Author Topic: How long can we wait while flattening the curve?  (Read 248153 times)

Kris

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Re: How long can we wait while flattening the curve?
« Reply #1350 on: April 29, 2020, 05:05:11 PM »
I really HOPE we get one this year but it doesnít 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.

I totally get that. But ó how shall I put this ó the perception of HIV urgency was colored by the sense that it was not a big problem for all sectors of the population.

GardenerB

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Re: How long can we wait while flattening the curve?
« Reply #1351 on: April 29, 2020, 05:12:54 PM »
Hopefully it's just a joke - mixing up "Niall' with "Neil".  Anyway, off topic...

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #1352 on: April 29, 2020, 05:17:50 PM »
I really HOPE we get one this year but it doesnít 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.

I totally get that. But ó how shall I put this ó the perception of HIV urgency was colored by the sense that it was not a big problem for all sectors of the population.

The was a recent vaccine trial, in the last year or so. I mention it because of the length of the investigation. There is obviously not vaccine one the market, despite the fact that I produced antibodies  because of the vaccine (I donít know about the other subjects).

GardenerB

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Re: How long can we wait while flattening the curve?
« Reply #1353 on: April 29, 2020, 05:51:09 PM »
"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."

Usual caveat that this is just another model, but estimated infection rates may not be as high as 50% of entire countries.  Dense areas and dense cities yes, but average over a whole country would be less.  IHME models estimate USA range of 74,073 (56,563 to 130,666).  Which implies just under 5% of USA infected with an IFR of 0.5% (again their estimates - IFR also has a wide range still around the world/regions).  Using an IFR of 0.8% for same % infected (5% or 16.5M)  gives 130,000 deaths on their upper range.  Still a bad/big number of course.

http://www.healthdata.org/covid/updates




AnnaGrowsAMustache

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Re: How long can we wait while flattening the curve?
« Reply #1354 on: April 29, 2020, 05:54:31 PM »
I really HOPE we get one this year but it doesnít 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.

I totally get that. But ó how shall I put this ó the perception of HIV urgency was colored by the sense that it was not a big problem for all sectors of the population.

Just say it like it is - the 'gay plague' was not a priority because of blatant homophobia.

T-Money$

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Re: How long can we wait while flattening the curve?
« Reply #1355 on: April 29, 2020, 05:55:00 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

Different guy.  Iím talking about the well educated yet inept British epidemiologist.

T-Money$

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Re: How long can we wait while flattening the curve?
« Reply #1356 on: April 29, 2020, 05:57:02 PM »
I really HOPE we get one this year but it doesnít 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.

I totally get that. But ó how shall I put this ó the perception of HIV urgency was colored by the sense that it was not a big problem for all sectors of the population.

Just say it like it is - the 'gay plague' was not a priority because of blatant homophobia.

Much like COVID, HIV is a major risk for a specific segment of the population.  The risk is certainly not distributed equally by any means.

https://www.cdc.gov/hiv/group/racialethnic/index.html

aspiringnomad

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Re: How long can we wait while flattening the curve?
« Reply #1357 on: April 29, 2020, 05:58:30 PM »
I really HOPE we get one this year but it doesnít 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.

I totally get that. But ó how shall I put this ó the perception of HIV urgency was colored by the sense that it was not a big problem for all sectors of the population.

The was a recent vaccine trial, in the last year or so. I mention it because of the length of the investigation. There is obviously not vaccine one the market, despite the fact that I produced antibodies  because of the vaccine (I donít know about the other subjects).

I assume you understand why a randomized control trial for a virus that spreads only through sexual intercourse or blood exchange would take much, much, much longer to prove efficacy than one that spreads like wildfire through respiratory droplets.

Add to that the urgency Kris noted in responding to a global pandemic that everyone is vulnerable to medically and economically. Add to that the differences between the two types of viruses and the groundwork that's already been laid for vaccines in coronaviruses similar to the one that causes covid-19 (this is purely based on what I've read, but I'm no expert).

Reading between all those lines, if I were a betting person, I would bet that there is at least one vaccine approved for emergency use by October of this year. Possibly more than one. I know it sounds optimistic, and I know it's not in line with the expectations set by health authorities, but I think it's well-founded optimism on my part and understandable expectation-setting on their part.

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #1358 on: April 29, 2020, 06:23:07 PM »
The body doesnít care how it contracts a pathogen, it still take time to make antibodies.

Edit: we were all HIV negative volunteers. We receive a vaccine and were tested to see if the vaccine induced antibody production. Thatís it.
« Last Edit: April 29, 2020, 06:25:08 PM by MudPuppy »

aspiringnomad

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Re: How long can we wait while flattening the curve?
« Reply #1359 on: April 29, 2020, 06:53:29 PM »
The body doesnít care how it contracts a pathogen, it still take time to make antibodies.

Edit: we were all HIV negative volunteers. We receive a vaccine and were tested to see if the vaccine induced antibody production. Thatís it.

Right. But to determine efficacy, you typically need real-world trials to be certain that the vaccine produces sufficient antibodies to actually protect against the disease itself. For now, that involves waiting until there is a statistically significant difference in the prevalence of a disease between the placebo and vaccine groups.

Challenge studies get around that by introducing the virus intentionally, but those would be unethical for HIV given the severity of that disease. As far as I'm aware, challenge studies are currently not under consideration for covid-19 (though they are used to study malaria, for example), so we'll have to wait until enough in the placebo group are exposed to demonstrate efficacy. Given the ease of transmission of this virus, that shouldn't be a years-long thing, particularly with a large enough study group in a country that hasn't squelched the virus. So you couldn't run such a trial in New Zealand right now even if you had a great vaccine in development there, but the UK and US are unfortunately/fortunately fertile ground it.

Bloop Bloop

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Re: How long can we wait while flattening the curve?
« Reply #1360 on: April 29, 2020, 07:02:10 PM »
I really HOPE we get one this year but it doesnít 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.

I totally get that. But ó how shall I put this ó the perception of HIV urgency was colored by the sense that it was not a big problem for all sectors of the population.

Just say it like it is - the 'gay plague' was not a priority because of blatant homophobia.

I wouldn't say it was necessarily homophobia, but that it was significantly confined in the west to the homosexual population because of the way that HIV transmission works, which means that heterosexual people had less self-interest in protecting against it. That sort of self-interested reasoning doesn't imply any sort of homophobia, any more than a young person being less worried about covid means that the young person is anti-aged.

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #1361 on: April 29, 2020, 07:20:37 PM »
The body doesnít care how it contracts a pathogen, it still take time to make antibodies.

Edit: we were all HIV negative volunteers. We receive a vaccine and were tested to see if the vaccine induced antibody production. Thatís it.

Right. But to determine efficacy, you typically need real-world trials to be certain that the vaccine produces sufficient antibodies to actually protect against the disease itself. For now, that involves waiting until there is a statistically significant difference in the prevalence of a disease between the placebo and vaccine groups.

Challenge studies get around that by introducing the virus intentionally, but those would be unethical for HIV given the severity of that disease. As far as I'm aware, challenge studies are currently not under consideration for covid-19 (though they are used to study malaria, for example), so we'll have to wait until enough in the placebo group are exposed to demonstrate efficacy. Given the ease of transmission of this virus, that shouldn't be a years-long thing, particularly with a large enough study group in a country that hasn't squelched the virus. So you couldn't run such a trial in New Zealand right now even if you had a great vaccine in development there, but the UK and US are unfortunately/fortunately fertile ground it.

My commentary was simply about MY experience re: timeline in THAT study. We arenít/werenít being tested for real world exposure on the study I was in. It was meant to provide context in the search for a vaccine. I know more testing needs to be done beyond the very first human trials.

aspiringnomad

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Re: How long can we wait while flattening the curve?
« Reply #1362 on: April 29, 2020, 07:33:08 PM »
The body doesnít care how it contracts a pathogen, it still take time to make antibodies.

Edit: we were all HIV negative volunteers. We receive a vaccine and were tested to see if the vaccine induced antibody production. Thatís it.

Right. But to determine efficacy, you typically need real-world trials to be certain that the vaccine produces sufficient antibodies to actually protect against the disease itself. For now, that involves waiting until there is a statistically significant difference in the prevalence of a disease between the placebo and vaccine groups.

Challenge studies get around that by introducing the virus intentionally, but those would be unethical for HIV given the severity of that disease. As far as I'm aware, challenge studies are currently not under consideration for covid-19 (though they are used to study malaria, for example), so we'll have to wait until enough in the placebo group are exposed to demonstrate efficacy. Given the ease of transmission of this virus, that shouldn't be a years-long thing, particularly with a large enough study group in a country that hasn't squelched the virus. So you couldn't run such a trial in New Zealand right now even if you had a great vaccine in development there, but the UK and US are unfortunately/fortunately fertile ground it.

My commentary was simply about MY experience re: timeline in THAT study. We arenít/werenít being tested for real world exposure on the study I was in. It was meant to provide context in the search for a vaccine. I know more testing needs to be done beyond the very first human trials.

Not really here to argue this, but your comment that I first quoted and your response (especially pre-edit) both suggested that because there's not a vaccine for HIV despite your antibodies to that disease, the covid vaccine will take forever.

My point is that they're apples and oranges for a whole bunch of reasons.

Telecaster

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Re: How long can we wait while flattening the curve?
« Reply #1363 on: April 29, 2020, 07:34:33 PM »
I certainly wouldn't expect a vaccine this year.

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

I know ďtheyĒ 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 doesnít necessarily bring us to a vaccine in 2020.

The rate limiting step is the clinical trials.  You just can't speed that process up. 

Sailor Sam

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Re: How long can we wait while flattening the curve?
« Reply #1364 on: April 29, 2020, 07:39:37 PM »
I really HOPE we get one this year but it doesnít 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.

I totally get that. But ó how shall I put this ó the perception of HIV urgency was colored by the sense that it was not a big problem for all sectors of the population.

Just say it like it is - the 'gay plague' was not a priority because of blatant homophobia.

I wouldn't say it was necessarily homophobia, but that it was significantly confined in the west to the homosexual population because of the way that HIV transmission works, which means that heterosexual people had less self-interest in protecting against it. That sort of self-interested reasoning doesn't imply any sort of homophobia, any more than a young person being less worried about covid means that the young person is anti-aged.

Dude.

Telecaster

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Re: How long can we wait while flattening the curve?
« Reply #1365 on: April 29, 2020, 07:50:37 PM »
Add to that the urgency Kris noted in responding to a global pandemic that everyone is vulnerable to medically and economically. Add to that the differences between the two types of viruses and the groundwork that's already been laid for vaccines in coronaviruses similar to the one that causes covid-19 (this is purely based on what I've read, but I'm no expert).

Reading between all those lines, if I were a betting person, I would bet that there is at least one vaccine approved for emergency use by October of this year. Possibly more than one. I know it sounds optimistic, and I know it's not in line with the expectations set by health authorities, but I think it's well-founded optimism on my part and understandable expectation-setting on their part.

I'm not an expert either, but I'm not nearly as confident.  Vaccines can have all sorts of unintended side effects including making you more susceptible to the disease, for reasons that are not fully understood.  Because the immune system itself is not fully understood.   Public health officials also don't want to prematurely introduce a bad vaccine for fear the public will begin to resist vaccination. 

I'm sure every effort is being made to speed this up as much as possible, but the vaccine will be ready when it is ready, and not before then. 

aspiringnomad

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Re: How long can we wait while flattening the curve?
« Reply #1366 on: April 29, 2020, 08:26:29 PM »
Add to that the urgency Kris noted in responding to a global pandemic that everyone is vulnerable to medically and economically. Add to that the differences between the two types of viruses and the groundwork that's already been laid for vaccines in coronaviruses similar to the one that causes covid-19 (this is purely based on what I've read, but I'm no expert).

Reading between all those lines, if I were a betting person, I would bet that there is at least one vaccine approved for emergency use by October of this year. Possibly more than one. I know it sounds optimistic, and I know it's not in line with the expectations set by health authorities, but I think it's well-founded optimism on my part and understandable expectation-setting on their part.

I'm not an expert either, but I'm not nearly as confident.  Vaccines can have all sorts of unintended side effects including making you more susceptible to the disease, for reasons that are not fully understood.  Because the immune system itself is not fully understood.   Public health officials also don't want to prematurely introduce a bad vaccine for fear the public will begin to resist vaccination. 

I'm sure every effort is being made to speed this up as much as possible, but the vaccine will be ready when it is ready, and not before then.

I'm aware of this but obviously we've come to a different conclusion. Vaccine trial timelines haven't bumped up against some immutable law of physics, but against probabilistic outcomes and public health risk/benefit calculations that have been made in the past under different circumstances.

That a "vaccine will be ready when it is ready" is a truism and pointless in the context of this conversation. My view is that the risk/benefit calculation has changed somewhat in this situation, given the outsize benefit of a vaccine that is safe and, in at least some subgroups, demonstrably effective. Having 70 or more vaccine candidates both increases the odds of that and introduces some degree of healthy competition (as far as funding goes) to be the first.

It'll be up to regulators, but I suspect as long as there's a high level of confidence around safety, then there may even be some degree of flexibility in terms of its efficacy. In other words, as long as you can show it's safe for everyone and demonstrably effective in (for example) young people, there will be emergency approvals for younger health care providers to receive that vaccine and dosage while clinics continue to study whether adjusting the dose level or other vaccines are more appropriate for others. Or maybe we'll get lucky and one candidate will turn out to be safe and effective across demographics. If I had to pick one against the field, it would be the Oxford candidate, but I guess we'll find out soonish. I'm not pinning all my hopes on my optimistic take being right, but am trying to read the tea leaves as clearly as I can.

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #1367 on: April 29, 2020, 08:29:10 PM »
The body doesnít care how it contracts a pathogen, it still take time to make antibodies.

Edit: we were all HIV negative volunteers. We receive a vaccine and were tested to see if the vaccine induced antibody production. Thatís it.

Right. But to determine efficacy, you typically need real-world trials to be certain that the vaccine produces sufficient antibodies to actually protect against the disease itself. For now, that involves waiting until there is a statistically significant difference in the prevalence of a disease between the placebo and vaccine groups.

Challenge studies get around that by introducing the virus intentionally, but those would be unethical for HIV given the severity of that disease. As far as I'm aware, challenge studies are currently not under consideration for covid-19 (though they are used to study malaria, for example), so we'll have to wait until enough in the placebo group are exposed to demonstrate efficacy. Given the ease of transmission of this virus, that shouldn't be a years-long thing, particularly with a large enough study group in a country that hasn't squelched the virus. So you couldn't run such a trial in New Zealand right now even if you had a great vaccine in development there, but the UK and US are unfortunately/fortunately fertile ground it.

My commentary was simply about MY experience re: timeline in THAT study. We arenít/werenít being tested for real world exposure on the study I was in. It was meant to provide context in the search for a vaccine. I know more testing needs to be done beyond the very first human trials.

Not really here to argue this, but your comment that I first quoted and your response (especially pre-edit) both suggested that because there's not a vaccine for HIV despite your antibodies to that disease, the covid vaccine will take forever.

My point is that they're apples and oranges for a whole bunch of reasons.

Apples and Asian pears at best. Vaccine timelines arenít like the h1 n1 is because weíve never made a coronviruz vaccine before. I was providing contact for vaccine trial timelines and that remains relevant.

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #1368 on: April 29, 2020, 10:46:54 PM »
Homophobia was a huge component of Americaís disastrous HIV response. Just like racism is the reason why young kidnapped/murdered white girls make national headlines and get made for TV movies while black girls do not.

Itís a decision, conscious or not, to value certain lives over others.

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #1369 on: April 29, 2020, 10:53:12 PM »
Per Pew research, in 1987, 43% of Americans believed that HIV and AIDS were Godís punishment for immoral sexual behavior.

That goes beyond disinterest because of self-interest. That is a significant portion of the country thinking HIV constitutes something close to righteousness. Thatís more the enough to affect public policy and government response.

It was homophobia.

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #1370 on: April 30, 2020, 12:42:42 AM »
Iím just going to copy @Telecaster here, since one of the big reasons the trial I was in wasnt simply declared ďgreat!Ē is this

Quote
I'm not an expert either, but I'm not nearly as confident.  Vaccines can have all sorts of unintended side effects including making you more susceptible to the disease, for reasons that are not fully understood.

Itís not that Iím wishing against the vaccine, itís just that a 6-10 month timeline for a type of vaccine weíve never succeeded in making ever before -despite efforts- feels like a stretch.

cerat0n1a

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Re: How long can we wait while flattening the curve?
« Reply #1371 on: April 30, 2020, 02:42:13 AM »
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

I think you might be confusing Niall Ferguson (contemptible neo-imperialist, based at Stanford) with Neil Ferguson (Imperial College Mathematical Biologist, who's advising the British government on Coronoavirus).

T-Money$

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Re: How long can we wait while flattening the curve?
« Reply #1372 on: April 30, 2020, 04:56:20 AM »
Homophobia was a huge component of Americaís disastrous HIV response. Just like racism is the reason why young kidnapped/murdered white girls make national headlines and get made for TV movies while black girls do not.

Itís a decision, conscious or not, to value certain lives over others.

What should the response have looked like?

former player

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Re: How long can we wait while flattening the curve?
« Reply #1373 on: April 30, 2020, 05:39:04 AM »
Homophobia was a huge component of Americaís disastrous HIV response. Just like racism is the reason why young kidnapped/murdered white girls make national headlines and get made for TV movies while black girls do not.

Itís a decision, conscious or not, to value certain lives over others.

What should the response have looked like?
One that valued all human life would have been a good start.

And how about you acknowledging the fact of the Pew research referred to by Mathlete?  In case your googlefu is weak, here's a link for you to follow -

https://www.pewresearch.org/2007/10/15/trends-in-attitudes-toward-religion-and-social-issues-19872007/

GuitarStv

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Re: How long can we wait while flattening the curve?
« Reply #1374 on: April 30, 2020, 07:35:11 AM »
Add to that the urgency Kris noted in responding to a global pandemic that everyone is vulnerable to medically and economically. Add to that the differences between the two types of viruses and the groundwork that's already been laid for vaccines in coronaviruses similar to the one that causes covid-19 (this is purely based on what I've read, but I'm no expert).

Reading between all those lines, if I were a betting person, I would bet that there is at least one vaccine approved for emergency use by October of this year. Possibly more than one. I know it sounds optimistic, and I know it's not in line with the expectations set by health authorities, but I think it's well-founded optimism on my part and understandable expectation-setting on their part.

I'm not an expert either, but I'm not nearly as confident.  Vaccines can have all sorts of unintended side effects including making you more susceptible to the disease, for reasons that are not fully understood.  Because the immune system itself is not fully understood.   Public health officials also don't want to prematurely introduce a bad vaccine for fear the public will begin to resist vaccination. 

I'm sure every effort is being made to speed this up as much as possible, but the vaccine will be ready when it is ready, and not before then.

I'm aware of this but obviously we've come to a different conclusion. Vaccine trial timelines haven't bumped up against some immutable law of physics, but against probabilistic outcomes and public health risk/benefit calculations that have been made in the past under different circumstances.

That a "vaccine will be ready when it is ready" is a truism and pointless in the context of this conversation. My view is that the risk/benefit calculation has changed somewhat in this situation, given the outsize benefit of a vaccine that is safe and, in at least some subgroups, demonstrably effective. Having 70 or more vaccine candidates both increases the odds of that and introduces some degree of healthy competition (as far as funding goes) to be the first.

It'll be up to regulators, but I suspect as long as there's a high level of confidence around safety, then there may even be some degree of flexibility in terms of its efficacy. In other words, as long as you can show it's safe for everyone and demonstrably effective in (for example) young people, there will be emergency approvals for younger health care providers to receive that vaccine and dosage while clinics continue to study whether adjusting the dose level or other vaccines are more appropriate for others. Or maybe we'll get lucky and one candidate will turn out to be safe and effective across demographics. If I had to pick one against the field, it would be the Oxford candidate, but I guess we'll find out soonish. I'm not pinning all my hopes on my optimistic take being right, but am trying to read the tea leaves as clearly as I can.

What you're suggesting here takes a lot of time and can't be rushed.  You can have safety or speed.  They're typically mutually exclusive in this kind of thing.  And a rushed/unsafe vaccine would damage public trust and end up being worse than nothing at all - so my suspicion is that medical practitioners will err on the side of caution, regardless of pressure/money being thrown at them.  We don't want a thalidomide type situation again.

JGS1980

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Re: How long can we wait while flattening the curve?
« Reply #1375 on: April 30, 2020, 08:12:08 AM »
Add to that the urgency Kris noted in responding to a global pandemic that everyone is vulnerable to medically and economically. Add to that the differences between the two types of viruses and the groundwork that's already been laid for vaccines in coronaviruses similar to the one that causes covid-19 (this is purely based on what I've read, but I'm no expert).

Reading between all those lines, if I were a betting person, I would bet that there is at least one vaccine approved for emergency use by October of this year. Possibly more than one. I know it sounds optimistic, and I know it's not in line with the expectations set by health authorities, but I think it's well-founded optimism on my part and understandable expectation-setting on their part.

I'm not an expert either, but I'm not nearly as confident.  Vaccines can have all sorts of unintended side effects including making you more susceptible to the disease, for reasons that are not fully understood.  Because the immune system itself is not fully understood.   Public health officials also don't want to prematurely introduce a bad vaccine for fear the public will begin to resist vaccination. 

I'm sure every effort is being made to speed this up as much as possible, but the vaccine will be ready when it is ready, and not before then.

I'm aware of this but obviously we've come to a different conclusion. Vaccine trial timelines haven't bumped up against some immutable law of physics, but against probabilistic outcomes and public health risk/benefit calculations that have been made in the past under different circumstances.

That a "vaccine will be ready when it is ready" is a truism and pointless in the context of this conversation. My view is that the risk/benefit calculation has changed somewhat in this situation, given the outsize benefit of a vaccine that is safe and, in at least some subgroups, demonstrably effective. Having 70 or more vaccine candidates both increases the odds of that and introduces some degree of healthy competition (as far as funding goes) to be the first.

It'll be up to regulators, but I suspect as long as there's a high level of confidence around safety, then there may even be some degree of flexibility in terms of its efficacy. In other words, as long as you can show it's safe for everyone and demonstrably effective in (for example) young people, there will be emergency approvals for younger health care providers to receive that vaccine and dosage while clinics continue to study whether adjusting the dose level or other vaccines are more appropriate for others. Or maybe we'll get lucky and one candidate will turn out to be safe and effective across demographics. If I had to pick one against the field, it would be the Oxford candidate, but I guess we'll find out soonish. I'm not pinning all my hopes on my optimistic take being right, but am trying to read the tea leaves as clearly as I can.

What you're suggesting here takes a lot of time and can't be rushed.  You can have safety or speed.  They're typically mutually exclusive in this kind of thing.  And a rushed/unsafe vaccine would damage public trust and end up being worse than nothing at all - so my suspicion is that medical practitioners will err on the side of caution, regardless of pressure/money being thrown at them.  We don't want a thalidomide type situation again.

I've read that the powers at be plan to produce multiple vaccines in huge quantities BEFORE they are proven safe and or effective. The goal is to save the 3-6 months needed for production prior to providing the actual shots to patients.  So if you are studying 10 separate vaccine trials, and 1 ends up being the best one, then use that one and dispose of the rest.  A 3 month advancement on the timeline would reap huge dividends, and safely as well.

Also, if one of the others are a little less effective, that does not mean we will not use that vaccine (as long as it is safe). Even a 20% decrease in infection could lead to impressive population effects of an exponentially spreading disease.

fattest_foot

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Re: How long can we wait while flattening the curve?
« Reply #1376 on: April 30, 2020, 08:14:27 AM »
So yesterday, April 29th, Cuomo finally decided that they should start sanitizing the subway cars.

Tell me more about how we should continue stay at home orders because of the numbers coming out of NYC.

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #1377 on: April 30, 2020, 08:17:57 AM »
I specifically said that NYC wasn't even on my radar because they are outliers at this point and that numbers coming out of most states still warrant the stay at home.

aspiringnomad

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Re: How long can we wait while flattening the curve?
« Reply #1378 on: April 30, 2020, 08:34:36 AM »

What you're suggesting here takes a lot of time and can't be rushed.  You can have safety or speed.  They're typically mutually exclusive in this kind of thing.  And a rushed/unsafe vaccine would damage public trust and end up being worse than nothing at all - so my suspicion is that medical practitioners will err on the side of caution, regardless of pressure/money being thrown at them.  We don't want a thalidomide type situation again.

Similar versions of some vaccine candidates have already shown to be safe in humans. Again, I'll point to the Oxford candidate which is a variation of a vaccine for MERS, a similar coronavirus, but my understanding is that there are other candidates that are also building on previously established iterations of similar vaccines.

Ironically, the safety and immunogenicty results for the ChAdOx1 MERS vaccine were just published ten days ago. If anything, those trials illustrate just how changeable our traditional vaccine timelines are given enough resources and urgency. Five years after MERS was first identified, they began a study of just 24 participants for safety and immune response and two years after that just published the results.

And yet less than four months after the Oxford clinicians began work on the ChAdOx1 n-Cov-19 variant of the vaccine they have already injected it into 1,100 trial participants with plans to inject it into another 5,000 within a month! That's unheard of, and if in February you had told any expert with a lifetime of experience in vaccine development that this would happen they probably would have laughed you out of the room. But that's where we are. A willingness and ability to inject it into 6,100 people also suggests a high degree of confidence in its safety.

Could this crash and burn in the efficacy test? Of course it can and it might very well. But luckily there are now 90 plus other candidates out there. So, while I acknowledge I'm applying some of my inherent Mustachian optimism to this subject, it's not completely blind optimism even if I doubt the relevance of previous vaccine development timelines to the current situation.

Further reading and relevant excerpt:

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30160-2/fulltext#seccestitle140

In conclusion, ChAdOx1 MERS was safe and well tolerated at all tested doses. A single dose was able to elicit both humoral and cellular responses against MERS-CoV. The results of this first-in-human clinical trial support clinical development progression into phase 1b and 2 trials in the Middle East. Healthy adults, health-care workers, people who are occupationally exposed to camels, and older age groups with comorbidities will be recruited and assessed for safety and immunogenicity of ChAdOx1 MERS to be given as a single or two-dose administration regimen.

And:

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30317-0/fulltext

The experience with SARS and the emergence of MERS, particularly during the outbreaks of 2014Ė15 in the Arabian and Korean peninsulas, were harbingers of the consequences of COVID-19, and similar pathogens, on all sectors of societyónot only in overall morbidity and mortality, but also in the capacity to level economies and disrupt social order. If MERS has been eclipsed by its pandemic cousin, then the lessons learned have prepared the global vaccine research and development community for moving coronavirus vaccines forward at an accelerated pace, such that first-in-human COVID-19 vaccine trials are moving on unprecedented, shortened timelines.

Edit: The vaccine candidate injection numbers above should be roughly halved, as almost half the participants will receive a placebo instead of the vaccine candidate. My understanding is that it's not exactly half, as a small subset received a double dose of the vaccine candidate (non blind) to assess dose variation. This doesn't change any of the points I've made in the above.
« Last Edit: April 30, 2020, 09:01:35 AM by aspiringnomad »

GuitarStv

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Re: How long can we wait while flattening the curve?
« Reply #1379 on: April 30, 2020, 08:45:07 AM »
So yesterday, April 29th, Cuomo finally decided that they should start sanitizing the subway cars.

Tell me more about how we should continue stay at home orders because of the numbers coming out of NYC.

They've been sanitizing the subway cars every 72 hours for more than a month.  What he decided was to increase the sanitation measures to every night . . . likely because it's expected that more people will be using the cars.

fattest_foot

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Re: How long can we wait while flattening the curve?
« Reply #1380 on: April 30, 2020, 09:05:48 AM »
They've been sanitizing the subway cars every 72 hours for more than a month.  What he decided was to increase the sanitation measures to every night . . . likely because it's expected that more people will be using the cars.

I can't tell, is this you defending New York? We've got people sanitizing workstations every single day that only 2-3 people use, and we've been doing it for the last month and a half. Meanwhile our county of almost 1 million people has sub-1000 cases and only 6 deaths.

But NYC sanitizing the subways every 3 days was okay for the first 2 months of a pandemic, and now they're super serious and going to up that to once a day! I take it they just never cleaned them during a normal period?

Saw something this morning with the following numbers:
NY's deaths per million: 1,197
NYC's deaths per million: 1,489
The rest of the US combined deaths per million population: 117.7

I feel like I'm living in crazy world where people rationalize the government actions right now.

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #1381 on: April 30, 2020, 09:21:20 AM »
Homophobia was a huge component of America’s disastrous HIV response. Just like racism is the reason why young kidnapped/murdered white girls make national headlines and get made for TV movies while black girls do not.

It’s a decision, conscious or not, to value certain lives over others.

What should the response have looked like?

There are lots of studies on this as well as contemporary and extemporaneous reporting. If you want my answer though, it's more money. The initial allotment was very small. Like, ten million dollars or something.

T-Money$

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Re: How long can we wait while flattening the curve?
« Reply #1382 on: April 30, 2020, 09:22:20 AM »
Delaying herd immunity is costing lives, says Harvard Medical School Professor.

https://www.spiked-online.com/2020/04/29/delaying-herd-immunity-is-costing-lives/

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #1383 on: April 30, 2020, 09:23:11 AM »
Thanks for the links, @aspiringnomad


I'm still not pinning my hopes on a vaccine in this year, but it does make me a couple hairs more hopeful!

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #1384 on: April 30, 2020, 09:24:57 AM »
If you want my answer though, it's more money.


I initially read this as you demanding to be paid for answering the question. Thank you for the belly laugh.

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #1385 on: April 30, 2020, 09:25:35 AM »
They've been sanitizing the subway cars every 72 hours for more than a month.  What he decided was to increase the sanitation measures to every night . . . likely because it's expected that more people will be using the cars.

I can't tell, is this you defending New York? We've got people sanitizing workstations every single day that only 2-3 people use, and we've been doing it for the last month and a half. Meanwhile our county of almost 1 million people has sub-1000 cases and only 6 deaths.

But NYC sanitizing the subways every 3 days was okay for the first 2 months of a pandemic, and now they're super serious and going to up that to once a day! I take it they just never cleaned them during a normal period?

Saw something this morning with the following numbers:
NY's deaths per million: 1,197
NYC's deaths per million: 1,489
The rest of the US combined deaths per million population: 117.7

I feel like I'm living in crazy world where people rationalize the government actions right now.

All three tri-state states are above 500/M, and we had 2,000 deaths yesterday in states not named New York.

I'll again ask everyone to imagine what their communities would look like if LGA, JFK, and EWR were boarding 6 million departures a month, and every city in the country wasn't conducting their own measures to limit community spread.

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #1386 on: April 30, 2020, 09:26:01 AM »
If you want my answer though, it's more money.


I initially read this as you demanding to be paid for answering the question. Thank you for the belly laugh.

lol I WISH I were that funny.

fattest_foot

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Re: How long can we wait while flattening the curve?
« Reply #1387 on: April 30, 2020, 09:30:29 AM »
Up to 30M unemployed now. And that's not considering the amount of people who are having issues filing, which I've read could add another 3-6M.

I'm guessing everyone here who's in favor of keeping closed are completely isolated from this. We're within striking distance of Great Depression unemployment numbers, in just over a month.

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #1388 on: April 30, 2020, 09:36:08 AM »
Up to 30M unemployed now. And that's not considering the amount of people who are having issues filing, which I've read could add another 3-6M.

I'm guessing everyone here who's in favor of keeping closed are completely isolated from this. We're within striking distance of Great Depression unemployment numbers, in just over a month.

Literally everyone in this thread knows this. That was the trade-off. Unfathomably high unemployment that we expect to alleviate in the long term since it's not systemic to the economy. Borrowing at near-zero interest to try to make people whole. Stem the damage of an emerging pandemic risk.

Once again, if you've got evidence backed conclusions that what the President and governors are doing, as advised by their medical and economic experts, I implore you to get yourself in the room. A trillion dollars of economic activity is at stake.

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #1389 on: April 30, 2020, 09:37:12 AM »
I would really love there to be a way to control rampant death by pestilence that didn't affect the economy, but we dont have that right now, so we're making do with this.


In this vein of conversation, are you spending much time with those sick and dying from this virus and those in high risk groups?

Michael in ABQ

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Re: How long can we wait while flattening the curve?
« Reply #1390 on: April 30, 2020, 09:45:04 AM »
Interesting article that points out the risks of dying from COVID-19 for older cohorts are not much higher than normal.

https://www.realclearmarkets.com/articles/2020/04/30/how_we_should_think_about_the_odds_of_dying_from_covid-19_490323.html

Quote
The 2017 crude death rate, according to CDC, for the entire U.S. population (325 million) was 8.65 per thousand (yielding a probability of dying in any one year of 0.87%). This is calculated from a total of 2,813,000 deaths from all causes. Most epidemiological models are now showing 60,000Ė70,000 deaths for Covid-19 by August. Even if total Covid-19 deaths were to rise to 120,000 for the entire year, the crude death rate for the entire population would rise to only 0.9%.

I'm not sure about all the numbers though as we're already at about 60,000 deaths in the US. So even if we're past the peak 100,000 deaths seems likely. But based on 2.8 million deaths a year in the US from all causes that's about 7,700 per day in the US - obviously with most of those concentrated in older cohorts. So while we fixate on over 60,000 deaths in the US over the last two months or so, approximately 460,000 people would normally be expected to die during that timeframe.   

It would be nice to see some actuarial data. What is the probably of death of say a typical 75-year old? How has that changed in the last few months? Has it gone from 0.7% to 0.8% or from 0.7% to 2.0%? (using made-up numbers). What about for a 45-year old?

Have we traded traffic accident deaths for COVID-19 deaths? Or are more people dying of cancer or suicide or drug overdoses than before?



This recent article in the Financial Times looks at changes in overall deaths to try and calculate the overall impact and how many deaths from COVID-19 are potentially going unreported, or are due to second-order effects like increased suicides.

Global coronavirus death toll could be 60% higher than reported
Mortality statistics show 122,000 deaths in excess of normal levels across 14 countries analysed by the FT
https://www.ft.com/content/6bd88b7d-3386-4543-b2e9-0d5c6fac846c

Quote
The death toll from coronavirus may be almost 60 per cent higher than reported in official counts, according to an FT analysis of overall fatalities during the pandemic in 14 countries. Mortality statistics show 122,000 deaths in excess of normal levels across these locations, considerably higher than the 77,000 official Covid-19 deaths reported for the same places and time periods.

If the same level of under-reporting observed in these countries was happening worldwide, the global Covid-19 death toll would rise from the current official total of 201,000 to as high as 318,000.To calculate excess deaths, the FT has compared deaths from all causes in the weeks of a locationís outbreak in March and April 2020 to the average for the same period between 2015 and 2019. The total of 122,000 amounts to a 50 per cent rise in overall mortality relative to the historical average for the locations studied.

The region surrounding the Italian city of Bergamo registered the worst increase internationally with a 464 per cent rise in deaths above normal levels, followed by New York City with a 200 per cent increase, and Madrid, Spain, with a 161 per cent increase.

In the Indonesian capital Jakarta, data on burials shows an increase of 1,400 relative to the historical average during the same period ó 15 times the official figure of 90 Covid deaths for the same period.

former player

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Re: How long can we wait while flattening the curve?
« Reply #1391 on: April 30, 2020, 09:48:15 AM »
I would really love there to be a way to control rampant death by pestilence that didn't affect the economy, but we dont have that right now, so we're making do with this.


In this vein of conversation, are you spending much time with those sick and dying from this virus and those in high risk groups?
Based on egillespie's posts so far I would be surprised to find out that they even think they know anyone in a high risk group, let alone having any closer acquaintance with the effects of this virus.

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #1392 on: April 30, 2020, 09:50:49 AM »
I muted that poster. I don't believe they're participating in this conversation in good faith. There's discussing differing opinions and there's... whatever that is.

GuitarStv

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Re: How long can we wait while flattening the curve?
« Reply #1393 on: April 30, 2020, 09:53:25 AM »
They've been sanitizing the subway cars every 72 hours for more than a month.  What he decided was to increase the sanitation measures to every night . . . likely because it's expected that more people will be using the cars.

I can't tell, is this you defending New York? We've got people sanitizing workstations every single day that only 2-3 people use, and we've been doing it for the last month and a half. Meanwhile our county of almost 1 million people has sub-1000 cases and only 6 deaths.

But NYC sanitizing the subways every 3 days was okay for the first 2 months of a pandemic, and now they're super serious and going to up that to once a day! I take it they just never cleaned them during a normal period?

Saw something this morning with the following numbers:
NY's deaths per million: 1,197
NYC's deaths per million: 1,489
The rest of the US combined deaths per million population: 117.7

I feel like I'm living in crazy world where people rationalize the government actions right now.


You wrote:

So yesterday, April 29th, Cuomo finally decided that they should start sanitizing the subway cars.

Tell me more about how we should continue stay at home orders because of the numbers coming out of NYC.

This was incorrect, New York has been sanitizing the subway cars for more than a month.


As far as what New York is doing regarding sanitation and subways, I have no idea what appropriate action would be.  The problem is people.  Wiping down the cars every night vs every three nights . . . it doesn't change the fact that every person who goes on public transit needs to immediately wash their hands afterwards and avoid other people while on the train, so I don't know if the benefit would have been significant or not.  (My inclination would be to shut down public transit entirely . . . but that brings a raft of new problems, particularly in a country that doesn't care for it's poor.)

I'm glad that your county has only 1000 infected people and 6 deaths.  Sounds like the stay at home orders and sanitation you've been doing have been effective.

the_fixer

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Re: How long can we wait while flattening the curve?
« Reply #1394 on: April 30, 2020, 09:57:44 AM »
I would really love there to be a way to control rampant death by pestilence that didn't affect the economy, but we dont have that right now, so we're making do with this.


In this vein of conversation, are you spending much time with those sick and dying from this virus and those in high risk groups?
Based on egillespie's posts so far I would be surprised to find out that they even think they know anyone in a high risk group, let alone having any closer acquaintance with the effects of this virus.
And egillespie is even in NY, hard to imagine being there and being such a contrarian.

Meanwhile here in Colorado, i have a very small tight knit circle and am not very social yet...

I have been quarantined 2 x due to being in contact with someone that tested positive.

My ex step dad has it and is in a care facility

One of my co-workers had it and was in the hospital for a week

One of my co-workers had it and was really sick but was ok

My wifeís running / walking buddy had it and was in the hospital for several days

My wifeís co-worker lost her dad and grandpa

We know several other people that are close to us that have not been tested but are pretty sure they had it including one that was unable to get out of the bed for 3 weeks.


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mathlete

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Re: How long can we wait while flattening the curve?
« Reply #1395 on: April 30, 2020, 09:58:49 AM »
I'm glad that your county has only 1000 infected people and 6 deaths.  Sounds like the stay at home orders and sanitation you've been doing have been effective.

Implicit in a lot of these discussions seems to be that the lockdown does nothing. We compare the measures against actual experience when we should be comparing them to how bad we think things might have gotten without them.

If the lockdown measures do absolutely nothing, and we'd be at 60K excess deaths right now either way, I agree, the lockdown is dumb and bad.

fattest_foot

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Re: How long can we wait while flattening the curve?
« Reply #1396 on: April 30, 2020, 10:00:08 AM »
I would really love there to be a way to control rampant death by pestilence that didn't affect the economy, but we dont have that right now, so we're making do with this.


In this vein of conversation, are you spending much time with those sick and dying from this virus and those in high risk groups?

I guess you didn't read my previous post where I stated we have under 1000 cases in a county of a million. Even if I wanted to, I don't think I could find someone to associate with that has it.

fattest_foot

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Re: How long can we wait while flattening the curve?
« Reply #1397 on: April 30, 2020, 10:03:28 AM »
I'm glad that your county has only 1000 infected people and 6 deaths.  Sounds like the stay at home orders and sanitation you've been doing have been effective.

That's the joke(?) I'm trying to get through to you with though.

That's not just my county, that's almost the entire country!

There's no changing any of your minds though. We have to stay closed for the rest of the summer because you're scared. I guess we need big daddy government to tell us what to do.

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #1398 on: April 30, 2020, 10:07:45 AM »
I'm glad that your county has only 1000 infected people and 6 deaths.  Sounds like the stay at home orders and sanitation you've been doing have been effective.

That's the joke(?) I'm trying to get through to you with though.

That's not just my county, that's almost the entire country!

There's no changing any of your minds though. We have to stay closed for the rest of the summer because you're scared. I guess we need big daddy government to tell us what to do.

Okay. And what would things look like with millions of passengers boarding planes from tri-state (and the Midwest and Louisiana and Spain and Italy really) to all over the United States. What would things look like if every city weren't limiting community spread.

If you've got numbers to that say the answer is "Not much different than they look now," then please please please go knock on the door of the CDC, the NIH, and the White House (be careful with that one) and save us from trillion dollar GDP contractions.

the_fixer

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How long can we wait while flattening the curve?
« Reply #1399 on: April 30, 2020, 10:07:51 AM »
I would really love there to be a way to control rampant death by pestilence that didn't affect the economy, but we dont have that right now, so we're making do with this.


In this vein of conversation, are you spending much time with those sick and dying from this virus and those in high risk groups?

I guess you didn't read my previous post where I stated we have under 1000 cases in a county of a million. Even if I wanted to, I don't think I could find someone to associate with that has it.
And what would it look like if they did not take the steps they took?

I told my wife when this started that when / if we are able to get it under control we will have people saying ďsee it was not as bad as predicted so we did not need to take step XYZĒ

Maybe it was not as bad as predicted because of the steps that they took?

Too bad we can not rewind time, try an option see how it played out and test multiple scenarios like we can with portfolio visualizer then we could know the right choice.


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« Last Edit: April 30, 2020, 10:11:33 AM by the_fixer »