I actually believe it will be on the inside 12 months side.

Though that still doesn’t necessarily bring us to a vaccine in 2020.

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #1348 on: April 29, 2020, 04:52:35 PM »
I really HOPE we get one this year but it doesn’t feel realistic.

I volunteered in an HIV vaccine trial that took 18 months of human subject participation and that was after the vaccine was created, animal trialed, etc.

dang1

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Re: How long can we wait while flattening the curve?
« Reply #1349 on: April 29, 2020, 05:05:04 PM »
ah, Neil Ferguson, conservative propagandist spouting right-wing garbage.

Can you elaborate on that a bit?

https://harvardmagazine.com/2007/05/the-global-empire-of-nia.html empire lover start

https://www.edwardrcarr.com/opentheechochamber/2019/09/07/shut-up-niall-ferguson/ ferguson should just really not pontificate on things he doesnt know about and stick to his white man burden fantasies