Author Topic: How long can we wait while flattening the curve?  (Read 253671 times)

frugalnacho

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Re: How long can we wait while flattening the curve?
« Reply #2900 on: July 07, 2020, 10:12:35 AM »
At this point I can't believe anyone is taking Bloop Bloop seriously and still engaging with him.  If you don't have him on literal "ignore user" you should at least be mentally dismissing his posts when you see them.  He didn't have a clue several months ago, and still doesn't. 

former player

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Re: How long can we wait while flattening the curve?
« Reply #2901 on: July 07, 2020, 10:31:12 AM »
[redacted]
I would say I'm shocked by your selfishness but you've pretty much made your fuck-you-got-mine attitude clear from the beginning of the pandemic. I'm disgusted and appalled by it but if such things bothered you you would not behave as you do. If folks with your attitude didn't exist, we'd have had far more luck controlling the spread of this virus than we have done.

I feel sorry for his dates.
Well none of them seem to last for more than one date, so they are only losing one evening to him which is less than we've had to put up with here.  If anyone does stick for longer than that it will be evidence of the power of assortive mating and they'll only be making two people unhappy instead of four.

Davnasty

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Re: How long can we wait while flattening the curve?
« Reply #2902 on: July 07, 2020, 10:36:31 AM »
Personal attacks are against forum rules. Not calling anyone specific out, but the piling on is a bit much.

obstinate

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Re: How long can we wait while flattening the curve?
« Reply #2903 on: July 07, 2020, 10:47:36 AM »
Personal attacks are against forum rules. Not calling anyone specific out, but the piling on is a bit much.
Thanks for the reminder. I've adjusted my comment to make it clearer that the attitude evinced by the comment is the target of my negative feelings, not the person. Although if we attack an idea and not a person, but the person continues to hew to that idea, I'm not sure how clear the distinction is. In any case, if the mods feel it's over the line, I'll accept correction.

DadJokes

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Re: How long can we wait while flattening the curve?
« Reply #2904 on: July 07, 2020, 11:14:25 AM »

Yep. What's next, blame the hospital workers?

They've had a free ride for far too long!

/s

OtherJen

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Re: How long can we wait while flattening the curve?
« Reply #2905 on: July 07, 2020, 12:49:21 PM »
NY Times: Sweden Has Become the World’s Cautionary Tale

Quote
Sweden’s central bank expects its economy to contract by 4.5 percent this year, a revision from a previously expected gain of 1.3 percent. The unemployment rate jumped to 9 percent in May from 7.1 percent in March. “The overall damage to the economy means the recovery will be protracted, with unemployment remaining elevated,” Oxford Economics concluded in a recent research note.

This is more or less how damage caused by the pandemic has played out in Denmark, where the central bank expects that the economy will shrink 4.1 percent this year, and where joblessness has edged up to 5.6 percent in May from 4.1 percent in March.

In short, Sweden suffered a vastly higher death rate while failing to collect on the expected economic gains.

kenmoremmm

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Re: How long can we wait while flattening the curve?
« Reply #2906 on: July 07, 2020, 01:13:30 PM »
NY Times: Sweden Has Become the World’s Cautionary Tale

still a work in progress. the virus isn't done. there is no vaccine yet. it's too early to say what has worked and what hasn't.

my personal belief, right or wrong, is that herd immunity is possible; that a vaccine is far far from guaranteed; that there is a legitimate chance that countries/states that have opened back up for business might actually fare better in the long haul; and that countries that have "beat" the virus (australia, s. korea, NZ, china) will only beat the virus if a vaccine is developed --- otherwise, they are playing a very long game of open up and then shut down OR locking out international travel indefinitely.

Wrenchturner

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Re: How long can we wait while flattening the curve?
« Reply #2907 on: July 07, 2020, 01:20:19 PM »
still a work in progress. the virus isn't done. there is no vaccine yet. it's too early to say what has worked and what hasn't.

I totally agree! 

frugalnacho

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Re: How long can we wait while flattening the curve?
« Reply #2908 on: July 07, 2020, 01:21:57 PM »
You're telling me it's the virus causing economic damage and not the lockdowns?





Who could have possibly guessed this? And who could have possibly known Sweden's idea was terrible?  I mean besides everyone.

I feel like a broken record because I've said this a dozen times, but economic damage was a forgone conclusion.  It's the virus causing the economic damage, not the lockdown.  I've been bitching plenty on the forum about my area (Metro Detroit) disregarding the lockdown orders and social distancing guidelines because some (10-15%) of the population is completely disregarding it, but that means 85-90% are complying with it voluntarily.  If the lockdown was lifted in its entirety plenty of people would still comply resulting in a defacto lockdown.  I don't care if they lift the restrictions today, I'm not going to an airport, I'm not going to a concert or sporting event, and I'm not going to sit in a crowded restaurant, and I have a feeling that's also true for a lot of other reasonable people.  All of those venues are going to suffer economically no matter what.

frugalnacho

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Re: How long can we wait while flattening the curve?
« Reply #2909 on: July 07, 2020, 01:23:21 PM »
NY Times: Sweden Has Become the World’s Cautionary Tale

still a work in progress. the virus isn't done. there is no vaccine yet. it's too early to say what has worked and what hasn't.

my personal belief, right or wrong, is that herd immunity is possible; that a vaccine is far far from guaranteed; that there is a legitimate chance that countries/states that have opened back up for business might actually fare better in the long haul; and that countries that have "beat" the virus (australia, s. korea, NZ, china) will only beat the virus if a vaccine is developed --- otherwise, they are playing a very long game of open up and then shut down OR locking out international travel indefinitely.

The entire point was to keep the economy open and humming along, and yet Sweden is getting hit economically just as much as everywhere else, just with a higher death toll.  Sweden's approach has failed, even Sweden admits that. 

It's almost like rational, reasonable people don't want to die and don't want their loved ones to die and are taking precautions themselves which are detrimental to the ever expanding economy. 

GuitarStv

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Re: How long can we wait while flattening the curve?
« Reply #2910 on: July 07, 2020, 01:35:00 PM »
It's almost like rational, reasonable people don't want to die and don't want their loved ones to die and are taking precautions themselves which are detrimental to the ever expanding economy.

So that's why Florida is experiencing no detrimental economic impacts from this pandemic!

Shane

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Re: How long can we wait while flattening the curve?
« Reply #2911 on: July 07, 2020, 01:45:05 PM »
NY Times: Sweden Has Become the World’s Cautionary Tale

Quote
Sweden’s central bank expects its economy to contract by 4.5 percent this year, a revision from a previously expected gain of 1.3 percent. The unemployment rate jumped to 9 percent in May from 7.1 percent in March. “The overall damage to the economy means the recovery will be protracted, with unemployment remaining elevated,” Oxford Economics concluded in a recent research note.

This is more or less how damage caused by the pandemic has played out in Denmark, where the central bank expects that the economy will shrink 4.1 percent this year, and where joblessness has edged up to 5.6 percent in May from 4.1 percent in March.

In short, Sweden suffered a vastly higher death rate while failing to collect on the expected economic gains.

Many people seem to badly want the narrative expressed in that NYT article to be true. IMHO, judging Sweden's strategy now is premature, as we don't know yet how things are going to end with the pandemic. My state of PA has roughly 20% higher population than Sweden and, so far, 27% more people have died in PA than in Sweden. That's with a 6+ week lockdown here, with total school closures, and none in Sweden. Mandatory masks here in PA. None in Sweden.

If Sweden's economy was the only thing that mattered, then maybe their acceptance of a higher death rate in exchange for a less authoritarian approach to dealing with covid could be said to have failed. I've seen Sweden's State Epidemiologist, Anders Tegnell, interviewed. He never once mentioned anything about "the economy." What I heard him say was that Sweden's strategy, in contrast to countries that did complete lockdowns, was meant to be sustainable, indefinitely, if necessary. I think there are other factors, besides the economy, that should be considered, as well. For example, shutting down elementary schools in my state has had negative effects on many children, mine included. The American Academy of Pediatrics seems to agree. They're recommending reopening schools next month, even though covid cases are still increasing in many parts of the country.

Quote
AAP strongly advocates that all policy considerations for the coming school year should start with a goal of having students physically present in school. The importance of in-person learning is well-documented, and there is already evidence of the negative impacts on children because of school closures in the spring of 2020. Lengthy time away from school and associated interruption of supportive services often results in social isolation, making it difficult for schools to identify and address important learning deficits as well as child and adolescent physical or sexual abuse, substance use, depression, and suicidal ideation. This, in turn, places children and adolescents at considerable risk of morbidity and, in some cases, mortality. Beyond the educational impact and social impact of school closures, there has been substantial impact on food security and physical activity for children and families.

HBFIRE

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Re: How long can we wait while flattening the curve?
« Reply #2912 on: July 07, 2020, 01:54:21 PM »
Sweden's approach wasn't just to keep their economy going.  The chief epidemiologist (who still stands by the strategy) felt it was the best long term course of action rather than intermittent lockdowns.  It remains to be seen if this strategy is correct.   Judging it now is only done to serve confirmation bias of already held views.  The truth is, the experts aren't even certain what the best long term strategy is -- we're unfortunately all living in a worldwide experiment of various approaches.  Armchair keyboard premature hindsight journalism is irresponsible imo.
« Last Edit: July 07, 2020, 02:00:00 PM by HBFIRE »

Shane

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Re: How long can we wait while flattening the curve?
« Reply #2913 on: July 07, 2020, 01:58:59 PM »
Why Sweden is still not asking people to wear face masks

Quote
But the official advice from the Swedish Public Health Agency remains: "Face masks aren't needed in normal situations in society, where it's better to keep distance from other people and be careful to wash hands." The agency has issued instructions for owners of restaurants, bars and shops on how they should ensure social distancing takes place, and some restaurants have been forced to close temporarily for violating these laws.

Bloop Bloop

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Re: How long can we wait while flattening the curve?
« Reply #2914 on: July 07, 2020, 05:45:03 PM »
Um... I'm sorry, have you not been advocating that people do what they want, basically, since the beginning of this pandemic??? And also that you're low risk etc etc. Well, people have done whatever they wanted, and now your area is screwed. But you're low risk, so no worries??? Enjoy your 6 week lockdown. When it ends, perhaps you could be one of the ones making better choices for the good of everyone.

Yeah, I am low risk. Let's compare me to a typical quarantine hotel worker who's responsible for one of the clusters

I live alone - He lives with a large extended family

I work from home - He works in a quarantine hotel/abattoir/whatever

I have no colleagues - He has lots of coworkers

I contact no one in close proximity - He contacts lots of people in close proximity

When I do see family, it's a gathering of 4 - When he sees family, it's a gathering of 10+ (see Daniel Andrews's run down of what people were doing wrong)

I don't live in the north/western suburbs where 90% of infections are - He does.

So...don't compare me to the people who screwed it up for everyone.

Bloop Bloop, you have privilege that those you say screwed it up for everyone don't. The people living in extended family groups and working hazardous high contact low wage jobs aren't generally doing that because they think it is fun. They are doing it because it is literally the best option available to survive and care for their loved ones.

You could make choices that would reduce your own risk and that of your community. You don't, and then vilify people who are doing the best they can under far more challenging circumstances.

I do have privilege. That doesn't mean that I'm wrong in saying that I'm objectively contributing less to the pandemic than the people I'm pointing out who are breaking different rules from me in a much different way. If a security guard say, has sex with a quarantined traveller (yes...this happened) then goes home from his tiring job and spreads it to his family living in cramped confines in the northwestern suburbs of my city...that starts a cluster of 20+ infections from which our situation spirals out of control. Quite different from me as a young healthy person dating other individual young healthy people in the eastern suburbs where numbers are literally 1/10 what they are in the hot spot suburbs.

You guys can criticise me all you like, I'm all for fair discussion and it doesn't faze me. I see your point as being that I'm subjectively being cavalier about it (and I accept that) and that my subjective "sacrifices" are minor compared to those of people who ostensibly don't have a choice but to work low paid jobs, go home to extended families, etc etc

None of that changes the objective risk profile.

No one I know has contacted coronavirus. Literally no one. And I'd know, because every time I go to a coffee shop or restaurant or bar we have to write our names and phone numbers down for contact tracing purposes and I've not been called.

By the way if I go on a date with a woman who works in a person-facing role (e.g. doctor, teacher) I either don't make direct physical contact with her or I ask if she's been tested first. I will be frank, not because I care much about the virus (I still don't believe it is likely to cause anything more than mild symptoms in me), but because I know that if I develop any symptoms afterwards then it's going to be embarrassing doing all the contact tracing, plus I have to lock myself down for 2 weeks and that's no fun. So hey, I am using some form of protection. A lot more than those quarantine workers did.
« Last Edit: July 07, 2020, 05:52:30 PM by Bloop Bloop »

Bloop Bloop

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Re: How long can we wait while flattening the curve?
« Reply #2915 on: July 07, 2020, 05:46:57 PM »
NY Times: Sweden Has Become the World’s Cautionary Tale

still a work in progress. the virus isn't done. there is no vaccine yet. it's too early to say what has worked and what hasn't.

my personal belief, right or wrong, is that herd immunity is possible; that a vaccine is far far from guaranteed; that there is a legitimate chance that countries/states that have opened back up for business might actually fare better in the long haul; and that countries that have "beat" the virus (australia, s. korea, NZ, china) will only beat the virus if a vaccine is developed --- otherwise, they are playing a very long game of open up and then shut down OR locking out international travel indefinitely.

The entire point was to keep the economy open and humming along, and yet Sweden is getting hit economically just as much as everywhere else, just with a higher death toll.  Sweden's approach has failed, even Sweden admits that. 

It's almost like rational, reasonable people don't want to die and don't want their loved ones to die and are taking precautions themselves which are detrimental to the ever expanding economy.

Let's give it a bit more time before we jump to any conclusions. It's only been a few months. And there may yet be hidden positives/negatives that are yet to be analysed.

Mr. Green

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Re: How long can we wait while flattening the curve?
« Reply #2916 on: July 07, 2020, 07:24:55 PM »
Just watched an interesting interview of an infectious disease doctor in Florida, Dr. Aileen Marty, and she reported that they are finding lung damage, scar tissue, in asymptomatic people. She says 67% of people they look at have lung damage appearing on x-rays. Apparently this has been reported on around the world previously and I missed it.

Lung damage greatly increases the risk of complications from influenza. So COVID may be priming lots of folks for flu deaths later this year. Might be a good time to start getting a flu shot.

Beyond that, what other unseen damage may still be occurring in asymptomatic people that will only come to light years from now when they get ill and find damage to their bodies.

I can't help but think of the scene in the movie Contact where Jodie Foster is being handed the capsule to bite down and kill herself. She's incredulous, saying she wasn't going to travel billions of light years just to commit suicide. The man's response is, "It's for all the reasons we can't think of that we're giving you this."

Likewise, it's for all the reasons we don't yet know that you should do your damnedest not to get COVID-19.
« Last Edit: July 07, 2020, 07:33:39 PM by Mr. Green »

scottish

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Re: How long can we wait while flattening the curve?
« Reply #2917 on: July 07, 2020, 07:27:54 PM »
Why Sweden is still not asking people to wear face masks

Quote
But the official advice from the Swedish Public Health Agency remains: "Face masks aren't needed in normal situations in society, where it's better to keep distance from other people and be careful to wash hands." The agency has issued instructions for owners of restaurants, bars and shops on how they should ensure social distancing takes place, and some restaurants have been forced to close temporarily for violating these laws.

Sweden's an interesting case.   I'm glad to see there are a few countries that are trying different approaches.

First, the Swedish government didn't have the legal authority to impose a lockdown.   How do you like that?  A socialist country like Sweden has more constraints on it's government than a capitalist country like the US.   https://www.foreigner.fi/articulo/coronavirus/the-legal-reason-why-sweden-could-not-impose-lockdown/20200426195308005498.html

Second, the Swedish government stayed on message for the whole pandemic.   They aren't making a big deal over masks because the evidence is weak and they don't want to change the message.    The WHO itself says masks are about the message as much as about the science.    Linky from up above:   https://www.thelocal.se/20200608/why-isnt-sweden-asking-people-to-wear-face-masks

Quote
The [WHO] organisation stated that "governments should encourage the general public to wear masks in specific situations and settings as part of a comprehensive approach". It advised governments to weigh up factors including availability of masks, risk of exposure to the virus, and the setting. Some of the benefits listed were to reduce asymptomatic transmission, reduce stigmatisation of those wearing masks, and helping people to feel they were playing a role in stopping the infection.

Third, today Sweden had 57 new cases of COVID-19, while the US reported over 55,000.      Sweden is #7 in deaths per capita, with the US catching up rapidly.  It's disingenuous at best for the NYT to write an article criticizing Sweden's approach.

Finally, as many people have pointed out, it ain't over until it's over.    We'll see how Sweden makes out compared to everybody else in another year or two.

Kyle Schuant

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Re: How long can we wait while flattening the curve?
« Reply #2918 on: July 07, 2020, 07:39:35 PM »
At this point I can't believe anyone is taking Bloop Bloop seriously and still engaging with him.
I disagree with Bloop on essentially every political topic you can come up with. I largely agree with him on this. The spreading of this disease like other things follows the 80/20 rule. In a study back in April in Victoria, 9% of the people caused 91% of the infections - there was one guy working at three different hospitality venues who spread it to 75 people. In an international study, 70% of those infected themselves infected no-one at all.


Some people, by virtue of their lifestyle or career, are likely to be superspreaders of a disease, and others are not. Any sensible strategy has to address the high-risk individuals. For example, in dealing with sexually-transmitted diseases, clinicians focus on getting contraception to sex workers and single people 15-25yo. Your 50yo married person will generally not spread it to as many people as a 20yo single might. A sensible and sustainable strategy has to focus on the small number of people who will cause the largest number of infections.


What I heard him say was that Sweden's strategy, in contrast to countries that did complete lockdowns, was meant to be sustainable, indefinitely, if necessary.
An important consideration which is largely ignored in many countries.


The evidence is that there may be some aerosol transmission, the occasional dirty handrail and so on, but the vast bulk of infections come from,


- people in each-other's faces for sustained periods of time, and/or shouting/singing, with enclosed spaces improving the odds, and
- sharing food and drink


so those activities have to be minimised and/or monitored, whether voluntarily or by law.


Now, to what degree they should be reduced or banned, and for how long, that's up to argument. But I'd point again a couple of things. In the military there's a concept called "target fixation", where someone gets so focused on dealing with one target they fail to notice other threats. You're desperately trying to shoot down one plane and another one pops up from behind and takes you out. This can happen in public affairs, too.


Many things kill people, and the attention given them is not in proportion to the number of deaths. For example, firearms control advocates talk a lot about firearms homicides, but not much about firearms suicides - of which there are in most countries a much greater number. Unfortunately you can't focus on everything (that's pretty much the definition of "focus"), so something or someone will always be neglected. Such is life - and death.


Now in the US it's different, but Bloop is speaking from Australia. We had bushfires this year which killed about 100 people directly - but then just quietly a few months later it turns out that another 500 or so far away from the fires died of smoke-related stuff, mostly people like severe asthmatics, etc. So the true toll was 600 or so, not 100.


Likewise with covid and the lockdown. We've had about 100 deaths from covid. But the lockdown? Well, we're running at about 20% less road deaths, which if kept up for 12 months would be 240 people, great! And there are some less cardiac deaths - heart attacks go down during a recession as people are less stressed from work and commuting. So that's good.


But there are a lot more cancer deaths as the medical system discouraged people from getting ordinary checkups and followups. And one recent report was an extra 800 people had died from things like diabetes and dementia. Now, some have dismissed that as "well, they were going to die soon anyway" - but the same is said of covid deaths. I don't agree with it, but if you do, then you have to have consistent standards - you can't dismiss sickly elderly deaths from the lockdown but be worried about sickly elderly deaths from covid, or vice versa. Me, I worry about them both.


And of course, recessions see a rise in suicide and unintentional overdoses. Normally for each 1% rise in unemployment you get 1% more suicides and 3% more unintentional overdoses. However many thousands of these your country has, well you can do the arithmetic. Obviously even if you have no lockdowns the virus causes a recession so that might seem like it'll even out, we're no worse off. But right now the lockdown here means that we can't have any visitors at all, including from family. Normally during a recession people can lean on friends and family a bit. But now? They'll be alone.


My oldest is a paramedic. She's seeing a lot less road accidents, though a growing proportion pedestrians (as more people are out on foot as allowable excursions), but a lot more suicides, unintentional overdoses, and mental health episodes. There are people locked up with abusive spouses. Happy marriages turning mediocre, and mediocre marriages turning bad and breaking up - but they can't split right now, so they stay in the same house, and this is how we get domestic violence.


So the lockdown has a cost in lives and suffering, too. As I've said many times before, the Trolley Problem is illustrative - there's a runaway tram, 5 people on one track and 1 person on the other, you can change the track of the tram but can't stop it, do you let 1 person die or 5 people? That's a difficult decision, though clear enough. Politics is a giant Trolley Problem where you're dealing with thousands of lives. But you can't always see it's 5 or 1, the people are hidden in a fog so you just judge by the screaming. You can't know for sure the outcome until the tram passes, you make your way through the fog and count the bodies. It's a difficult business even for the mythical entirely benevolent and unselfish politician.


Right now, the covid victims are screaming very, very loudly through the fog. The suicides, the unintentional overdoses, the cancer patients, the domestic violence victims and broken marriages, these aren't making such a big noise.


Unfortunately our governments seem to have only two possible states: apathy and panic. I would suggest that between the apathy of the US response and the panic of the response of our state leaders here in Victoria, there is a vast middle ground of options and approaches. We're not politicians, we don't have to be apathetic, nor do we have to panic.

Bloop Bloop

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Re: How long can we wait while flattening the curve?
« Reply #2919 on: July 07, 2020, 08:42:48 PM »
Kyle, you and I have brought up the trolley problem a few times and invited people to lay on the line the QALY figures (I remember seeing a stat that the average life years lost per CV victim is about 13) but it seems that few like doing it. But just because something is unpalatable doesn't mean it shouldn't be done. You have to reduce people to statistics when it comes to matters of public health.

I understand some people are focussing on the long-term repercussions in covid cases that do not end in death. In the same vein, though, economic damage that does not (e.g.) lead to suicide or outright job loss can still end up in attenuation of one's working life or happiness. It's a pretty complicated matrix, to be sure.

Infections, like car accidents, like almost all bad outcomes in life, follow a power rule. You have to concentrate on the greatest vectors and try to quash them. That's why our government (correctly) moved pretty quickly to try to contain the outbreaks in the public housing towers and the northwest suburbs generally. The housing towers have been really well contained, it seems. The main mistakes made, with the benefit of hindsight, were in relation to the abattoir, the religious school and the quarantine hotel.

Abe

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Re: How long can we wait while flattening the curve?
« Reply #2920 on: July 07, 2020, 10:38:29 PM »
I’m interested on hearing everyone’s opinion on how to handle the situation in Texas. Hospitals are at or above standard  ICU capacity, and ~5% of current hospital capacity is being used up each day with net new COVID admissions (Houston has about 5 days worth of buffer before all hospital beds are occupied), so hard decisions are coming fast. However deaths have not been nearly as bad as in NYC/NJ with similar cases, suggesting the more vulnerable are somewhat spared.

- total lockdown of all non-essential businesses?
- lockdown of in-person business interactions?
- mask order in public?
- business as usual

Here in SoCal we’re going up and up with hospitalizations. So far not nearing capacity for regular beds, but pushing close for ICU. There’s minimal discussion about what to do and it seems everyone doesn’t care anymore. I only have a month left of duty to serve in the hospital, and am confident that my exposure risk is relatively low with an N95 despite multiple patients with COVID, so am also less personally invested in what happens. It is frustrating that few outside of the health professions cares anymore in this county.  We will just learn the hard way.

« Last Edit: July 07, 2020, 10:49:07 PM by Abe »

HBFIRE

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Re: How long can we wait while flattening the curve?
« Reply #2921 on: July 07, 2020, 10:57:11 PM »

Here in SoCal we’re going up and up with hospitalizations. So far not nearing capacity for regular beds, but pushing close for ICU. There’s minimal discussion about what to do and it seems everyone doesn’t care anymore. I only have a month left of duty to serve in the hospital, and am confident that my exposure risk is relatively low with an N95 despite multiple patients with COVID, so am also less personally invested in what happens. It is frustrating that few outside of the health professions cares anymore in this county.  We will just learn the hard way.

My friend who is also a physician here in OC just sent me this:  "The death count is going to start going up. The only question is what ultimately the death rate will be. I think we are doing a better job now in screening before sending back to nursing homes and performing infection control in nursing homes. I also know we are doing a better job treating covid19 patients in the hospital. Keeping them prone and avoiding vents as much as possible, using steroids, using Remdesivir, aggressively,anti-coagulating, etc."

lost_in_the_endless_aisle

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Re: How long can we wait while flattening the curve?
« Reply #2922 on: July 07, 2020, 10:59:52 PM »
I’m interested on hearing everyone’s opinion on how to handle the situation in Texas and Arizona. Hospitals are near ICU capacity, and ~5% of current hospital capacity is being used up each day with net new COVID admissions, so hard decisions are coming. However deaths have not been nearly as bad as in NYC/NJ with similar cases, suggesting the more vulnerable are somewhat spared.

- total lockdown of all non-essential businesses?
- lockdown of in-person business interactions?
- mask order in public?
- business as usual
Global lockdowns are far more expensive economically than they are worth in terms of results, especially considering the long-term impacts (outside of areas where social control is tight enough to ensure eradication of all disease, e.g. high-trust islands, totalitarian states, or otherwise easily isolated states. Only highest risk activities should be restricted (large indoor events where there is lots of talking, etc.).
Masks are of uncertain value but are certainly net-positive and there are good logical arguments they should be at least moderately effective in reducing spread in indoor environments where distancing is not feasible. Mandatory use & enforcement indoors makes sense. Otherwise, business as usual. IFR is probably much lower than initially feared in almost all age groups (<=6x a bad flu) and complications (though uncertain in severity and duration in spite of some alarmist anecdotal reports) are probably not particularly bad, though there are some early indications to the contrary that should be monitored. Therapeutic interventions are improving steadily for severe cases as well. Regional outbreaks will test hospital capacity but ad-hoc surge capacity should generally accommodate increases in case loads. Covid should be considered more of a wake-up call than a complete disaster.

Abe

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Re: How long can we wait while flattening the curve?
« Reply #2923 on: July 07, 2020, 11:06:16 PM »
Ok but how’ll we find ad-hoc nurses and physicians? Do we accept poorer than standard care for everyone (it wouldn’t be equitable to decrease staffing ratios for covid patients alone)? Or we’ll just expect them to be pushed to the edge while the rest of society does what it wants? Those are questions we need to answer, and soon.

With all due respect, if we were getting better at treating and/or preventing this, our ICU numbers would be stable to decreasing despite increased cases, not also increasing. Does your friend work in an inpatient setting? Maybe their hospital is getting less of the cases.
« Last Edit: July 07, 2020, 11:13:08 PM by Abe »

HBFIRE

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Re: How long can we wait while flattening the curve?
« Reply #2924 on: July 07, 2020, 11:19:24 PM »

With all due respect, if we were getting better at treating and/or preventing this, our ICU numbers would be stable to decreasing despite increased cases, not also increasing. Does your friend work in an inpatient setting? Maybe their hospital is getting less of the cases.

Was just passing along his thoughts.  Here is the data here in OC I was looking at earlier.  From this data, at least, it looks like ICU capacity is relatively flat despite increased hospitalizations.  Is this accurate?  Though I guess the important metric to watch is covid+ICU.

« Last Edit: July 07, 2020, 11:21:54 PM by HBFIRE »

Abe

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Re: How long can we wait while flattening the curve?
« Reply #2925 on: July 07, 2020, 11:27:19 PM »
The capacity is flat because we are not doing operations that normally require ICU care, and admissions from the ERs are down. We’re also trying to avoid putting patients in the ICU unless absolutely necessary. Absolute numbers of ICU covid patients are going up as noted in the table. Not an ideal situation. Right now we’re ok, but there’s no good plan on what to do when those remaining beds are taken up. At current rates that will be in about 3 weeks. Hopefully things will level off?

Other issue is that LTACs are full, so even if we get someone stabilized on a trach and they need 2-3 weeks to get Off the vent, there’s nowhere for them to go. They stay in the ICU. This is common for pneumonia patients, especially those with ARDS. Our hospital has a fair number of people who recovered otherwise, but are vent or high flow nasal cannula dependent, but can’t be discharged anywhere.


And again I’m not advocating for major shutdowns, but people are not even trying (at least in my area of the county). Few masks to be seen outside of the hospital and clinics. No distancing in stores or restaurants (Weak substitute for masks). Having huge birthdays in parks.
« Last Edit: July 07, 2020, 11:35:25 PM by Abe »

lemanfan

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Re: How long can we wait while flattening the curve?
« Reply #2926 on: July 07, 2020, 11:47:00 PM »
but a lot more suicides, unintentional overdoses, and mental health episodes. There are people locked up with abusive spouses. Happy marriages turning mediocre, and mediocre marriages turning bad and breaking up - but they can't split right now, so they stay in the same house, and this is how we get domestic violence.

In my part of Sweden, the regional authorities just this week sent out a pamphlet to all households with contact information to support numbers for people stuck at home.  A little about generic suicide hotlines, but the majority was to social services (including the equivalent of child protection services in some other places) and women shelters and numbers for kids to call when abused.  I can't remember seeing that before.

HBFIRE

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Re: How long can we wait while flattening the curve?
« Reply #2927 on: July 07, 2020, 11:56:40 PM »
And again I’m not advocating for major shutdowns, but people are not even trying (at least in my area of the county). Few masks to be seen outside of the hospital and clinics. No distancing in stores or restaurants (Weak substitute for masks). Having huge birthdays in parks.

Agree, HB is a shit fest when it comes to this.  We have a pretty dense population of extreme right wingers that are anti-mask, etc.  And unfortunately, our beach attracts a lot of people during the summer. 

Michael in ABQ

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Re: How long can we wait while flattening the curve?
« Reply #2928 on: July 08, 2020, 12:56:38 AM »
Just watched an interesting interview of an infectious disease doctor in Florida, Dr. Aileen Marty, and she reported that they are finding lung damage, scar tissue, in asymptomatic people. She says 67% of people they look at have lung damage appearing on x-rays. Apparently this has been reported on around the world previously and I missed it.

Lung damage greatly increases the risk of complications from influenza. So COVID may be priming lots of folks for flu deaths later this year. Might be a good time to start getting a flu shot.

Beyond that, what other unseen damage may still be occurring in asymptomatic people that will only come to light years from now when they get ill and find damage to their bodies.

I can't help but think of the scene in the movie Contact where Jodie Foster is being handed the capsule to bite down and kill herself. She's incredulous, saying she wasn't going to travel billions of light years just to commit suicide. The man's response is, "It's for all the reasons we can't think of that we're giving you this."

Likewise, it's for all the reasons we don't yet know that you should do your damnedest not to get COVID-19.

Have there been any controlled studies of examining lungs of people who are known to never have been exposed to COVID-19? I say this because I've had some medical imaging over the years that have found various things that ultimately didn't affect me. I.e. I have some breakdown of spinal discs in my lower back. Is that from almost 20 years in the military carrying a rucksack and/or body armor on long marches, or is it just natural degradation that would be seen in 10, 20, 30% of people my age? We are doing far more medical imaging now that even a decade or two ago - and it's not an exact science, especially when it comes to things like identifying cancer. You have a human interpreting an image, not a clear test where the level of something is above/below a certain amount like with blood tests.

I know it takes a while to conduct and publish medical/scientific studies but hopefully it turns out that the long-term damage from things like lung/kidney damage or loss of smell, are not widespread. I'm in my mid 30's and personally not worried about dying from COVID-19. But the idea of never even feeling sick or getting a mild case that causes something like a permanent loss of smell is pretty scary.

AnnaGrowsAMustache

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Re: How long can we wait while flattening the curve?
« Reply #2929 on: July 08, 2020, 01:02:27 AM »
Just watched an interesting interview of an infectious disease doctor in Florida, Dr. Aileen Marty, and she reported that they are finding lung damage, scar tissue, in asymptomatic people. She says 67% of people they look at have lung damage appearing on x-rays. Apparently this has been reported on around the world previously and I missed it.

Lung damage greatly increases the risk of complications from influenza. So COVID may be priming lots of folks for flu deaths later this year. Might be a good time to start getting a flu shot.

Beyond that, what other unseen damage may still be occurring in asymptomatic people that will only come to light years from now when they get ill and find damage to their bodies.

I can't help but think of the scene in the movie Contact where Jodie Foster is being handed the capsule to bite down and kill herself. She's incredulous, saying she wasn't going to travel billions of light years just to commit suicide. The man's response is, "It's for all the reasons we can't think of that we're giving you this."

Likewise, it's for all the reasons we don't yet know that you should do your damnedest not to get COVID-19.

Have there been any controlled studies of examining lungs of people who are known to never have been exposed to COVID-19? I say this because I've had some medical imaging over the years that have found various things that ultimately didn't affect me. I.e. I have some breakdown of spinal discs in my lower back. Is that from almost 20 years in the military carrying a rucksack and/or body armor on long marches, or is it just natural degradation that would be seen in 10, 20, 30% of people my age? We are doing far more medical imaging now that even a decade or two ago - and it's not an exact science, especially when it comes to things like identifying cancer. You have a human interpreting an image, not a clear test where the level of something is above/below a certain amount like with blood tests.

I know it takes a while to conduct and publish medical/scientific studies but hopefully it turns out that the long-term damage from things like lung/kidney damage or loss of smell, are not widespread. I'm in my mid 30's and personally not worried about dying from COVID-19. But the idea of never even feeling sick or getting a mild case that causes something like a permanent loss of smell is pretty scary.

Some degree of spinal degeneration is normal with aging (even by mid thirties) and wouldn't impact you, although it would be noted by a radiologist. I think you can assume that if medical folk are talking about long term damage, there's long term damage. Covid isn't a million miles from SARS, and there's certainly widespread and longterm damage for SARS patients. I think I would count myself goddamn lucky if I got covid and only came away with a permanent loss of smell.

OtherJen

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Re: How long can we wait while flattening the curve?
« Reply #2930 on: July 08, 2020, 04:37:36 AM »
Ok but how’ll we find ad-hoc nurses and physicians? Do we accept poorer than standard care for everyone (it wouldn’t be equitable to decrease staffing ratios for covid patients alone)? Or we’ll just expect them to be pushed to the edge while the rest of society does what it wants? Those are questions we need to answer, and soon.

With all due respect, if we were getting better at treating and/or preventing this, our ICU numbers would be stable to decreasing despite increased cases, not also increasing. Does your friend work in an inpatient setting? Maybe their hospital is getting less of the cases.

Excellent questions. Critical care med and pulmonary med are specialties. A generalist or specialist in another subfield would require training to provide that care competently.

Paper Chaser

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Re: How long can we wait while flattening the curve?
« Reply #2931 on: July 08, 2020, 05:22:32 AM »
For those concerned about long term health impacts, perhaps it's helpful to consider the long term effects of SARS when trying to predict the long term effects of COVID? Here's a 15 year follow up study on the largest group of SARS patients:

https://www.nature.com/articles/s41413-020-0084-5#Tab2

38% of the sample (27 of 71 patients) had some visible lung damage. In general, any lung damage decreased (particularly in the first couple of years) for most in the sample:



Not sure how this compares to the lungs of a non-SARS patient over the same 15 year period, or somebody with lung damage from another respiratory virus like pneumonia after 15 years.



In some cases, bone damage was caused by steroids during treatment ****(may not be relevant if heavy steroid use isn't part of COVID treatment), and that also generally decreased over time:


« Last Edit: July 08, 2020, 05:25:28 AM by Paper Chaser »

js82

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Re: How long can we wait while flattening the curve?
« Reply #2932 on: July 08, 2020, 05:47:18 AM »
Global lockdowns are far more expensive economically than they are worth in terms of results, especially considering the long-term impacts (outside of areas where social control is tight enough to ensure eradication of all disease, e.g. high-trust islands, totalitarian states, or otherwise easily isolated states. Only highest risk activities should be restricted (large indoor events where there is lots of talking, etc.).

Masks are of uncertain value but are certainly net-positive and there are good logical arguments they should be at least moderately effective in reducing spread in indoor environments where distancing is not feasible. Mandatory use & enforcement indoors makes sense. Otherwise, business as usual. IFR is probably much lower than initially feared in almost all age groups (<=6x a bad flu) and complications (though uncertain in severity and duration in spite of some alarmist anecdotal reports) are probably not particularly bad, though there are some early indications to the contrary that should be monitored. Therapeutic interventions are improving steadily for severe cases as well. Regional outbreaks will test hospital capacity but ad-hoc surge capacity should generally accommodate increases in case loads. Covid should be considered more of a wake-up call than a complete disaster.

Going to challenge/disagree with the part I bolded/italicized above.  While mask use is a no-brainer at this point(clearly more efficient/sustainable than the other options places have used to reduce transmission), I don't think you can say "business as usual" across the board.  One of the problems with the US response has been that we haven't been nuanced enough with respect to the needs of localities.  What's appropriate for NYC is too strict for much of Upstate New York; what's appropriate for rural Texas isn't sufficiently cautious for Houston, Dallas, or Austin.

As a general rule in the USA this has been run at the state instead of the local level, with the Blue states erring on the side of a response that is too strict for their more rural, less-dense areas, and the red states erring on the side of something that's far too loose for their denser urban areas.  While "mask use plus not doing blatantly stupid stuff" is probably enough for small towns/less-dense areas, it's not enough for some of our bigger cities.
« Last Edit: July 08, 2020, 05:50:00 AM by js82 »

Mr. Green

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Re: How long can we wait while flattening the curve?
« Reply #2933 on: July 08, 2020, 07:35:28 AM »
Just watched an interesting interview of an infectious disease doctor in Florida, Dr. Aileen Marty, and she reported that they are finding lung damage, scar tissue, in asymptomatic people. She says 67% of people they look at have lung damage appearing on x-rays. Apparently this has been reported on around the world previously and I missed it.

Lung damage greatly increases the risk of complications from influenza. So COVID may be priming lots of folks for flu deaths later this year. Might be a good time to start getting a flu shot.

Beyond that, what other unseen damage may still be occurring in asymptomatic people that will only come to light years from now when they get ill and find damage to their bodies.

I can't help but think of the scene in the movie Contact where Jodie Foster is being handed the capsule to bite down and kill herself. She's incredulous, saying she wasn't going to travel billions of light years just to commit suicide. The man's response is, "It's for all the reasons we can't think of that we're giving you this."

Likewise, it's for all the reasons we don't yet know that you should do your damnedest not to get COVID-19.

Have there been any controlled studies of examining lungs of people who are known to never have been exposed to COVID-19? I say this because I've had some medical imaging over the years that have found various things that ultimately didn't affect me. I.e. I have some breakdown of spinal discs in my lower back. Is that from almost 20 years in the military carrying a rucksack and/or body armor on long marches, or is it just natural degradation that would be seen in 10, 20, 30% of people my age? We are doing far more medical imaging now that even a decade or two ago - and it's not an exact science, especially when it comes to things like identifying cancer. You have a human interpreting an image, not a clear test where the level of something is above/below a certain amount like with blood tests.

I know it takes a while to conduct and publish medical/scientific studies but hopefully it turns out that the long-term damage from things like lung/kidney damage or loss of smell, are not widespread. I'm in my mid 30's and personally not worried about dying from COVID-19. But the idea of never even feeling sick or getting a mild case that causes something like a permanent loss of smell is pretty scary.

Some degree of spinal degeneration is normal with aging (even by mid thirties) and wouldn't impact you, although it would be noted by a radiologist. I think you can assume that if medical folk are talking about long term damage, there's long term damage. Covid isn't a million miles from SARS, and there's certainly widespread and longterm damage for SARS patients. I think I would count myself goddamn lucky if I got covid and only came away with a permanent loss of smell.
There is a growing chorus of medical professionals that believe the loss of smell is actually the result of neurological damage. If that is the case, then what other damage might be happening in the brain but possibly going unseen until people hit their 50s, 60s, 70s when brain function would normally start to decline.

GuitarStv

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Re: How long can we wait while flattening the curve?
« Reply #2934 on: July 08, 2020, 07:40:10 AM »
Global lockdowns are far more expensive economically than they are worth in terms of results, especially considering the long-term impacts (outside of areas where social control is tight enough to ensure eradication of all disease, e.g. high-trust islands, totalitarian states, or otherwise easily isolated states. Only highest risk activities should be restricted (large indoor events where there is lots of talking, etc.).

Masks are of uncertain value but are certainly net-positive and there are good logical arguments they should be at least moderately effective in reducing spread in indoor environments where distancing is not feasible. Mandatory use & enforcement indoors makes sense. Otherwise, business as usual. IFR is probably much lower than initially feared in almost all age groups (<=6x a bad flu) and complications (though uncertain in severity and duration in spite of some alarmist anecdotal reports) are probably not particularly bad, though there are some early indications to the contrary that should be monitored. Therapeutic interventions are improving steadily for severe cases as well. Regional outbreaks will test hospital capacity but ad-hoc surge capacity should generally accommodate increases in case loads. Covid should be considered more of a wake-up call than a complete disaster.

Going to challenge/disagree with the part I bolded/italicized above.  While mask use is a no-brainer at this point(clearly more efficient/sustainable than the other options places have used to reduce transmission), I don't think you can say "business as usual" across the board.  One of the problems with the US response has been that we haven't been nuanced enough with respect to the needs of localities.  What's appropriate for NYC is too strict for much of Upstate New York; what's appropriate for rural Texas isn't sufficiently cautious for Houston, Dallas, or Austin.

As a general rule in the USA this has been run at the state instead of the local level, with the Blue states erring on the side of a response that is too strict for their more rural, less-dense areas, and the red states erring on the side of something that's far too loose for their denser urban areas.  While "mask use plus not doing blatantly stupid stuff" is probably enough for small towns/less-dense areas, it's not enough for some of our bigger cities.

The issue you're seeing is directly related to the fact that there has been far too much left to whims of governors and individual cities, and no real planning/actions/recommendations taken by the federal government.  Everyone's on their own and most have been grasping at straws in the leadership vacuum.  There's no nuance because there has been no federal nationwide guidance of any kind - beyond outright lies like telling people that this is the same as the flu, causing runs on unproven drugs, and musings about injecting yourself with bleach.  Earlier on states were competing with each other to get protective equipment . . . all with the blessing and directly due to the actions of Donald J Trump.  A unified plan/approach for how to handle this disease (including different measures for areas with different population sizes and infection rates) would have really helped the US - exactly the kind of thing that the pandemic task force would have recommended and released to the public.

Until America gets less overtly stupid leadership at the top it's hard to see how the country will be able to handle the rest of the coronavirus crisis, or any other crisis in the future.  It's strange to see the US voluntarily weakening itself as badly as it has done.

snacky

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Re: How long can we wait while flattening the curve?
« Reply #2935 on: July 08, 2020, 07:58:15 AM »
Um... I'm sorry, have you not been advocating that people do what they want, basically, since the beginning of this pandemic??? And also that you're low risk etc etc. Well, people have done whatever they wanted, and now your area is screwed. But you're low risk, so no worries??? Enjoy your 6 week lockdown. When it ends, perhaps you could be one of the ones making better choices for the good of everyone.

Yeah, I am low risk. Let's compare me to a typical quarantine hotel worker who's responsible for one of the clusters

I live alone - He lives with a large extended family

I work from home - He works in a quarantine hotel/abattoir/whatever

I have no colleagues - He has lots of coworkers

I contact no one in close proximity - He contacts lots of people in close proximity

When I do see family, it's a gathering of 4 - When he sees family, it's a gathering of 10+ (see Daniel Andrews's run down of what people were doing wrong)

I don't live in the north/western suburbs where 90% of infections are - He does.

So...don't compare me to the people who screwed it up for everyone.

Bloop Bloop, you have privilege that those you say screwed it up for everyone don't. The people living in extended family groups and working hazardous high contact low wage jobs aren't generally doing that because they think it is fun. They are doing it because it is literally the best option available to survive and care for their loved ones.

You could make choices that would reduce your own risk and that of your community. You don't, and then vilify people who are doing the best they can under far more challenging circumstances.

I was just coming to say this. Thank you.

OtherJen

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Re: How long can we wait while flattening the curve?
« Reply #2936 on: July 08, 2020, 07:59:02 AM »
In states like mine, there’s also the issue of vacation homes. Many people in the more densely populated areas downstate have second homes in northern Michigan, where the permanent population density is much lower and the communities are already underserved by medical infrastructure. An influx of people escaping metro Detroit during the worst of the spring COVID wave could have quickly overloaded those rural medical centers and brought the disease to the locals in those areas, who didn’t have the option to bail. Hence the statewide shutdown.

Probably the Upper Peninsula didn’t need to shut down as hard, and that was the first area to have the mandates relaxed. The northern Lower Peninsula was less of a risk in early spring, but now it’s peak tourism season in the Traverse City and Mackinac straits regions. We may see more shutdowns as tourists bring illness with them.

habanero

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Re: How long can we wait while flattening the curve?
« Reply #2937 on: July 08, 2020, 08:25:03 AM »
Sweden's approach wasn't just to keep their economy going.  The chief epidemiologist (who still stands by the strategy) felt it was the best long term course of action rather than intermittent lockdowns.  It remains to be seen if this strategy is correct.   Judging it now is only done to serve confirmation bias of already held views.  The truth is, the experts aren't even certain what the best long term strategy is -- we're unfortunately all living in a worldwide experiment of various approaches.  Armchair keyboard premature hindsight journalism is irresponsible imo.

Sweden is a textbook example of "flattening the curve" - the holy grail for everyone at the start of this pandemic. Now a lot of countries, at least in Europe, have switched to a "suppress and keep down" approach wich - so far - seems to be working pretty well some places (Norway, for example) but less so other places which have seen a surge in cases, albeit pretty concentrated in various hotspots. Many countries have not even really gotten to the "reopening" phase and doesn't really know what will happen when they try that.

Sweden has never been out of ICU capacity. It has of course been a very challenging time for the healthcare system, but they have at any time had >20% spare ICU capacity. Makeshift ICU unit built in Stockholm was never used and is long since taken down if I recall correctly.

In the international press there is also this bizarre idea that Sweden has just been humming along like normal all the time which is very far from what has actually happened in Sweden. The main diifference is the lack of outright banning stuff, but if you see a press conference with the "Swedish CDC" they mention the importance of social distancing, staying home if you are sick etc probably 10 to 20 times. A lot of swedes work from home and utilization of public transport is way down, restaurants etc have reduced capacity and the list goes on and on. It's not like they haven't done anything to limit spreading and making sure the healthcare system can cope with patients needing treatment.

When this stuff got going there was a lot of talk about Sweden soon to experience the horrific scenes seen from northern Italy. There has been no such thing in Sweden and all main indicators (ICU admittance, deaths) are heading due south and has been from some time. There is an increase in reported cases in Sweden, but this is a result of much higher testing capacity and much wider testing (i.e. people with very mild sympthoms who were never tested in the beginning but are tested now).

This is the chart for daily new ICU admissions in Sweden - does this look like something which is about to be spiraling out of control? I think the US health officials would swap with Sweden any day if given the choice.





JGS1980

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Re: How long can we wait while flattening the curve?
« Reply #2938 on: July 08, 2020, 08:33:52 AM »
Sweden has had the same economic turmoil of neighboring Scandinavian countries such as Norway, Finland, Denmark while also having greatly increased morbidly and mortality. How can that be considered a win at this time?

Sweden has 559 deaths per million (7th in the world)
Denmark -105 dpm
Finland   -59 dpm
Norway  -46 dpm

Ultimately, only time will tell the full story. But right now, Sweden is losing.

habanero

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Re: How long can we wait while flattening the curve?
« Reply #2939 on: July 08, 2020, 08:48:58 AM »
Sweden has had the same economic turmoil of neighboring Scandinavian countries such as Norway, Finland, Denmark while also having greatly increased morbidly and mortality. How can that be considered a win at this time?

Sweden has 559 deaths per million (7th in the world)
Denmark -105 dpm
Finland   -59 dpm
Norway  -46 dpm

Ultimately, only time will tell the full story. But right now, Sweden is losing.

Yes, it appears so now. And even if you are aiming to win a war it doesn't hurt winning the first battle. But it's easy to forget that Sweden has actually managed what everyone wanted to do in the beginning - to flatten the curve and they have done so without enforcing any nation-wide lockdown which other countries were essentially forced to do and still got an overwhelmed health care system which Sweden never got.

Sweden's economy was also significantly weaker to start with due to several reasons and it is also significantly more export-oriented than the neigbouring countries. I have not seen the numbers from Sweden, but for Norway the estimates were that 1/3 of the decline was from reduced foreign demand while 2/3 was from reduced domestic demand. Im pretty certain the fraction is quite different for Sweden. Denmark for example has a large pharma industry which is very much alive and kicking these days.

The swedes probably hoped/expected more countries would take a similar approach. One of their early points was that if infections are roughly equal in countries travel bans and such make no sense, while what is happening in Scandinavia now is that travel is opening out but the Swedes are left out as the infection rate is much higher than in Norway or Denmark. I can pretty much freely travel to Denmark now (and vice versa) but I am strongly discouraged from going to Sweden and if I do I have to self-quarantine for 2 weeks upon returning home. There are some exceptions for people living/working across borders but the overall picture is that trave to sweden is a no-go. On the other hand there are regions in Sweden where infections are very low and you can visit without really interacting with the local community, but the rules are a one-size-fits-all approach which is hurting Swedish border regions particularily hard as they relay a lot on foreigners for the local business.

sui generis

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Re: How long can we wait while flattening the curve?
« Reply #2940 on: July 08, 2020, 09:08:33 AM »


Yes, it appears so now. And even if you are aiming to win a war it doesn't hurt winning the first battle. But it's easy to forget that Sweden has actually managed what everyone wanted to do in the beginning - to flatten the curve and they have done so without enforcing any nation-wide lockdown which other countries were essentially forced to do and still got an overwhelmed health care system which Sweden never got.

Did Sweden really manage to do what everyone wanted, though? Because you left out one part.  Did everyone really want a much higher death rate, in order to achieve a greater preservation of liberties/looser regulation, while also keeping their healthcare system under control (the latter of which many countries *did* achieve anyway)?  There's a tradeoff.  One that I know a lot of my fellow Americans would be super happy to have taken.  There are many Americans that would be happy to see 10 or 100x as many people die if they didn't have to have someone ask them to wear a mask when they went to Costco or to not be able to get their haircut and nails done for a few months.  But, not everyone wants that. And notwithstanding that statement about my fellow Americans, I'm not totally against the approach Sweden took.  As I said, it's a tradeoff.  But we musn't pretend they achieved what everyone was trying to achieve.  There are lots of people and places that still wouldn't make that decision and wouldn't find the tradeoff worth it.

I'm also curious for people that say to watch Sweden in the long-term, what kind of results one envisions happening that would change our valuation of how well their strategy worked?  Is there some way their death rate would come in line with others over time?  Seems unlikely to me, but I don't know.  Is there some thought their economy, which has not done better, would bounce back faster or some other metric by which we'd see they did the right thing?  If not, is it some more amorphous thing about them being happier in the long-term not having suffered the trauma of lock-down?  Or perhaps a lower suicide/domestic violence/etc. increase?  I'm honestly curious as I'm just not imaginative enough to know what may or could feasibly happen over the course of the next year that would show a hard departure in results between them and other countries. In a positive, as opposed to negative, direction as is currently the case, of course..

Wolfpack Mustachian

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Re: How long can we wait while flattening the curve?
« Reply #2941 on: July 08, 2020, 09:14:12 AM »


Yes, it appears so now. And even if you are aiming to win a war it doesn't hurt winning the first battle. But it's easy to forget that Sweden has actually managed what everyone wanted to do in the beginning - to flatten the curve and they have done so without enforcing any nation-wide lockdown which other countries were essentially forced to do and still got an overwhelmed health care system which Sweden never got.

Did Sweden really manage to do what everyone wanted, though? Because you left out one part.  Did everyone really want a much higher death rate, in order to achieve a greater preservation of liberties/looser regulation, while also keeping their healthcare system under control (the latter of which many countries *did* achieve anyway)?  There's a tradeoff.  One that I know a lot of my fellow Americans would be super happy to have taken.  There are many Americans that would be happy to see 10 or 100x as many people die if they didn't have to have someone ask them to wear a mask when they went to Costco or to not be able to get their haircut and nails done for a few months.  But, not everyone wants that. And notwithstanding that statement about my fellow Americans, I'm not totally against the approach Sweden took.  As I said, it's a tradeoff.  But we musn't pretend they achieved what everyone was trying to achieve.  There are lots of people and places that still wouldn't make that decision and wouldn't find the tradeoff worth it.

I'm also curious for people that say to watch Sweden in the long-term, what kind of results one envisions happening that would change our valuation of how well their strategy worked?  Is there some way their death rate would come in line with others over time?  Seems unlikely to me, but I don't know.  Is there some thought their economy, which has not done better, would bounce back faster or some other metric by which we'd see they did the right thing?  If not, is it some more amorphous thing about them being happier in the long-term not having suffered the trauma of lock-down?  Or perhaps a lower suicide/domestic violence/etc. increase?  I'm honestly curious as I'm just not imaginative enough to know what may or could feasibly happen over the course of the next year that would show a hard departure in results between them and other countries. In a positive, as opposed to negative, direction as is currently the case, of course..

I'd assumed the implication is that this will continue on for years but that Sweden will have better outcomes over the long haul, when others who have limited exposure now will end up still getting the exposure when Sweden's gotten through the worst of it. Just speculation.

slappy

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Re: How long can we wait while flattening the curve?
« Reply #2942 on: July 08, 2020, 09:18:28 AM »
At this point I can't believe anyone is taking Bloop Bloop seriously and still engaging with him.  If you don't have him on literal "ignore user" you should at least be mentally dismissing his posts when you see them.  He didn't have a clue several months ago, and still doesn't.

Is there an ignore user functionality on this forum?

sui generis

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Re: How long can we wait while flattening the curve?
« Reply #2943 on: July 08, 2020, 09:26:41 AM »


Yes, it appears so now. And even if you are aiming to win a war it doesn't hurt winning the first battle. But it's easy to forget that Sweden has actually managed what everyone wanted to do in the beginning - to flatten the curve and they have done so without enforcing any nation-wide lockdown which other countries were essentially forced to do and still got an overwhelmed health care system which Sweden never got.

Did Sweden really manage to do what everyone wanted, though? Because you left out one part.  Did everyone really want a much higher death rate, in order to achieve a greater preservation of liberties/looser regulation, while also keeping their healthcare system under control (the latter of which many countries *did* achieve anyway)?  There's a tradeoff.  One that I know a lot of my fellow Americans would be super happy to have taken.  There are many Americans that would be happy to see 10 or 100x as many people die if they didn't have to have someone ask them to wear a mask when they went to Costco or to not be able to get their haircut and nails done for a few months.  But, not everyone wants that. And notwithstanding that statement about my fellow Americans, I'm not totally against the approach Sweden took.  As I said, it's a tradeoff.  But we musn't pretend they achieved what everyone was trying to achieve.  There are lots of people and places that still wouldn't make that decision and wouldn't find the tradeoff worth it.

I'm also curious for people that say to watch Sweden in the long-term, what kind of results one envisions happening that would change our valuation of how well their strategy worked?  Is there some way their death rate would come in line with others over time?  Seems unlikely to me, but I don't know.  Is there some thought their economy, which has not done better, would bounce back faster or some other metric by which we'd see they did the right thing?  If not, is it some more amorphous thing about them being happier in the long-term not having suffered the trauma of lock-down?  Or perhaps a lower suicide/domestic violence/etc. increase?  I'm honestly curious as I'm just not imaginative enough to know what may or could feasibly happen over the course of the next year that would show a hard departure in results between them and other countries. In a positive, as opposed to negative, direction as is currently the case, of course..

I'd assumed the implication is that this will continue on for years but that Sweden will have better outcomes over the long haul, when others who have limited exposure now will end up still getting the exposure when Sweden's gotten through the worst of it. Just speculation.

Ah, right.  I recall now that I think they were partially banking on getting to herd immunity faster, and thus the idea is that other countries would catch up to their death rate eventually while their more vulnerable populations continued to suffer waiting for effective treatment and vaccines. 

From a callous perspective, it's good to have this experiment.  Since there are a lot of unknowns that each side of the experiment is counting on (is herd immunity a thing with this virus?  How long does immunity last? How fast will a vaccine or effective treatment be approved and how effectively will it be deployed?), I can imagine that some outcomes might after all look different in a year or more.  However, in those cases, I think it would be unfair to say that it was because one way was necessarily wiser or smarter.  More that they got lucky in counting on variables they couldn't and didn't know would turn out how they did.  A gamble that paid off and makes them look smart in retrospect.  But is not necessarily a lesson learned for the next pandemic or emergency in general.

And given that death rates seem to be decreasing among newly infected as compared to a few months ago (as has been discussed on this thread and may have several causes) it seems hard to believe the rest of the world would catch up with Sweden's death rate. But <shrug> I don't have anything other than gut instinct telling me that.

habanero

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Re: How long can we wait while flattening the curve?
« Reply #2944 on: July 08, 2020, 09:28:34 AM »
Did Sweden really manage to do what everyone wanted, though? Because you left out one part.  Did everyone really want a much higher death rate, in order to achieve a greater preservation of liberties/looser regulation, while also keeping their healthcare system under control (the latter of which many countries *did* achieve anyway)?  There's a tradeoff.  One that I know a lot of my fellow Americans would be super happy to have taken.  There are many Americans that would be happy to see 10 or 100x as many people die if they didn't have to have someone ask them to wear a mask when they went to Costco or to not be able to get their haircut and nails done for a few months.  But, not everyone wants that. And notwithstanding that statement about my fellow Americans, I'm not totally against the approach Sweden took.  As I said, it's a tradeoff.  But we musn't pretend they achieved what everyone was trying to achieve.  There are lots of people and places that still wouldn't make that decision and wouldn't find the tradeoff worth it.

I'm also curious for people that say to watch Sweden in the long-term, what kind of results one envisions happening that would change our valuation of how well their strategy worked?  Is there some way their death rate would come in line with others over time?  Seems unlikely to me, but I don't know.  Is there some thought their economy, which has not done better, would bounce back faster or some other metric by which we'd see they did the right thing?  If not, is it some more amorphous thing about them being happier in the long-term not having suffered the trauma of lock-down?  Or perhaps a lower suicide/domestic violence/etc. increase?  I'm honestly curious as I'm just not imaginative enough to know what may or could feasibly happen over the course of the next year that would show a hard departure in results between them and other countries. In a positive, as opposed to negative, direction as is currently the case, of course..

So far its not easy to see what Sweden has gained. Current restrictions are, in some ways, stricter in Sweden than in other Scandinavian countries for example.

In the early days effectively getting rid of infections was deemed impossible unless you approached draconican measures like in China and implemented a total control over the population and threw out all civil liberties. This has so far been proven wrong, when Norway gradually opened up the key indicators continued to drop and has now stabilized at a very, very low rate (as of now 8 people in hospital and 2 in ICU in the entire country and 5-20 new cases per day). It will be exiting to see if it holds during and after the holiday season and when people get more and more relax about social distancing, hygiene etc.

habanero

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Re: How long can we wait while flattening the curve?
« Reply #2945 on: July 08, 2020, 09:30:03 AM »

Ah, right.  I recall now that I think they were partially banking on getting to herd immunity faster, and thus the idea is that other countries would catch up to their death rate eventually while their more vulnerable populations continued to suffer waiting for effective treatment and vaccines. 

Herd immunity through infections has never been the Swedish strategy. But yes, they have assumed other countries would catch up eventually and end outcome would be pretty much the same regardless of approach.

sui generis

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Re: How long can we wait while flattening the curve?
« Reply #2946 on: July 08, 2020, 09:42:28 AM »

Ah, right.  I recall now that I think they were partially banking on getting to herd immunity faster, and thus the idea is that other countries would catch up to their death rate eventually while their more vulnerable populations continued to suffer waiting for effective treatment and vaccines. 

Herd immunity through infections has never been the Swedish strategy. But yes, they have assumed other countries would catch up eventually and end outcome would be pretty much the same regardless of approach.

Perhaps it's still too early in the morning for me, but are you implying they are trying to achieve herd immunity through something other than infections? 

Also, whether their strategy was "pure-herd immunity" or "herd immunity as byproduct"...it does seem that that is part, as I said, of their strategy:

Quote
A pure herd-immunity approach would simply let COVID-19 burn through the population unhindered, which is not the approach in Sweden, where large crowds are banned and people have been encouraged to practice social distancing. Rather, Tegnell, the head of the Public Health Agency of Sweden, has repeated ad nauseam that the strategy is to slow the spread while achieving herd immunity as a byproduct.
https://foreignpolicy.com/2020/06/23/sweden-coronavirus-failure-anders-tegnell-started-long-before-the-pandemic/

mm1970

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Re: How long can we wait while flattening the curve?
« Reply #2947 on: July 08, 2020, 09:50:34 AM »
And again I’m not advocating for major shutdowns, but people are not even trying (at least in my area of the county). Few masks to be seen outside of the hospital and clinics. No distancing in stores or restaurants (Weak substitute for masks). Having huge birthdays in parks.

Agree, HB is a shit fest when it comes to this.  We have a pretty dense population of extreme right wingers that are anti-mask, etc.  And unfortunately, our beach attracts a lot of people during the summer.
Yep.  We have a fair bit of this up here in Santa Barbara too, but it appears that people are maybe starting to try a bit more.  Closing our beaches on July 4 weekend helped.

I guess that I can understand the need to vacation and go places. I want to vacation and go places!  You can do it relatively safely even (one day's drive, take all your own food, rent a private cabin), but...jeez louise, CA is a hot mess.  It seems incredibly selfish and stupid to drive up to a cabin in the Sierras, or to go to Mammoth or whatever because you are tired of where you live.  The absolute worst in my area are the teachers.  They are the ones traveling the most often, probably because they do it every summer.  Our cases are up in this county, they are up all over SO Cal, should you really be traveling?

Parties...I was seeing big parties over weekends, esp 2nd weekend in June, right after graduation.  We went for a weekend hike about 45 min from home, in Los Padres.  There were HUGE parties all along the river.  It hasn't abated either.  I see birthday parties with no masks or distancing on Instagram.  These are parties with 30+ people.

Shane

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Re: How long can we wait while flattening the curve?
« Reply #2948 on: July 08, 2020, 10:16:35 AM »


Yes, it appears so now. And even if you are aiming to win a war it doesn't hurt winning the first battle. But it's easy to forget that Sweden has actually managed what everyone wanted to do in the beginning - to flatten the curve and they have done so without enforcing any nation-wide lockdown which other countries were essentially forced to do and still got an overwhelmed health care system which Sweden never got.

Did Sweden really manage to do what everyone wanted, though? Because you left out one part.  Did everyone really want a much higher death rate, in order to achieve a greater preservation of liberties/looser regulation, while also keeping their healthcare system under control (the latter of which many countries *did* achieve anyway)?  There's a tradeoff.  One that I know a lot of my fellow Americans would be super happy to have taken.  There are many Americans that would be happy to see 10 or 100x as many people die if they didn't have to have someone ask them to wear a mask when they went to Costco or to not be able to get their haircut and nails done for a few months.  But, not everyone wants that. And notwithstanding that statement about my fellow Americans, I'm not totally against the approach Sweden took.  As I said, it's a tradeoff.  But we musn't pretend they achieved what everyone was trying to achieve.  There are lots of people and places that still wouldn't make that decision and wouldn't find the tradeoff worth it.

I'm also curious for people that say to watch Sweden in the long-term, what kind of results one envisions happening that would change our valuation of how well their strategy worked?  Is there some way their death rate would come in line with others over time?  Seems unlikely to me, but I don't know.  Is there some thought their economy, which has not done better, would bounce back faster or some other metric by which we'd see they did the right thing?  If not, is it some more amorphous thing about them being happier in the long-term not having suffered the trauma of lock-down?  Or perhaps a lower suicide/domestic violence/etc. increase?  I'm honestly curious as I'm just not imaginative enough to know what may or could feasibly happen over the course of the next year that would show a hard departure in results between them and other countries. In a positive, as opposed to negative, direction as is currently the case, of course..

I'd assumed the implication is that this will continue on for years but that Sweden will have better outcomes over the long haul, when others who have limited exposure now will end up still getting the exposure when Sweden's gotten through the worst of it. Just speculation.

Countries that locked down hard initially have kept infections and death rates low, for now, but it's unlikely that any country can sustain a strict lockdown for long. Sweden's strategy has resulted in more lives lost initially, but their public health officials have stated that the voluntary social distancing measures they are using are sustainable for the longer term, indefinitely if necessary.

OtherJen

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Re: How long can we wait while flattening the curve?
« Reply #2949 on: July 08, 2020, 10:19:08 AM »


Yes, it appears so now. And even if you are aiming to win a war it doesn't hurt winning the first battle. But it's easy to forget that Sweden has actually managed what everyone wanted to do in the beginning - to flatten the curve and they have done so without enforcing any nation-wide lockdown which other countries were essentially forced to do and still got an overwhelmed health care system which Sweden never got.

Did Sweden really manage to do what everyone wanted, though? Because you left out one part.  Did everyone really want a much higher death rate, in order to achieve a greater preservation of liberties/looser regulation, while also keeping their healthcare system under control (the latter of which many countries *did* achieve anyway)?  There's a tradeoff.  One that I know a lot of my fellow Americans would be super happy to have taken.  There are many Americans that would be happy to see 10 or 100x as many people die if they didn't have to have someone ask them to wear a mask when they went to Costco or to not be able to get their haircut and nails done for a few months.  But, not everyone wants that. And notwithstanding that statement about my fellow Americans, I'm not totally against the approach Sweden took.  As I said, it's a tradeoff.  But we musn't pretend they achieved what everyone was trying to achieve.  There are lots of people and places that still wouldn't make that decision and wouldn't find the tradeoff worth it.

I'm also curious for people that say to watch Sweden in the long-term, what kind of results one envisions happening that would change our valuation of how well their strategy worked?  Is there some way their death rate would come in line with others over time?  Seems unlikely to me, but I don't know.  Is there some thought their economy, which has not done better, would bounce back faster or some other metric by which we'd see they did the right thing?  If not, is it some more amorphous thing about them being happier in the long-term not having suffered the trauma of lock-down?  Or perhaps a lower suicide/domestic violence/etc. increase?  I'm honestly curious as I'm just not imaginative enough to know what may or could feasibly happen over the course of the next year that would show a hard departure in results between them and other countries. In a positive, as opposed to negative, direction as is currently the case, of course..

I'd assumed the implication is that this will continue on for years but that Sweden will have better outcomes over the long haul, when others who have limited exposure now will end up still getting the exposure when Sweden's gotten through the worst of it. Just speculation.

Countries that locked down hard initially have kept infections and death rates low, for now, but it's unlikely that any country can sustain a strict lockdown for long. Sweden's strategy has resulted in more lives lost initially, but their public health officials have stated that the voluntary social distancing measures they are using are sustainable for the longer term, indefinitely if necessary.

Therein lies the difference between Swedish and US society.