Author Topic: How long can we wait while flattening the curve?  (Read 248316 times)

bacchi

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Re: How long can we wait while flattening the curve?
« Reply #1400 on: April 30, 2020, 10:09:06 AM »
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.

You're the freedom fighter we've long needed. Free the TP! Free the one-way aisles in grocery stores! Vive la liberté!

js82

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Re: How long can we wait while flattening the curve?
« Reply #1401 on: April 30, 2020, 10:11:47 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/

My one bone to pick with this article is that I think his stance applies to a certain set of starting states - i.e. where the virus has propagated to the extent that containing it via testing/contact tracing/isolating individuals(or much more localized action) as a means of holding out for a vaccine isn't feasible.  That's the case in the US and most of Europe - but doesn't necessarily apply to a few spots(Australia).

The other key discussion on this topic revolves around the following quote from the article:

Quote
Herd immunity arrives after a certain still unknown percentage of the population has acquired immunity. Through long-term sustainable social distancing and better hygiene, like not shaking hands, this percentage can be lowered, saving lives.

We need to collectively decide as a society what constitutes "long-term sustainable" - clearly where we are right now is not, but there are also a whole host of measures that aren't 100% "free", but will move us in a positive direction in terms of meaningfully lowering the terminal number of cases(and hence deaths) once we get into the later stages of this epidemic.

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #1402 on: April 30, 2020, 10:15:48 AM »
There's no changing any of your minds though. We have to stay closed for the rest of the summer because you're scared.

Really resent this since for several days, I've been begging people to change my mind on this. Texas decided to let their stay at home order expire today, and despite a lot of left leaning Internet sentiment being against that, I think it might be a good idea. We need data on what we can do to open up without dramatically increasing the reproduction rate. Texas is a big state that hasn't been hit too hard. Seems like a fine place to start to me.

I want to open up. I want to get things back to normal. Everyone does.

I guess we need big daddy government to tell us what to do.

Blind skepticism of authority/expertise is just as bad or worse than blind faith.

bacchi

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Re: How long can we wait while flattening the curve?
« Reply #1403 on: April 30, 2020, 10:17:41 AM »
Re: rushed vaccines

https://en.wikipedia.org/wiki/1976_swine_flu_outbreak

The 1976 swine flu worried everyone enough that a vaccine was rushed to market. The vaccine manufacturer was granted indemnification.

The vaccine caused too many reported cases of Guillain–Barré syndrome (paralysis, death) and the nationwide vaccination program was suspended.

https://www.smithsonianmag.com/smart-news/long-shadow-1976-swine-flu-vaccine-fiasco-180961994/

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #1404 on: April 30, 2020, 10:18:31 AM »
We need to collectively decide as a society what constitutes "long-term sustainable" - clearly where we are right now is not, but there are also a whole host of measures that aren't 100% "free", but will move us in a positive direction in terms of meaningfully lowering the terminal number of cases(and hence deaths) once we get into the later stages of this epidemic.

Very good comments. We brought the hammer down a month and a half ago. It made sense to do that. What we need now, is evidence that says which less intrusive measures we have available to us can help keep R0 near or below 1.

the_fixer

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Re: How long can we wait while flattening the curve?
« Reply #1405 on: April 30, 2020, 10:20:52 AM »
I was having a discussion with my wife last nite RE when / if a vaccine comes out.

She said she will be the first person in line to get it

I on the other hand think I might give it a bit to see what happens before getting it :)


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former player

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Re: How long can we wait while flattening the curve?
« Reply #1406 on: April 30, 2020, 10:27:12 AM »
We need to collectively decide as a society what constitutes "long-term sustainable" - clearly where we are right now is not, but there are also a whole host of measures that aren't 100% "free", but will move us in a positive direction in terms of meaningfully lowering the terminal number of cases(and hence deaths) once we get into the later stages of this epidemic.

Very good comments. We brought the hammer down a month and a half ago. It made sense to do that. What we need now, is evidence that says which less intrusive measures we have available to us can help keep R0 near or below 1.
I can see that there are parts of the USA where a lower level of restriction is appropriate except 1) you've already got parts of the USA where there are lower levels of restriction (or indeed none) and 2) because there are no border controls within the USA I don't see how the problem of travellers bringing infections to areas with low levels of infection can be dealt with, at least absent widespread testing and tracing which you do not have.

As I understand it there are no federal level restrictions or even, after today, advisories.  So presumably in order to argue for "opening up" the argument needs to be made separately for each area with a different level of infection and restrictions?  I don't see how a "we need to open up" statement gets anywhere with that, it's just too general. 

The other problem of course is that whatever government says there is going to be a sizeable proportion of the population that won't want to spend their money in restaurants and at sporting events and concerts whatever Trump says.  Although I suppose he may get his more rabid supporters to turn up at one of his rallies.

YttriumNitrate

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Re: How long can we wait while flattening the curve?
« Reply #1407 on: April 30, 2020, 10:30:59 AM »
Re: rushed vaccines
https://en.wikipedia.org/wiki/1976_swine_flu_outbreak
The 1976 swine flu worried everyone enough that a vaccine was rushed to market. The vaccine manufacturer was granted indemnification.
The vaccine caused too many reported cases of Guillain–Barré syndrome (paralysis, death) and the nationwide vaccination program was suspended.
https://www.smithsonianmag.com/smart-news/long-shadow-1976-swine-flu-vaccine-fiasco-180961994/
In 1976, 45 million people were vaccinated and 450 were paralyzed. (link). That a 0.001% incidence rate, so if the same numbers applied to Covid19, 999 out of 1000 people would be better off with a rushed vaccine.

GuitarStv

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Re: How long can we wait while flattening the curve?
« Reply #1408 on: April 30, 2020, 10:42:24 AM »
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.

I'm not particularly scared.  For myself at least.  I'm a young guy in good shape, with no serious medical problems.  Fear that I have is largely for family members who are older and not in good shape.

But you're right.  You (as a random guy on the internet) are not likely to change my mind.  When the consensus of most medical experts is that we should start opening back up, that's when I'll believe that we should do it.  My province has released guidelines for the process of re-opening, and we're slowly heading towards that.

Yes, in a pandemic situation where asymptomatic people can easily spread/carry the disease we really do need a government to tell us what to do.  This type of problem is not something that's manageable on an individual basis.

dandarc

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Re: How long can we wait while flattening the curve?
« Reply #1409 on: April 30, 2020, 10:44:06 AM »
@YttriumNitrate - 99,999 per 100,000.

.001% = .00001

Jon Bon

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Re: How long can we wait while flattening the curve?
« Reply #1410 on: April 30, 2020, 10:46:35 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 “see it was not as bad as predicted so we did not need to take step XYZ”

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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Both sides are right......

In late February early march we did not have the data we have now.

"Holy shit 3-5% fatalities, that will kill 15 million Americans, we can't do that!"

However fast forward to present day. IFR is <2%, could be <1%. So dangerous, but not close down the world dangerous.
statistically the danger is almost exclusive to old people, and those with compromised immune systems.  Both of these groups already take precautions every cold and flu season.

What I am saying (and maybe others) is why not both? (insert little girl meme here)

Surely we can lock down nursing homes and senior centers, shelter in place with our elderly folks as they currently are doing. At the same time send our younger low risk folks back to work. Why is a targeted approach unacceptable?

I dont think any reasonable person is screaming for 100% back to normal right away. States are starting to open, I think in some ways they could be a bit more targeted but it is progress in the right direction.

My personal opinion is the politicians/media overdid it on the fear-mongering and now are having a hard time walking it back.

js82

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Re: How long can we wait while flattening the curve?
« Reply #1411 on: April 30, 2020, 10:56:02 AM »
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.

I'm not particularly scared.  For myself at least.  I'm a young guy in good shape, with no serious medical problems.  Fear that I have is largely for family members who are older and not in good shape.

This.  Those of us in our 20's/30's who are approaching this with caution aren't doing so out of fear for ourselves, as much as our older family/friends/coworkers.  The outcomes for this disease for individuals in their 70's aren't something I want to mess with.

I'm a pragmatist regarding our ability to "contain" this (I don't think we can, from where we currently are in the USA) and that shapes my view on what policies are and are not realistic going forward, but that doesn't mean I'm okay with downplaying the very real health risks to my family, and many others like them.  Nor am I okay with a total dismissal of any efforts, because there are plenty of things we can do that don't involve shutting everything down, that will still save lives via reducing the total number of cases required for effective herd immunity if people make the effort to do them.

RetiredAt63

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Re: How long can we wait while flattening the curve?
« Reply #1412 on: April 30, 2020, 11:23:18 AM »
As someone closing in on 70, whose lungs are so-so (parents smoked, old enough to have had pneumonia a few times), I appreciate those of you who are being careful for those of us who are older or have other reasons to be more vulnerable.

People keep bringing up Y2K and how nothing happened.  I knew some programmers back then (1998/99) who were working massive overtime to sort out computer systems so they would not crash.  The predicted Y2K mess didn't happen because the appropriate precautions were taken, so those who never saw the hard work involved decided it was a big fuss over nothing.  It seems to me the same thing is happening here, we are taking the precautions so that the worst predictions are no longer valid, and then people complain because the precautions worked.

Telecaster

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Re: How long can we wait while flattening the curve?
« Reply #1413 on: April 30, 2020, 11:41:18 AM »
Both sides are right......

In late February early march we did not have the data we have now.

"Holy shit 3-5% fatalities, that will kill 15 million Americans, we can't do that!"

However fast forward to present day. IFR is <2%, could be <1%. So dangerous, but not close down the world dangerous.
statistically the danger is almost exclusive to old people, and those with compromised immune systems.  Both of these groups already take precautions every cold and flu season.

What I am saying (and maybe others) is why not both? (insert little girl meme here)

Surely we can lock down nursing homes and senior centers, shelter in place with our elderly folks as they currently are doing. At the same time send our younger low risk folks back to work. Why is a targeted approach unacceptable?

I dont think any reasonable person is screaming for 100% back to normal right away. States are starting to open, I think in some ways they could be a bit more targeted but it is progress in the right direction.

My personal opinion is the politicians/media overdid it on the fear-mongering and now are having a hard time walking it back.

Remember, the point of social distancing was to flatten the curve, such that we don't overload our medical system.  And it worked.  But even so, there were critical shortages of PPE and some locations needed like New York needed temporary hospital and morgue space.  If prompt action hadn't been taken, we might have seen patient dying in hallways due to lack of hospital beds like we saw happen in Italy and Spain.

Now we're through the worst of it (we hope) we can start opening up, which AFAIK all states are doing or have plans to do. 


Telecaster

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Re: How long can we wait while flattening the curve?
« Reply #1414 on: April 30, 2020, 11:46:59 AM »
People keep bringing up Y2K and how nothing happened.  I knew some programmers back then (1998/99) who were working massive overtime to sort out computer systems so they would not crash.  The predicted Y2K mess didn't happen because the appropriate precautions were taken, so those who never saw the hard work involved decided it was a big fuss over nothing.  It seems to me the same thing is happening here, we are taking the precautions so that the worst predictions are no longer valid, and then people complain because the precautions worked.


This point cannot be emphasized enough.  Y2K did not happen because people took direct action to prevent it from happening.  We did not see the worst case scenario in this situation, because people took direct action to prevent it from happening.   

I believe the best estimate for the IFR is about 0.7%.   Now multiply that number by the number possible infections.   You wind up with very, very large number. 

bacchi

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Re: How long can we wait while flattening the curve?
« Reply #1415 on: April 30, 2020, 11:55:56 AM »
Re: rushed vaccines
https://en.wikipedia.org/wiki/1976_swine_flu_outbreak
The 1976 swine flu worried everyone enough that a vaccine was rushed to market. The vaccine manufacturer was granted indemnification.
The vaccine caused too many reported cases of Guillain–Barré syndrome (paralysis, death) and the nationwide vaccination program was suspended.
https://www.smithsonianmag.com/smart-news/long-shadow-1976-swine-flu-vaccine-fiasco-180961994/
In 1976, 45 million people were vaccinated and 450 were paralyzed. (link). That a 0.001% incidence rate, so if the same numbers applied to Covid19, 999 out of 1000 people would be better off with a rushed vaccine.

Thanks, I was wondering what the numbers were.

Even at .001%, it was enough to halt vaccinations at 25% of the US population. Whether that was warranted or not is left to the reader.

Quote from: discover
This government-led campaign was widely viewed as a debacle and put an irreparable dent in future public health initiative, as well as negatively influenced the public’s perception of both the flu and the flu shot in this country.

the_fixer

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Re: How long can we wait while flattening the curve?
« Reply #1416 on: April 30, 2020, 12:19:15 PM »
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 “see it was not as bad as predicted so we did not need to take step XYZ”

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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Surely we can lock down nursing homes and senior centers, shelter in place with our elderly folks as they currently are doing. At the same time send our younger low risk folks back to work. Why is a targeted approach unacceptable?


Never said It was. Just pointing out that if things went better than estimated we were bound to get the naysayers that claimed it was too much or unnecessary. Maybe we will all be looking at Australia a few years from now and thinking what an amazing job they did... or maybe we will look at Sweden and say they had it right.

For now anyone making the decisions is Dammed if they do and Damned if they don’t by the Monday morning quarterbacks.


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ReadySetMillionaire

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Re: How long can we wait while flattening the curve?
« Reply #1417 on: April 30, 2020, 12:21:02 PM »
Just looking at the updated CDC data: https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm

People aged 0-64 account for roughly 83% of the population, but just 20.5% of the deaths.  This virus is quite clearly attacking older people. It is hard to understate how staggering of a difference that is -- that 83% of the population accounts for just 21% of deaths, and inversely, that 17% of the population accounts for 79% of deaths.

The data is showing us that this is a serious, serious, serious virus for older people. Very serious, and likely the most incredibly serious and life-threatening respiratory virus that our senior population has faced in 100 years.

Despite this incredibly robust data, we have somehow been convinced that the best strategy to tackle this is not age-based (i.e., isolate the older, the immuno-compromised, and make especially stringent plans for nursing homes), but industry-based.  Given what the data is showing us, how does it make more sense to open Industry A, B, and then C instead of developing plans based on people's ages?

Put more simply -- why are we not making plans that reflect what the data is showing us?

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #1418 on: April 30, 2020, 12:29:42 PM »
Because younger people spreading it like wildfire will infect older people just the same.

JGS1980

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Re: How long can we wait while flattening the curve?
« Reply #1419 on: April 30, 2020, 12:32:14 PM »
Re: rushed vaccines
https://en.wikipedia.org/wiki/1976_swine_flu_outbreak
The 1976 swine flu worried everyone enough that a vaccine was rushed to market. The vaccine manufacturer was granted indemnification.
The vaccine caused too many reported cases of Guillain–Barré syndrome (paralysis, death) and the nationwide vaccination program was suspended.
https://www.smithsonianmag.com/smart-news/long-shadow-1976-swine-flu-vaccine-fiasco-180961994/
In 1976, 45 million people were vaccinated and 450 were paralyzed. (link). That a 0.001% incidence rate, so if the same numbers applied to Covid19, 999 out of 1000 people would be better off with a rushed vaccine.

Per my google search, ultimately only 200 people got the disease, and 1 person died in 1976 from the Swine Flu

1 death vs 450 permanently paralyzed people.... hmmmmm

Of course, did only 1 person die because 45 million (of 218 million) people were vaccinated?

Thanks, I was wondering what the numbers were.

Even at .001%, it was enough to halt vaccinations at 25% of the US population. Whether that was warranted or not is left to the reader.

Quote from: discover
This government-led campaign was widely viewed as a debacle and put an irreparable dent in future public health initiative, as well as negatively influenced the public’s perception of both the flu and the flu shot in this country.

nereo

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Re: How long can we wait while flattening the curve?
« Reply #1420 on: April 30, 2020, 12:34:24 PM »
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/

Why the name change from egillepsie To @T-Money$ ?

No, I don’t believe that reducing the infection rate will cause more deaths overall. 

boy_bye

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Re: How long can we wait while flattening the curve?
« Reply #1421 on: April 30, 2020, 12:34:43 PM »
Because younger people spreading it like wildfire will infect older people just the same.

yep. and big gatherings like concerts and church and ball games can mean that one infected person can pass it along to many many other people, very quickly.

there's also the fact that, even for folks who survive, there seem to be some other pretty shitty health outcomes. it's not as binary as 1% dies and 99% live -- many folks who survive will still have serious problems.

hell, we don't even know if a person who has been infected can reliably be counted on to have immunity afterwards, nor do we know how long that immunity might last. there's so much we still don't know.

i'm not averse to opening things slowly, with precautions, and keeping an eye on the numbers, but the scientists who know the most about this are saying that we don't really have the test and trace ability to do this yet. so, seems like we're flying blind.

ReadySetMillionaire

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Re: How long can we wait while flattening the curve?
« Reply #1422 on: April 30, 2020, 12:35:55 PM »
Because younger people spreading it like wildfire will infect older people just the same.

How is this possible if we isolate them via SAH orders?

boy_bye

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Re: How long can we wait while flattening the curve?
« Reply #1423 on: April 30, 2020, 12:37:34 PM »
Because younger people spreading it like wildfire will infect older people just the same.

How is this possible if we isolate them via SAH orders?

young people have old people in their families. young people work with older people in healthcare and other kinds of care situations. young people bring old people groceries and medicines. the more young people who get the rona, the more old people will also get it.

ReadySetMillionaire

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Re: How long can we wait while flattening the curve?
« Reply #1424 on: April 30, 2020, 12:39:16 PM »
Because younger people spreading it like wildfire will infect older people just the same.

yep. and big gatherings like concerts and church and ball games can mean that one infected person can pass it along to many many other people, very quickly.

there's also the fact that, even for folks who survive, there seem to be some other pretty shitty health outcomes. it's not as binary as 1% dies and 99% live -- many folks who survive will still have serious problems.

hell, we don't even know if a person who has been infected can reliably be counted on to have immunity afterwards, nor do we know how long that immunity might last. there's so much we still don't know.

i'm not averse to opening things slowly, with precautions, and keeping an eye on the numbers, but the scientists who know the most about this are saying that we don't really have the test and trace ability to do this yet. so, seems like we're flying blind.

First, all evidence indicates that people who get it have immunity. The scare headlines from a week ago have all been debunked (see Nate Silver’s timeline on this).

Second, a general rule of thumb is to not make broad policy based on anecdotes, which is what seemingly everyone wants to do these days.

ReadySetMillionaire

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Re: How long can we wait while flattening the curve?
« Reply #1425 on: April 30, 2020, 12:41:08 PM »
Because younger people spreading it like wildfire will infect older people just the same.

How is this possible if we isolate them via SAH orders?

young people have old people in their families. young people work with older people in healthcare and other kinds of care situations. young people bring old people groceries and medicines. the more young people who get the rona, the more old people will also get it.

Seclude them. Stay at home orders. Work from home. Deliver foods and services.

The fastest way to herd immunity (immunity that slows transmission) is to let young people get it and recover, thus reducing transmission. So let’s go.

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Re: How long can we wait while flattening the curve?
« Reply #1426 on: April 30, 2020, 12:43:29 PM »
I feel like we’re one step away from promoting ‘Pox Parties’ again.

dandarc

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Re: How long can we wait while flattening the curve?
« Reply #1427 on: April 30, 2020, 12:44:04 PM »
And you base that on absolutely nothing RSM. Congratulations, you just made the list.

MrThatsDifferent

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Re: How long can we wait while flattening the curve?
« Reply #1428 on: April 30, 2020, 12:49:54 PM »
America has screwed this up so badly for the world. Ever other country is going to get this under control, except the US. People so desperate to not be told what the do are going to ensure that this virus rages for years. Your death toll is going to be incredible. The elderly and far too many people of color will die. Younger people are experiencing strokes. The fear and insecurity will be intense. The economic and psychic impact unimaginable. And it will be virtually impossible for anyone to travel to the US or anyone from the US to travel without strict testing and possible quarantine. All because of your batshit crazy leader and the feckless sycophants who don’t call his stupidity out. All that needed to happen was total commitment immediately to 2 months of strict stay at home orders, mass testing and quarantine. But no, you got protests and states opening things back up, while this thing keeps raging out of control. Insane.

ReadySetMillionaire

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Re: How long can we wait while flattening the curve?
« Reply #1429 on: April 30, 2020, 12:50:27 PM »
And you base that on absolutely nothing RSM. Congratulations, you just made the list.

What do you mean? CDC data and a Harvard scientist aren’t good enough?

Abe

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Re: How long can we wait while flattening the curve?
« Reply #1430 on: April 30, 2020, 12:53:15 PM »
Who can outline a way to shelter the elderly (age 60+, for Better or worse, approximately 70 million people) from the rest of the population. Keep in mind that the majority of nursing home workers are <60, as are healthcare workers, and delivery drivers, etc.

Also we need to isolate patients over 50 with comorbidities such as CAD, obesity, diabetes as they are also high risk. Roughly 1:3 of adults have one of these problems so that’s another 40m / 3 = 13m.

Then there is the 20-50yo, about 20% of whom have one of these comorbidities, so that’s another 130/5 = 26m.

That’s 110m, or a third of the population. Should they be provided a stipend or basic income to stay at home until a vaccine is developed? If we gave them all 1200 x 6 months (early end of widespread vaccine timeline), that’s about $800b, which seems something we could afford. Just have to cut down on the defense budget for a few years.

The other 2/3 can go about their daily activities, and with an IFR of 0.1%, that’s only 220k dead! With a hospitalization rate of 1%, we’d only have about 2 millions patients, roughly twice our hospital bed capacity for the country, and have to defer all other healthcare for the year to accommodate the covid patients. Let’s be extra generous and assume the 30% of US living in rural areas won’t get it at all. Still doesn’t help much.

 1/3 of economy collapsed, healthcare system collapsed and a quarter of million dead sounds like quite a bargain! /s

In all seriousness, it’s a hard question and I don’t think anyone has a good answer yet. Especially dealing with the survivors and their disabilities.
« Last Edit: April 30, 2020, 12:56:50 PM by Abe »

nereo

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Re: How long can we wait while flattening the curve?
« Reply #1431 on: April 30, 2020, 12:56:08 PM »
What are the legal and ethical ramifications of ordering a subset of the population to shelter at home, while allowing another segment of the population to roam relatively uninhibited?


ReadySetMillionaire

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Re: How long can we wait while flattening the curve?
« Reply #1432 on: April 30, 2020, 12:58:10 PM »
Who can outline a way to shelter the elderly (age 60+, for Better or worse, approximately 70 million people) from the rest of the population. Keep in mind that the majority of nursing home workers are <60, as are healthcare workers, and delivery drivers, etc.

Also we need to isolate patients over 50 with comorbidities such as CAD, obesity, diabetes as they are also high risk. Roughly 1:3 of adults have one of these problems so that’s another 40m / 3 = 13m.

Then there is the 20-50yo, about 20% of whom have one of these comorbidities, so that’s another 130/5 = 26m.

That’s 110m, or a third of the population. Should they be provided a stipend or basic income to stay at home until a vaccine is developed? If we gave them all 1200 x 6 months (early end of widespread vaccine timeline), that’s about $800b, which seems something we could afford. Just have to cut down on the defense budget for a few years.

The other 2/3 can go about their daily activities, and with an IFR of 0.1%, that’s only 220k dead! With a hospitalization rate of 1%, we’d only have about 2 millions patients, roughly twice our hospital bed capacity for the country, and have to defer all other healthcare for the year to accommodate the covid patients. Let’s be extra generous and assume the 30% of US living in rural areas won’t get it at all. Still doesn’t help much.

 1/3 of economy collapsed, healthcare system collapsed and a quarter of million dead sounds like quite a bargain! /s

In all seriousness, it’s a hard question and I don’t think anyone has a good answer yet.

Some good policy proposals here. I think we could also implement testing for those that interact with the elderly. My wife is a speech therapist and takes her temperature every day before starting her shifts. It’s a small step but more could be done.

Also, I do not agree that the IFR is anywhere close to .1% for younger people. Not anywhere close.

What I’m wondering from the above posters so strongly disagreeing with me — how is trying to control all 325 million people better and easier to accomplish than controlling 100 million? It’s pretty much been proven, during this six week process, that Americans just wont put up with SAH orders for long. Especially young people. They just won’t.

So why not do a more targeted approach?
« Last Edit: April 30, 2020, 01:04:33 PM by ReadySetMillionaire »

ReadySetMillionaire

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Re: How long can we wait while flattening the curve?
« Reply #1433 on: April 30, 2020, 01:03:45 PM »
What are the legal and ethical ramifications of ordering a subset of the population to shelter at home, while allowing another segment of the population to roam relatively uninhibited?

Unlike race and national origin (which require strict scrutiny), discrimination based on age is subject to rational basis review — government action only has to be proven to be rationally related to a “legitimate” government interest. Any age-based policy would clearly pass this relatively low standard given the CDC data we have. 

Jon Bon

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Re: How long can we wait while flattening the curve?
« Reply #1434 on: April 30, 2020, 01:04:31 PM »
I feel like we’re one step away from promoting ‘Pox Parties’ again.

Aren't we almost there?

The toothpaste is so out of the tube sometimes it feels like we should do the "reverse lockdown"

*insert sarcasm font*
Throw all the healthy young people in a woodstock type concert, infect every single one. Hide all the old people for 3 weeks, problem solved!!

All I can see is as options are:

1) Endless lock-down until vaccine
2) Controlled heard immunity.

I'm sure there is a third option that someone will point out, but the two above are pretty mutually exclusive. Maybe we are all just discussing various version of #2 but the aggressiveness of the plan is the point of contention. I hear lots about contract tracing and increased testing and such but if this is the novel corona virus for a reason is it not? Infections as hell even in folks that show no symptoms. 

Also to be fair I think everyone is being generally pretty moderate in here, I dont think anyone is advocating for martial law, and or business as usual. Often we take the tone that we are arguing with someone who is.








nereo

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Re: How long can we wait while flattening the curve?
« Reply #1435 on: April 30, 2020, 01:06:04 PM »

Some good policy proposals here. I think we could also implement testing for those that interact with the elderly. My wife is a speech therapist and takes her temperature every day before starting her shifts.


I think you missed the sarcasm tag.
Also - like many states, mine currently does not have sufficient testing capacity at present to do anything near what you are suggesting.  AS it they can only test individuals who are exhibiting symptoms or people who have been in close contact with a known case for at least 10 minutes.  You currently cannot get tested just to see if you have been infected (I.e. asymptomatic or mildly symptomatic).

GuitarStv

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Re: How long can we wait while flattening the curve?
« Reply #1436 on: April 30, 2020, 01:06:16 PM »
Throw all the healthy young people in a woodstock type concert, infect every single one. Hide all the old people for 3 weeks, problem solved!!

How much is this concert going to cost, and who's headlining it?  The answers to those two questions will determine my participation.  :P

ReadySetMillionaire

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Re: How long can we wait while flattening the curve?
« Reply #1437 on: April 30, 2020, 01:07:25 PM »

Some good policy proposals here. I think we could also implement testing for those that interact with the elderly. My wife is a speech therapist and takes her temperature every day before starting her shifts.


I think you missed the sarcasm tag.
Also - like many states, mine currently does not have sufficient testing capacity at present to do anything near what you are suggesting.  AS it they can only test individuals who are exhibiting symptoms or people who have been in close contact with a known case for at least 10 minutes.  You currently cannot get tested just to see if you have been infected (I.e. asymptomatic or mildly symptomatic).

I was commenting on the stipend proposals. Seems like a good idea since we are printing money anyway.

boy_bye

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Re: How long can we wait while flattening the curve?
« Reply #1438 on: April 30, 2020, 01:10:31 PM »
Because younger people spreading it like wildfire will infect older people just the same.

yep. and big gatherings like concerts and church and ball games can mean that one infected person can pass it along to many many other people, very quickly.

there's also the fact that, even for folks who survive, there seem to be some other pretty shitty health outcomes. it's not as binary as 1% dies and 99% live -- many folks who survive will still have serious problems.

hell, we don't even know if a person who has been infected can reliably be counted on to have immunity afterwards, nor do we know how long that immunity might last. there's so much we still don't know.

i'm not averse to opening things slowly, with precautions, and keeping an eye on the numbers, but the scientists who know the most about this are saying that we don't really have the test and trace ability to do this yet. so, seems like we're flying blind.

First, all evidence indicates that people who get it have immunity. The scare headlines from a week ago have all been debunked (see Nate Silver’s timeline on this).

Second, a general rule of thumb is to not make broad policy based on anecdotes, which is what seemingly everyone wants to do these days.

Nate Silver's timeline says that WHO didn't communicate well about this, NOT that there is strong evidence that people who get it have immunity at any predictable level or timeframe.

And I quote: "The consensus of the evidence, as best as I can tell, is that there’s very likely to be some degree of immunity, although we don’t know how absolute it is and for how long it confers and there's still a lot to be learned about it."

Which is exactly what I said.

"hell, we don't even know if a person who has been infected can reliably be counted on to have immunity afterwards, nor do we know how long that immunity might last. there's so much we still don't know."

I didn't say that no one is ever immune. I said WE DON'T KNOW. Which is true. So pipe down with your thinking you know every damn thing about how this works because clearly LITERALLY NO ONE DOES.

nereo

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Re: How long can we wait while flattening the curve?
« Reply #1439 on: April 30, 2020, 01:11:05 PM »

Some good policy proposals here. I think we could also implement testing for those that interact with the elderly. My wife is a speech therapist and takes her temperature every day before starting her shifts.


I think you missed the sarcasm tag.
Also - like many states, mine currently does not have sufficient testing capacity at present to do anything near what you are suggesting.  AS it they can only test individuals who are exhibiting symptoms or people who have been in close contact with a known case for at least 10 minutes.  You currently cannot get tested just to see if you have been infected (I.e. asymptomatic or mildly symptomatic).

I was commenting on the stipend proposals. Seems like a good idea since we are printing money anyway.
??

I was asking you how we implement testing on everyone who interacts with the elderly or at-risk population (which @Abe ballparked at ~25MM), when we currently do not have the testing capacity we need as is.

Hopefully we can solve that bottleneck ASAP - but it’s been 51 days since we were promised that “anyone who wants to get testing can get testing”. Hasn’t happened.

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #1440 on: April 30, 2020, 01:16:18 PM »
I definitely think there’s middle ground. When our PPE situation is rosier and when we have good (reliable, accessible, widespread, etc) testing abilities, and our active cases have truly downshifted I think reopening daily life* can begin. Ideally I’d like to have a reasonably reliable drug or combo of drugs available too but can’t really rush more than we are. 

I’ve stated before that I’m in a state that’s well positioned for a “good” outcome if we had waited another week or two to reopen retail, dine-in restaurants, and gyms. Unfortunately my state did not. Even though we are technically 2 weeks out from our peak in deaths per day, we’ve only showed a meaningful decline from that peak for the past 3, in my opinion.


*Staying far apart, washing hands, Avoiding gatherings etc remaining
« Last Edit: April 30, 2020, 01:18:05 PM by MudPuppy »

Abe

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Re: How long can we wait while flattening the curve?
« Reply #1441 on: April 30, 2020, 01:18:53 PM »
We know for a fact that in NYC the IFR for 45-64 year olds is 136/100000 = 0.136%, assuming everyone has been infected already and no further deaths (both unlikely), while for 18-44 it is 0.01%. So it’s somewhere between those two values for 18-60, and thus can be close to 0.1% overall.

I do agree we need to risk stratify people, but age is too weak a stratifier, our working age population is sicker than prior may suspect, and we need better testing to tamp down outbreaks when they occur. Otherwise we will overwhelm the hospital system. One of the largest, best funded hospital systems in the country almost ran out of capacity and resources with NYC outbreaks. Most other systems in the country wouldn’t have been able to tolerate a quarter of that surge.
« Last Edit: April 30, 2020, 01:23:48 PM by Abe »

ReadySetMillionaire

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Re: How long can we wait while flattening the curve?
« Reply #1442 on: April 30, 2020, 01:23:11 PM »

Some good policy proposals here. I think we could also implement testing for those that interact with the elderly. My wife is a speech therapist and takes her temperature every day before starting her shifts.


I think you missed the sarcasm tag.
Also - like many states, mine currently does not have sufficient testing capacity at present to do anything near what you are suggesting.  AS it they can only test individuals who are exhibiting symptoms or people who have been in close contact with a known case for at least 10 minutes.  You currently cannot get tested just to see if you have been infected (I.e. asymptomatic or mildly symptomatic).

I was commenting on the stipend proposals. Seems like a good idea since we are printing money anyway.
??

I was asking you how we implement testing on everyone who interacts with the elderly or at-risk population (which @Abe ballparked at ~25MM), when we currently do not have the testing capacity we need as is.

Hopefully we can solve that bottleneck ASAP - but it’s been 51 days since we were promised that “anyone who wants to get testing can get testing”. Hasn’t happened.

This isn’t feasible, it’s never going to be feasible, and waiting for it to be feasible is horrible policy.

What, do we think we can test these folks every day? Every two days? It’s impossible to scale up to that magnitude. It’s a goal that is not achievable and will never be achievable.

Better policy would be to acknowledge this reality and create as best of a policy solution as you can. Ask these healthcare workers/senior workers to take special precautions. Take temperatures before their shifts. Monitor symptoms. Encourage more PPE/masks in these settings.

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Re: How long can we wait while flattening the curve?
« Reply #1443 on: April 30, 2020, 01:27:23 PM »
WHy is it not feasible? 
We seem to be the only developed nation that can’t implement a comprehensive testing program, that still lacks sufficient bandwidth 3+ months after the pandemic was fully recognized.

ReadySetMillionaire

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Re: How long can we wait while flattening the curve?
« Reply #1444 on: April 30, 2020, 01:28:48 PM »
We know for a fact that in NYC the IFR for 45-64 year olds is 136/100000 = 0.136%, assuming everyone has been infected already and no further deaths (both unlikely), while for 18-44 it is 0.01%. So it’s somewhere between those two values for 18-60, and thus can be close to 0.1% overall.

I do agree we need to risk stratify people, but age is too weak a stratifier, our working age population is sicker than prior may suspect, and we need better testing to tamp down outbreaks when they occur. Otherwise we will overwhelm the hospital system. One of the largest, best funded hospital systems in the country almost ran out of capacity and resources with NYC outbreaks. Most other systems in the country wouldn’t have been able to tolerate a quarter of that surge.

Thanks for the data. NY is also a great data set.

I do have questions about your conclusion in the first paragraph. People aged 0-44 make up 59% of the  population. If their IFR is .01%, and people aged 45-64 are just 25% of the population, wouldn’t the IFR be weighted far closer to the .01% than the .136%?

That’s been my interpretation.

ReadySetMillionaire

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Re: How long can we wait while flattening the curve?
« Reply #1445 on: April 30, 2020, 01:33:21 PM »
WHy is it not feasible? 
We seem to be the only developed nation that can’t implement a comprehensive testing program, that still lacks sufficient bandwidth 3+ months after the pandemic was fully recognized.

I guess my question would be the feasibility depends on the frequency of tests. I don’t see how Nurse X can get tested Monday, go work M-F, go to the grocery store on Tuesday, go to the post office Wednesday, etc. Wouldn’t we need to repeatedly test all of these workers over and over?

That just doesn’t seem feasible to me give the the size of the US.

Abe

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Re: How long can we wait while flattening the curve?
« Reply #1446 on: April 30, 2020, 01:33:48 PM »
We’d have to do the above measure - already implemented - and a random sampling of the population to identity outbreaks. We’re close to that level in some areas, but not nationally. High risk events/venues will have to be banned until a vaccine. I think isolated/rural communities should be offered the option of opening or not, with the understanding that they will not be able to treat most symptomatic, critically ill patients. Cities that are densely populated should continue to avoid businesses that can’t reasonably decrease capacity to a safe level. Low-risk workers from those businesses could be hired as part of a national health Program to help with outbreak control and medical surge capacity as needed. This would be need to be funded at a national level.

Abe

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Re: How long can we wait while flattening the curve?
« Reply #1447 on: April 30, 2020, 01:35:22 PM »
We know for a fact that in NYC the IFR for 45-64 year olds is 136/100000 = 0.136%, assuming everyone has been infected already and no further deaths (both unlikely), while for 18-44 it is 0.01%. So it’s somewhere between those two values for 18-60, and thus can be close to 0.1% overall.

I do agree we need to risk stratify people, but age is too weak a stratifier, our working age population is sicker than prior may suspect, and we need better testing to tamp down outbreaks when they occur. Otherwise we will overwhelm the hospital system. One of the largest, best funded hospital systems in the country almost ran out of capacity and resources with NYC outbreaks. Most other systems in the country wouldn’t have been able to tolerate a quarter of that surge.

Thanks for the data. NY is also a great data set.

I do have questions about your conclusion in the first paragraph. People aged 0-44 make up 59% of the  population. If their IFR is .01%, and people aged 45-64 are just 25% of the population, wouldn’t the IFR be weighted far closer to the .01% than the .136%?

That’s been my interpretation.

Thanks, good point. Weighted average is 0.04%, assuming 100% infection rate at this time. If 50% infected, then 0.08%.

Abe

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Re: How long can we wait while flattening the curve?
« Reply #1448 on: April 30, 2020, 01:37:08 PM »
WHy is it not feasible? 
We seem to be the only developed nation that can’t implement a comprehensive testing program, that still lacks sufficient bandwidth 3+ months after the pandemic was fully recognized.

I guess my question would be the feasibility depends on the frequency of tests. I don’t see how Nurse X can get tested Monday, go work M-F, go to the grocery store on Tuesday, go to the post office Wednesday, etc. Wouldn’t we need to repeatedly test all of these workers over and over?

That just doesn’t seem feasible to me give the the size of the US.

I think we’d have to limit this to areas of suspected outbreak risk, and high-risk employees, but with antigen testing (rapid flu test is an example), we would be able to at some scale. Widespread testing of everyone wouldn’t be feasible without major retooling of our manufacturing infrastructure.

ReadySetMillionaire

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Re: How long can we wait while flattening the curve?
« Reply #1449 on: April 30, 2020, 01:40:09 PM »
We know for a fact that in NYC the IFR for 45-64 year olds is 136/100000 = 0.136%, assuming everyone has been infected already and no further deaths (both unlikely), while for 18-44 it is 0.01%. So it’s somewhere between those two values for 18-60, and thus can be close to 0.1% overall.

I do agree we need to risk stratify people, but age is too weak a stratifier, our working age population is sicker than prior may suspect, and we need better testing to tamp down outbreaks when they occur. Otherwise we will overwhelm the hospital system. One of the largest, best funded hospital systems in the country almost ran out of capacity and resources with NYC outbreaks. Most other systems in the country wouldn’t have been able to tolerate a quarter of that surge.

Thanks for the data. NY is also a great data set.

I do have questions about your conclusion in the first paragraph. People aged 0-44 make up 59% of the  population. If their IFR is .01%, and people aged 45-64 are just 25% of the population, wouldn’t the IFR be weighted far closer to the .01% than the .136%?

That’s been my interpretation.

Thanks, good point. Weighted average is 0.04%, assuming 100% infection rate at this time. If 50% infected, then 0.08%.

You’re obviously better with numbers than I am so thanks.

I guess my question is this — the data is showing us that this affects 65+ much, much, much more harshly than the younger population.

Given this observation, what policy should we implement? I simply cannot believe that the best weighing of public health vs. economy vs. everything else (could go on into infinity) results in a general lockdown.

That is all I’m saying. We have a ton of data now. We need to act on that data. What could we be doing differently?