Author Topic: How long can we wait while flattening the curve?  (Read 253695 times)

nereo

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Re: How long can we wait while flattening the curve?
« Reply #700 on: April 17, 2020, 11:02:38 AM »
An interesting comparison would be the expected number of deaths had social distancing protocols not been put into place ('business as usual' / open-economy) vs actual deaths under current circumstances vs typical (i.e. 'background') mortality under non-Covid circumstances.

I'm sure those will come in the years ahead - right now our underlying data is still evolving, and will be for some time.

frugalnacho

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Re: How long can we wait while flattening the curve?
« Reply #701 on: April 17, 2020, 11:11:56 AM »
Something people should be aware of is that case fatality rates aren't indicative of ultimate mortality since cases are probably under reported. Contemporary research suggests that actual mortality may be below 1.0% (still skewing heavily towards the elderly and immunocompromised).

This does not however, mean that COVID19 shouldn't be taken seriously. Daily deaths attributed to COVID19 are currently higher than heart disease; America's number one killer. There's still a lot of comorbidity to sift through, but we don't go from zero to 30,000 deaths in a little over a month for something that is no big deal.

The lock down is probably responsible for helping severely curb the spread in Texas and California. The two most populous states. If people were dying there like they are dying in Louisiana, total deaths would be 50% higher right now. What we are doing is working. Even in places that people claim aren't locking down like Sweden, universities have closed and people are being ask to work from home. It's also worth mentioning that Sweden's per capita deaths are currently above the US's. And even places reacting less harshly see benefits from their neighbors doing stricter lock downs. The entire United States, and probably the entire world, benefits from the fact that New York City is boarding 90% less passengers right now.

Maybe Sweden has the optimal approach though. I don't know. But even the countries that are "doing nothing" like Sweden are in fact, doing something and taking this very seriously. Nearly every country on the planet, as advised by their medical experts and economists, is taking this seriously.

If you think you've out thought the room on this, you're probably wrong.

And even places with lockdowns, like Michigan, are not fully locked down.  The governor issued a "safer at home" executive order that pretty much closed restaurants, bars, etc and all other non-essential business on March 23.  Business still went on like normal for many, many stores to the point they've been issuing fines and issuing clarifications to many stores that you are in fact non-essential so quit your bullshit and shut down.  They've had to rope off entire sections of stores because many businesses and people thought that if you could find a loophole to declare yourself essential, then EVERYTHING you do is essential.  Home depot is legitimately essential for some of the things they provide, but people were just going to the store to wander around just to break up the monotony of the quarantine, and people were buying clearly non-essential things like carpeting and furniture. 

Meanwhile with no official restrictions most of the population of Sweden is still following recommendations to social distance and and avoid unnecessary risk.  The official status of government mandates doesn't necessarily reflect the reality of the situation and it's a bit disingenuous to make the comparison between a place with official stay at home orders that are being partially ignored and a place like Sweden (no official stay at home orders, but people largely being sensible about it).  I'm not saying the lockdown orders don't affect people's behavior and have no effect, they clearly do, but it's not quite a binary 100% lockdown vs business as usual that some are presenting it as.


frugalnacho

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Re: How long can we wait while flattening the curve?
« Reply #702 on: April 17, 2020, 11:17:49 AM »
An interesting comparison would be the expected number of deaths had social distancing protocols not been put into place ('business as usual' / open-economy) vs actual deaths under current circumstances vs typical (i.e. 'background') mortality under non-Covid circumstances.

I'm sure those will come in the years ahead - right now our underlying data is still evolving, and will be for some time.


A lot of early predictions of the models were clearly bullshit, because they used the same mythical person that the 4% trinity study was based on.  They will withdraw 4% of their portfolio, never go back to work, never take social security, and basically never adapt no matter how dire the economic situation gets, just keep making withdraws as their stache gets decimated.  It's not realistic, almost no one would behave that way in real life.  I feel like the same is true of models that predicted 2M+ deaths in the USA.  The model only holds true if people robotically went about business as usual without adapting, but I have a hard time believing the vast majority of the population would continue with business as usual as the death toll kept climbing higher and higher, and I think we are already seeing people reacting of their own volition rather than because they are mandated.  Like who would would hit up a bar and go see a football game in a giant stadium with tens of thousands of other people as the death toll kept mounting ever higher?  It's completely unrealistic to think business could possibly continue "as usual" in the midst of this.

dandarc

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Re: How long can we wait while flattening the curve?
« Reply #703 on: April 17, 2020, 11:24:54 AM »
I would have had a really hard time staying away from the Final Four this year had MSU made it - just a 4-5 hour drive for me. Hard to say if that changes if things were a lot worse than they are as is.

Which is why they had to cancel these types of events nationwide. You might have had 10,000 or more people from the Lansing area alone in close quarters in a major city far away (Atlanta) for a weekend. Same thing for the other 3 schools that would have been involved. Plus all the alumni from all over the place that tend to show up for these sorts of events. Hard to see how the situation wouldn't be much worse in a lot of places had the event gone on as planned.

frugalnacho

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Re: How long can we wait while flattening the curve?
« Reply #704 on: April 17, 2020, 11:32:41 AM »
I would have had a really hard time staying away from the Final Four this year had MSU made it - just a 4-5 hour drive for me. Hard to say if that changes if things were a lot worse than they are as is.

Which is why they had to cancel these types of events nationwide. You might have had 10,000 or more people from the Lansing area alone in close quarters in a major city far away (Atlanta) for a weekend. Same thing for the other 3 schools that would have been involved. Plus all the alumni from all over the place that tend to show up for these sorts of events. Hard to see how the situation wouldn't be much worse in those cities had the event gone on as planned.

No doubt.  If Michigan didn't close restaurants I can guarantee a lot of people would still be going to out to eat and also going to the bars, I personally know a lot of them.  I however would not be, and probably a lot of other people would not as well.  I imagine the situation would be significantly worse than it currently is if there were no closures, but that would only force more and more people to take personal precautions.  I think it's pure fantasy that people think you can separate the virus from the economy, and that the economy could have somehow just stayed open with business as usual while millions of dead bodies piled up.  People are stupid, but they are rational as well.  The closures would have mostly happened anyway after enough people decided they want to stop spreading the disease and dying. 

nereo

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Re: How long can we wait while flattening the curve?
« Reply #705 on: April 17, 2020, 11:53:30 AM »

A lot of early predictions of the models were clearly bullshit, because they used the same mythical person that the 4% trinity study was based on.  They will withdraw 4% of their portfolio, never go back to work, never take social security, and basically never adapt no matter how dire the economic situation gets, just keep making withdraws as their stache gets decimated.  It's not realistic, almost no one would behave that way in real life.  I feel like the same is true of models that predicted 2M+ deaths in the USA.  The model only holds true if people robotically went about business as usual without adapting, but I have a hard time believing the vast majority of the population would continue with business as usual as the death toll kept climbing higher and higher, and I think we are already seeing people reacting of their own volition rather than because they are mandated.  Like who would would hit up a bar and go see a football game in a giant stadium with tens of thousands of other people as the death toll kept mounting ever higher?  It's completely unrealistic to think business could possibly continue "as usual" in the midst of this.

This applies to the economic costs as well.  An unsubstantiated premise of this thread is that the economic losses of keeping front-facing businesses closed is substantially higher than if we removed such policies now or never had them to begin with.  Even under present conditions (which has almost certainly reduced the spread and # of infected/dead) it seems certain to me that many people would not be going out-and-about "as usual".  There would be a crisis in confidence for many businesses that press people close together (bars, restaurants, sporting events) and people would be taking sick & bereavement leave in droves.  As we've seen, a number of large outbreaks have been traced back to specific large gatherings. 


frugalnacho

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Re: How long can we wait while flattening the curve?
« Reply #706 on: April 17, 2020, 12:01:14 PM »

A lot of early predictions of the models were clearly bullshit, because they used the same mythical person that the 4% trinity study was based on.  They will withdraw 4% of their portfolio, never go back to work, never take social security, and basically never adapt no matter how dire the economic situation gets, just keep making withdraws as their stache gets decimated.  It's not realistic, almost no one would behave that way in real life.  I feel like the same is true of models that predicted 2M+ deaths in the USA.  The model only holds true if people robotically went about business as usual without adapting, but I have a hard time believing the vast majority of the population would continue with business as usual as the death toll kept climbing higher and higher, and I think we are already seeing people reacting of their own volition rather than because they are mandated.  Like who would would hit up a bar and go see a football game in a giant stadium with tens of thousands of other people as the death toll kept mounting ever higher?  It's completely unrealistic to think business could possibly continue "as usual" in the midst of this.

This applies to the economic costs as well.  An unsubstantiated premise of this thread is that the economic losses of keeping front-facing businesses closed is substantially higher than if we removed such policies now or never had them to begin with.  Even under present conditions (which has almost certainly reduced the spread and # of infected/dead) it seems certain to me that many people would not be going out-and-about "as usual".  There would be a crisis in confidence for many businesses that press people close together (bars, restaurants, sporting events) and people would be taking sick & bereavement leave in droves.  As we've seen, a number of large outbreaks have been traced back to specific large gatherings.

Exactly.  I think it's naive to think the economic disruption is caused by the "lockdowns" and not the virus itself.  We have a major crisis on our hands regardless. 

nereo

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Re: How long can we wait while flattening the curve?
« Reply #707 on: April 17, 2020, 12:11:22 PM »
One question I've been pondering is the wrongful death lawsuits which will undoubtedly crop up in the months and years to come.

If I had a business like a bar I'd certainly be considering the legal liability of not putting some extensive (and expensive) anti-Covid measures in place, like severely limiting customers and disinfecting each table after ever customer.  Restaurants can go out of business with one cluster of food poisoning traced back to poor kitchen practices.  Imagine what would happen if a few people contracted covid at my establishment and someone died, and I wasn't keeping every table 6' apart.

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Re: How long can we wait while flattening the curve?
« Reply #708 on: April 17, 2020, 12:25:44 PM »
I think it will be near-impossible to know how someone caught COVID in the future if things open back up, and also it's on the responsibility of the customer to assume risks when they go out.

frugalnacho

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Re: How long can we wait while flattening the curve?
« Reply #709 on: April 17, 2020, 12:37:32 PM »
One question I've been pondering is the wrongful death lawsuits which will undoubtedly crop up in the months and years to come.

If I had a business like a bar I'd certainly be considering the legal liability of not putting some extensive (and expensive) anti-Covid measures in place, like severely limiting customers and disinfecting each table after ever customer.  Restaurants can go out of business with one cluster of food poisoning traced back to poor kitchen practices.  Imagine what would happen if a few people contracted covid at my establishment and someone died, and I wasn't keeping every table 6' apart.


nereo

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Re: How long can we wait while flattening the curve?
« Reply #710 on: April 17, 2020, 12:42:04 PM »
I think it will be near-impossible to know how someone caught COVID in the future if things open back up, and also it's on the responsibility of the customer to assume risks when they go out.

We've already traced a number of outbreaks back to specific events (e.g. the Milan Championship League game, a funeral in Georgia), and one of the areas where we've made the most progress is with community tracing.  With enough data it's not even that hard; if several people all come down to Covid, and each of them went to the same baseball game and sat in the same section but otherwise their lives don't overlap and they don't have close family members who are infected, it's a no-brainer.





dandarc

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Re: How long can we wait while flattening the curve?
« Reply #711 on: April 17, 2020, 12:54:11 PM »
To nereo's point - look at the map of confirmed cases in Georgia here:

https://dph.georgia.gov/covid-19-daily-status-report

You've got "Atlanta and surrounding area" which is to be expected, but then there's that blue county nowhere near Atlanta. That's the "Georgia funeral" being referenced - a county with under 100,000 people in it in rural Georgia is the #2 Covid-19 county in the whole state.

And their hospital did get overwhelmed - ICU full within 2 days of the first person showing up at the hospital, used what would normally be 6 months worth of supplies in a single week.

All from a couple of funerals that happened in the week before and the week of "we need to cancel everything right now". Wonder if the doctors in Albany Georgia wishes the physical distancing measures were in place a lot earlier?

bacchi

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Re: How long can we wait while flattening the curve?
« Reply #712 on: April 17, 2020, 01:00:46 PM »
Or the spring break chartered flight to Cabo. The company assured the students that it was safe. Over 25% came down with covid.

OtherJen

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Re: How long can we wait while flattening the curve?
« Reply #713 on: April 17, 2020, 01:21:24 PM »
There's a rural county (pop. ~24,665) in northern Lower Michigan that now has nearly 4 dozen confirmed cases (1.824/1000 residents) and 3 deaths. The initial outbreak was traced to dinner service at a restaurant in the county seat, where a presymptomatic superspreader who had just returned from overseas travel infected various other diners.

frugalnacho

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Re: How long can we wait while flattening the curve?
« Reply #714 on: April 17, 2020, 01:31:55 PM »
To nereo's point - look at the map of confirmed cases in Georgia here:

https://dph.georgia.gov/covid-19-daily-status-report

You've got "Atlanta and surrounding area" which is to be expected, but then there's that blue county nowhere near Atlanta. That's the "Georgia funeral" being referenced - a county with under 100,000 people in it in rural Georgia is the #2 Covid-19 county in the whole state.

And their hospital did get overwhelmed - ICU full within 2 days of the first person showing up at the hospital, used what would normally be 6 months worth of supplies in a single week.

All from a couple of funerals that happened in the week before and the week of "we need to cancel everything right now". Wonder if the doctors in Albany Georgia wishes the physical distancing measures were in place a lot earlier?

People are very resistant to not having funerals.  Our friend just had her dad die from covid-19.  They have been super strict about quarantine this entire time, they won't even go to the grocery store (they get it all delivered).  But they are breaking quarantine and dropping the kids off at a relatives house and having a funeral this weekend.  On the one hand I feel like you still need to maintain the quarantine, but on the other hand her dad died and that's rough.  I just hope they are smart about it and maintain social distancing for the funeral and keep it somewhat low key to at least try to mitigate the spread between everyone. 

GuitarStv

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Re: How long can we wait while flattening the curve?
« Reply #715 on: April 17, 2020, 01:35:07 PM »
To nereo's point - look at the map of confirmed cases in Georgia here:

https://dph.georgia.gov/covid-19-daily-status-report

You've got "Atlanta and surrounding area" which is to be expected, but then there's that blue county nowhere near Atlanta. That's the "Georgia funeral" being referenced - a county with under 100,000 people in it in rural Georgia is the #2 Covid-19 county in the whole state.

And their hospital did get overwhelmed - ICU full within 2 days of the first person showing up at the hospital, used what would normally be 6 months worth of supplies in a single week.

All from a couple of funerals that happened in the week before and the week of "we need to cancel everything right now". Wonder if the doctors in Albany Georgia wishes the physical distancing measures were in place a lot earlier?

People are very resistant to not having funerals.  Our friend just had her dad die from covid-19.  They have been super strict about quarantine this entire time, they won't even go to the grocery store (they get it all delivered).  But they are breaking quarantine and dropping the kids off at a relatives house and having a funeral this weekend.  On the one hand I feel like you still need to maintain the quarantine, but on the other hand her dad died and that's rough.  I just hope they are smart about it and maintain social distancing for the funeral and keep it somewhat low key to at least try to mitigate the spread between everyone.

Not around here they aren't.  At least from the two funerals I've passed while riding my bike around.  No distancing at all.

nereo

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Re: How long can we wait while flattening the curve?
« Reply #716 on: April 17, 2020, 01:43:56 PM »
There's human empathy and social norms.  Hard not to give a crying relative a hug or shake the hand of someone who's just lost their significant other.  I, personally, would feel like an ass standing 6'+ away, exuding the message "I feel bad for you, but not bad enough to risk MY health". 

I really hope I don't to do that.  With my extended family and their risk factors and locations, it's a definite possibility.

Luz

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Re: How long can we wait while flattening the curve?
« Reply #717 on: April 17, 2020, 01:45:48 PM »

A lot of early predictions of the models were clearly bullshit, because they used the same mythical person that the 4% trinity study was based on.  They will withdraw 4% of their portfolio, never go back to work, never take social security, and basically never adapt no matter how dire the economic situation gets, just keep making withdraws as their stache gets decimated.  It's not realistic, almost no one would behave that way in real life.  I feel like the same is true of models that predicted 2M+ deaths in the USA.  The model only holds true if people robotically went about business as usual without adapting, but I have a hard time believing the vast majority of the population would continue with business as usual as the death toll kept climbing higher and higher, and I think we are already seeing people reacting of their own volition rather than because they are mandated.  Like who would would hit up a bar and go see a football game in a giant stadium with tens of thousands of other people as the death toll kept mounting ever higher?  It's completely unrealistic to think business could possibly continue "as usual" in the midst of this.

This applies to the economic costs as well.  An unsubstantiated premise of this thread is that the economic losses of keeping front-facing businesses closed is substantially higher than if we removed such policies now or never had them to begin with.  Even under present conditions (which has almost certainly reduced the spread and # of infected/dead) it seems certain to me that many people would not be going out-and-about "as usual".  There would be a crisis in confidence for many businesses that press people close together (bars, restaurants, sporting events) and people would be taking sick & bereavement leave in droves.  As we've seen, a number of large outbreaks have been traced back to specific large gatherings.

I think this issue is wrongly seen as: we either sacrifice lives or collapse our economy. But there was a third way all along. We use testing, quarantine of the sick and contact tracing to "box in" the virus. I think one can be critical of lockdown measures enacted without robust containment measures. We've done so much more damage than was necessary (on both public health and economic fronts). It's not an either-or issue. It's having a smart (and honestly, quite basic and cost-effective) strategy to stay ahead of the virus.

dandarc

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Re: How long can we wait while flattening the curve?
« Reply #718 on: April 17, 2020, 01:57:12 PM »
First and 3rd things on your list are only starting to be available @Luz. Absent good data, it is impossible to "box it in".

Unemployment offices across the country are also facing this problem - almost no excess capacity to process claims in the normal times, and they're hit with a 20+ fold increase in the need for that service. So the money's been thrown at that problem, but it will be much longer to actually be able to scale that up to where the money can get to the people.

Or put another way, once you've let things get as far as we did in the US, you can't just jump to the dance without the hammer.

https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-the-dance-be9337092b56

hdatontodo

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Re: How long can we wait while flattening the curve?
« Reply #719 on: April 17, 2020, 02:07:19 PM »
There's human empathy and social norms.  Hard not to give a crying relative a hug or shake the hand of someone who's just lost their significant other.  I, personally, would feel like an ass standing 6'+ away, exuding the message "I feel bad for you, but not bad enough to risk MY health". 

I really hope I don't to do that.  With my extended family and their risk factors and locations, it's a definite possibility.

We had a 18 person funeral for my mother when the group limit in Maryland was 50 people. We stood apart from each other in church and at the cemetery, and skipped the hugging/touching. Not worth having to go to a 2nd funeral right after the first. After the pallbearers loaded the hearse, I squirt their hands.

frugalnacho

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Re: How long can we wait while flattening the curve?
« Reply #720 on: April 17, 2020, 02:11:19 PM »
There's human empathy and social norms.  Hard not to give a crying relative a hug or shake the hand of someone who's just lost their significant other.  I, personally, would feel like an ass standing 6'+ away, exuding the message "I feel bad for you, but not bad enough to risk MY health". 

I really hope I don't to do that.  With my extended family and their risk factors and locations, it's a definite possibility.

It's not really YOUR health though, it's everyone's health. If even one person is sick, and each person hugs each other person... well you've all read the news so you know what happens. I had this discussion with my wife last night as we discussed their funeral.  Is it too much of a risk to have a funeral for your own father? Probably not as long as you're smart about it.  But 60 people all crying and hugging up on each other in a hot spot is a very, very bad idea.  If you must hug maybe just limit it to very close family members.  I'd be completely fine with no hugs at a funeral, I don't even know 3/4 of the people at any funeral I attend, even when it's a close family member, so I'd have no problem social distancing from most of those people. 


A lot of early predictions of the models were clearly bullshit, because they used the same mythical person that the 4% trinity study was based on.  They will withdraw 4% of their portfolio, never go back to work, never take social security, and basically never adapt no matter how dire the economic situation gets, just keep making withdraws as their stache gets decimated.  It's not realistic, almost no one would behave that way in real life.  I feel like the same is true of models that predicted 2M+ deaths in the USA.  The model only holds true if people robotically went about business as usual without adapting, but I have a hard time believing the vast majority of the population would continue with business as usual as the death toll kept climbing higher and higher, and I think we are already seeing people reacting of their own volition rather than because they are mandated.  Like who would would hit up a bar and go see a football game in a giant stadium with tens of thousands of other people as the death toll kept mounting ever higher?  It's completely unrealistic to think business could possibly continue "as usual" in the midst of this.

This applies to the economic costs as well.  An unsubstantiated premise of this thread is that the economic losses of keeping front-facing businesses closed is substantially higher than if we removed such policies now or never had them to begin with.  Even under present conditions (which has almost certainly reduced the spread and # of infected/dead) it seems certain to me that many people would not be going out-and-about "as usual".  There would be a crisis in confidence for many businesses that press people close together (bars, restaurants, sporting events) and people would be taking sick & bereavement leave in droves.  As we've seen, a number of large outbreaks have been traced back to specific large gatherings.

I think this issue is wrongly seen as: we either sacrifice lives or collapse our economy. But there was a third way all along. We use testing, quarantine of the sick and contact tracing to "box in" the virus. I think one can be critical of lockdown measures enacted without robust containment measures. We've done so much more damage than was necessary (on both public health and economic fronts). It's not an either-or issue. It's having a smart (and honestly, quite basic and cost-effective) strategy to stay ahead of the virus.

As long as we are using fantasy thinking why not just wish the virus was eradicated altogether?  We don't have the ability to do that testing.  It's not even a possibility in most areas of the world at this point, even though it's been going on for months at this point.  Hell most sick people aren't even getting tested, there is no way we could be doing testing on a mass scale.  Maybe if they had prepared for this months ago, but they didn't so it's not even an option at this point. 

In detroit right now if you are really sick, and it's obviously coronavirus, and you can still technically breath they won't test you.  They will advise you to stay home and rest until you cannot breath, and only at that point should you go to the hospital, and they might test you.   

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robartsd

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Re: How long can we wait while flattening the curve?
« Reply #722 on: April 17, 2020, 02:33:39 PM »
People are very resistant to not having funerals.  Our friend just had her dad die from covid-19.  They have been super strict about quarantine this entire time, they won't even go to the grocery store (they get it all delivered).  But they are breaking quarantine and dropping the kids off at a relatives house and having a funeral this weekend.  On the one hand I feel like you still need to maintain the quarantine, but on the other hand her dad died and that's rough.  I just hope they are smart about it and maintain social distancing for the funeral and keep it somewhat low key to at least try to mitigate the spread between everyone.
I'm not at all concerned about my own health. Sure, catching COVID-19 might be extremely unpleasant, but very unlikely to be life threatening to myself or those in my household. It certainly could be life threatening to some of my loved ones. If one of them died as a confirmed COVID-19 case, I would certainly not let social distancing concerns prevent me from being there for those that they live with who would nearly certainly have already been exposed and would have a fairly high chance of being contagious. I would however follow up with increased social distancing from non family members (stock up on any supplies for my household BEFORE contact with the household with known COVID-19 exposure, strict stay at home protocol for two weeks afterward).

The harder question to answer is what would I do if a family member died during a quarantine period from something else? Would I maintain social distancing to prevent the possibility that I would be the asymptomatic carrier that exposes them? I don't think I can answer that question unless the situation comes up.

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Re: How long can we wait while flattening the curve?
« Reply #723 on: April 17, 2020, 03:13:25 PM »
Wow New Zealand, great for you! 11 deaths here is a drop in the bucket, unfortunately. For a population of nearly 5 million people, that is a great result.

Question, does NZ plan on having its borders closed to the rest of the world until this resolves?

So it's cool for New Zealand, but everyone in the US should remain on lockdown indefinitely?

My county of almost 1 million has been sitting at 3 deaths for the last 2 weeks.

Like I said, remove NYC and this whole thing looks ridiculous. But call me an idiot and "science denier." This board has become an echo chamber.
OK. Iíll bite. So youíre a science denier. 😁

I donít think the lockdowns stay around for much longer anyway. Itís that whole compliance thingy. Iím noticing more traffic and people out and about of late.

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Re: How long can we wait while flattening the curve?
« Reply #724 on: April 17, 2020, 03:55:25 PM »
Strangely - everyone I know is of the opinion that the lockdowns are out of proportion to the threat.

This forum is the only place I have interaction with that thinks otherwise.

RetiredAt63

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Re: How long can we wait while flattening the curve?
« Reply #725 on: April 17, 2020, 05:28:01 PM »
And the discussion from all the Americans above is why Canada is still keeping the borders shut except for essential traffic.  It is much harder for us to keep the country isolated than it is for New Zealand and Australia, but we are trying. 

FWIW, when I did my grocery shopping this week, most shoppers were wearing masks and almost everyone was really good at the 6' distancing.  The stores had things really well set up.  I'm a senior, so apparently I am disposable (/s)(my daughter would disagree), but given my family history I should have another 20-25 good years ahead of me.  I don't want to lose those years because someone else is not wearing a mask because it won't protect THEM.  OR keep a proper distance.  What about everyone around them?  There is a fine balance between the concerns of the individual and the concerns of the group - and Americans seem to trend too far towards the concerns of the individual.  From here it just looks plain self-centered and selfish.  Sorry/not sorry, and I know it isn't everyone.

And no, no Scandinavian ancestry, but I like their normal social distancing and hygge.


GuitarStv

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Re: How long can we wait while flattening the curve?
« Reply #726 on: April 17, 2020, 05:55:30 PM »
America has achieved some amazing things in their past, but the hyper individualist thing that has developed in recent history is not working well with the realities of living through a pandemic.

AnnaGrowsAMustache

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Re: How long can we wait while flattening the curve?
« Reply #727 on: April 17, 2020, 06:13:43 PM »
Its looking like we might have done it here in NZ. 4 weeks of Civil Obedience. Fairly tight lockdown largely complied with. New cases down to 8 today and all traceable to existing clusters I think. Our curve has collapsed.
And we are staying at this level of lockdown for at least a few more days with minimal protests.
There has been a lot of kindness and good humour, tempered with sadness at 11 deaths.
Thankfully we have a capable, sensible government and effective civil service.

Wow New Zealand, great for you! 11 deaths here is a drop in the bucket, unfortunately. For a population of nearly 5 million people, that is a great result.

Question, does NZ plan on having its borders closed to the rest of the world until this resolves?

We won't need to have closed borders for import/export, and we won't need to have closed tourism borders with the whole world. Just the mis-managed parts.

Abe

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Re: How long can we wait while flattening the curve?
« Reply #728 on: April 17, 2020, 06:20:25 PM »

I donít think the lockdowns stay around for much longer anyway. Itís that whole compliance thingy. Iím noticing more traffic and people out and about of late.

Yeah there are gradually more people on the road here in SoCal. We are seeing a slight uptick in deaths per day, but thatís expected and unrelated to the recent increase in activity. Will see what happens in 2-3 weeks. Itís be useful if someone can use cellphone aggregated data and compare to outcomes 2-3 weeks down the road in a given area.

simmias

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Re: How long can we wait while flattening the curve?
« Reply #729 on: April 17, 2020, 06:35:16 PM »
Strangely - everyone I know is of the opinion that the lockdowns are out of proportion to the threat.

This forum is the only place I have interaction with that thinks otherwise.

C'mon, man. You live in Greenville.

Vapour

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Re: How long can we wait while flattening the curve?
« Reply #730 on: April 17, 2020, 07:59:49 PM »
I think this issue is wrongly seen as: we either sacrifice lives or collapse our economy. But there was a third way all along. We use testing, quarantine of the sick and contact tracing to "box in" the virus.
Umm, I'm pretty sure this is exactly the plan for how to start opening things back up.  It's not like this is some new idea that no one's thought of.  The reason we had to shut everything down is because we were barely able to test anyone at all in the US when this virus started spreading.  So we got behind and basically the only option was to shut down or let this spread uncontrollably and overwhelm the healthcare system (and honestly destroy the economy anyway).  We shut down to try and limit the spread and buy time until we have the capability of doing sufficient testing and contract tracing.  And to buy time to prepare hospitals with more ICU beds, PPE, and ventilators in case we fail to contain the spread and start to strain the healthcare system.

I think one can be critical of lockdown measures enacted without robust containment measures. We've done so much more damage than was necessary (on both public health and economic fronts). It's not an either-or issue. It's having a smart (and honestly, quite basic and cost-effective) strategy to stay ahead of the virus.
What do you think we should have done instead of shut down then??  We literally could not enact the testing and contact tracing that you're proposing 6-8 weeks ago when this first started really spreading in the US.  We can't even do it today.  We're doing a lot more testing now, but in most places it seems like you can still only get a test if you're in the hospital with respiratory problems and a high fever.  If we can't widely deploy testing to everyone with symptoms and everyone who's come in contact with someone who tests positive, then we can't just open things back up and have it be fine.  I think the only way we could have avoided the damage to the economy and public health would have been to take this more seriously early in the year and put serious time/money/effort into developing fast, accurate, readily available tests and a comprehensive strategy for the nation BEFORE the virus started spreading here.  Once we failed to do that, I think a lockdown became the only real option until we get our shit figured out.

Luz

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Re: How long can we wait while flattening the curve?
« Reply #731 on: April 17, 2020, 08:59:20 PM »
First and 3rd things on your list are only starting to be available @Luz. Absent good data, it is impossible to "box it in".

Unemployment offices across the country are also facing this problem - almost no excess capacity to process claims in the normal times, and they're hit with a 20+ fold increase in the need for that service. So the money's been thrown at that problem, but it will be much longer to actually be able to scale that up to where the money can get to the people.

Or put another way, once you've let things get as far as we did in the US, you can't just jump to the dance without the hammer.

https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-the-dance-be9337092b56

But testing will give us this data! Not only that, but it's the only way to open things back up. We have to know what we're dealing with in order to effectively deal with it. I would argue, on the second bolded line about jumping to the dance without the hammer, that you'd be unwise to not go about the dance simultaneously with the hammer. Shutdowns with no mitigation strategy other than suppression alone are not an effective strategy. They might buy us time, but if we're not using that time to combat the virus via testing, tracing and isolation, we're back to where we started, with a lot of collateral damage. There's no good reason that one of the richest, most powerful and innovative countries in the world is unable to prioritize testing (it's not a capacity issue).

This is an older article, but still quite relevant: https://foreignpolicy.com/2020/03/23/coronavirus-pandemic-south-korea-italy-mass-testing-covid19-will-keep-spreading/

"Every outbreak starts and ends with a diagnostic test. The director-general of the World Health Organization, Tedros Adhanom Ghebreyesus, has made it clear that the ďbackboneĒ of every countryís public health response to this outbreak is testing, isolation, and contact tracingóand South Korea is showing how this model ultimately pays off in reducing spread, taking pressure off health services, and keeping its death rate one of the lowest in the world."

Also: https://www.businessinsider.com/south-koreas-coronavirus-curve-timeline-2020-4

"In many countries, it's not just one measure that flattens the curve. It's the combination of isolating, testing, and tracing. Countries that have been able to do all three swiftly have been able to lower their number of new cases, but those that haven't will likely take longer to flatten the curve."

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #732 on: April 17, 2020, 09:03:23 PM »
Yeah the time for South Korea style aggressive testing and containment in the US was probably some time in January when our president was alternating between calling it a hoax and saying we had it under control. We missed the boat. So did most countries though, so we shouldn't feel too bad.

The economy, the US economy at least, can survive running at decreased capacity for a few weeks/months while we figure out how to safely open up. We're the wealthiest country on the planet and our currency is the defacto global reserve standard. And we can print more of it.

I see more alarmism about the economy than I do about the virus.

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #733 on: April 17, 2020, 09:11:05 PM »
FWIW I do think we're making good use of the lockdown time. Johnson and Johnson and the Gates Vaccine Accelerator program have started down the most aggressive roadmap towards vaccine development in history. According to some sources, viable treatments may be only 3-4 months ways, and I'm sure we all saw the apparent good news regarding that this week.

The US has gone from being laughably far behind on testing to pulling in line with other developed countries on a per capita basis. The NIH has commissioned an antibody study to determine how widespread the disease is. This will hopefully get us better information on what the mortality rate is. We've started shoring up PPE reserves and coming up with alternatives. I think this will be important as we start to open up. Social distancing is already going to be time magazines word of the year or whatever. People and companies at large understand what's at stake.

We're gonna figure this out.

Kyle Schuant

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Re: How long can we wait while flattening the curve?
« Reply #734 on: April 17, 2020, 09:46:16 PM »
An interesting comparison would be the expected number of deaths had social distancing protocols not been put into place ('business as usual' / open-economy) vs actual deaths under current circumstances vs typical (i.e. 'background') mortality under non-Covid circumstances.
It'll be interesting, yes. We know that each 1% rise in unemployment gives a 1% rise in suicides. However, I'd expect that to be a bit higher this time. Normally when someone has personal problems like losing a job, they can turn to their family, friends, and wider community for help - but now people are locked in their homes, they don't have that support. And people who've lived through recessions have worse health outcomes long-term.

As well, because of fear of the virus and calls by leaders not to overwhelm the system, many people with serious symptoms are staying home rather than calling or going for help, so some cardiac patients, for example, who might have been saved - they'll die.

On the other hand, the lockdowns are having the effect of reducing transmission of seasonal flu, which of course kills people, too. And in times of recession people tend to use less tobacco and alcohol (because they can't afford it), but illicit drug use goes up a bit.

Governing for the public good is a giant trolley problem. But in the philosophical trolley problem, the outcome is clear - do I let 5 people die, or 1 person die? In public affairs the outcomes aren't as clear.

Luz

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Re: How long can we wait while flattening the curve?
« Reply #735 on: April 17, 2020, 10:32:07 PM »
I think this issue is wrongly seen as: we either sacrifice lives or collapse our economy. But there was a third way all along. We use testing, quarantine of the sick and contact tracing to "box in" the virus.
Umm, I'm pretty sure this is exactly the plan for how to start opening things back up.  It's not like this is some new idea that no one's thought of.  The reason we had to shut everything down is because we were barely able to test anyone at all in the US when this virus started spreading.  So we got behind and basically the only option was to shut down or let this spread uncontrollably and overwhelm the healthcare system (and honestly destroy the economy anyway).  We shut down to try and limit the spread and buy time until we have the capability of doing sufficient testing and contract tracing.  And to buy time to prepare hospitals with more ICU beds, PPE, and ventilators in case we fail to contain the spread and start to strain the healthcare system.

I think one can be critical of lockdown measures enacted without robust containment measures. We've done so much more damage than was necessary (on both public health and economic fronts). It's not an either-or issue. It's having a smart (and honestly, quite basic and cost-effective) strategy to stay ahead of the virus.
What do you think we should have done instead of shut down then??  We literally could not enact the testing and contact tracing that you're proposing 6-8 weeks ago when this first started really spreading in the US.  We can't even do it today.  We're doing a lot more testing now, but in most places it seems like you can still only get a test if you're in the hospital with respiratory problems and a high fever.  If we can't widely deploy testing to everyone with symptoms and everyone who's come in contact with someone who tests positive, then we can't just open things back up and have it be fine.  I think the only way we could have avoided the damage to the economy and public health would have been to take this more seriously early in the year and put serious time/money/effort into developing fast, accurate, readily available tests and a comprehensive strategy for the nation BEFORE the virus started spreading here.  Once we failed to do that, I think a lockdown became the only real option until we get our shit figured out.

Of course it's not some new idea. But I put it out there because this thread, as well as the national dialogue, still seems to focus on the false dichotomy of economy v lives, when that's not the real issue. I agree that, at a certain point, it was necessary to shut down. But I don't agree that it was our only option, as you say. We've had the option all along (and still have it) to prioritize testing, tracing and quarantine (which, in this context I mean isolation of the sick) while also enacting shut downs. It still doesn't seem like the priority is there (at least on a federal level).

Why couldn't we ramp up testing then and why can't we now? Haven't fast and accurate tests been available since mid-January? It's not like we're waiting for a scientific breakthrough. Readily-available is the more complicated part for the US, but that's mainly due to lack of federal mobilization, rather than the sheer impossibility of it. All I'm saying is that the discussion focusing on lockdown versus unmitigated spread as being our only two options is misleading. You ask what I think we should have done instead of shutting things down? I don't think at that point there was an "instead of". We should have shut things down while focusing on testing as if our lives depended on it. I think we still should do that.

Luz

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Re: How long can we wait while flattening the curve?
« Reply #736 on: April 17, 2020, 10:35:36 PM »
Yeah the time for South Korea style aggressive testing and containment in the US was probably some time in January when our president was alternating between calling it a hoax and saying we had it under control. We missed the boat. So did most countries though, so we shouldn't feel too bad.

The economy, the US economy at least, can survive running at decreased capacity for a few weeks/months while we figure out how to safely open up. We're the wealthiest country on the planet and our currency is the defacto global reserve standard. And we can print more of it.

I see more alarmism about the economy than I do about the virus.

We may have missed the boat in terms of prevention. But we still need testing to get ourselves out of the current stalemate (open the economy and a new wave hits, keep the economy closed and we risk creating excessive collateral damage).

Gremlin

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Re: How long can we wait while flattening the curve?
« Reply #737 on: April 17, 2020, 10:51:01 PM »
First and 3rd things on your list are only starting to be available @Luz. Absent good data, it is impossible to "box it in".

Unemployment offices across the country are also facing this problem - almost no excess capacity to process claims in the normal times, and they're hit with a 20+ fold increase in the need for that service. So the money's been thrown at that problem, but it will be much longer to actually be able to scale that up to where the money can get to the people.

Or put another way, once you've let things get as far as we did in the US, you can't just jump to the dance without the hammer.

https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-the-dance-be9337092b56

But testing will give us this data! Not only that, but it's the only way to open things back up. We have to know what we're dealing with in order to effectively deal with it. I would argue, on the second bolded line about jumping to the dance without the hammer, that you'd be unwise to not go about the dance simultaneously with the hammer. Shutdowns with no mitigation strategy other than suppression alone are not an effective strategy. They might buy us time, but if we're not using that time to combat the virus via testing, tracing and isolation, we're back to where we started, with a lot of collateral damage. There's no good reason that one of the richest, most powerful and innovative countries in the world is unable to prioritize testing (it's not a capacity issue).

This is an older article, but still quite relevant: https://foreignpolicy.com/2020/03/23/coronavirus-pandemic-south-korea-italy-mass-testing-covid19-will-keep-spreading/

"Every outbreak starts and ends with a diagnostic test. The director-general of the World Health Organization, Tedros Adhanom Ghebreyesus, has made it clear that the ďbackboneĒ of every countryís public health response to this outbreak is testing, isolation, and contact tracingóand South Korea is showing how this model ultimately pays off in reducing spread, taking pressure off health services, and keeping its death rate one of the lowest in the world."

Also: https://www.businessinsider.com/south-koreas-coronavirus-curve-timeline-2020-4

"In many countries, it's not just one measure that flattens the curve. It's the combination of isolating, testing, and tracing. Countries that have been able to do all three swiftly have been able to lower their number of new cases, but those that haven't will likely take longer to flatten the curve."

Australia's Chief Medical Officer was asked the other day about testing in the context of "isolating, testing, and tracing".  He made a comment that the only numbers he trusted in terms of testing were Australia's.  At the time I felt that was incredibly arrogant, but then this study was released:

https://cmmid.github.io/topics/covid19/severity/global_cfr_estimates.html

It'd be interesting to see where these numbers have progressed (the CMO claims Australia is up from a central estimate of 85% to 92% with more recent emerging data), but if they remain similar then really only Australia and NZ (not in the study since fewer than 10 deaths at the time) can truly go down this path.  As an Australian, I'm still nervous about opening up too quickly and seeing a spike as per Singapore/Japan, who are now battling second waves.  But also hopeful that we can properly do isolate, test and trace.

Luz

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Re: How long can we wait while flattening the curve?
« Reply #738 on: April 17, 2020, 11:07:31 PM »
FWIW I do think we're making good use of the lockdown time. Johnson and Johnson and the Gates Vaccine Accelerator program have started down the most aggressive roadmap towards vaccine development in history. According to some sources, viable treatments may be only 3-4 months ways, and I'm sure we all saw the apparent good news regarding that this week.

The US has gone from being laughably far behind on testing to pulling in line with other developed countries on a per capita basis. The NIH has commissioned an antibody study to determine how widespread the disease is. This will hopefully get us better information on what the mortality rate is. We've started shoring up PPE reserves and coming up with alternatives. I think this will be important as we start to open up. Social distancing is already going to be time magazines word of the year or whatever. People and companies at large understand what's at stake.

We're gonna figure this out.

I like your optimism. I think the phrase of the year will be "flatten the curve".

Luz

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Re: How long can we wait while flattening the curve?
« Reply #739 on: April 17, 2020, 11:19:10 PM »
There's human empathy and social norms.  Hard not to give a crying relative a hug or shake the hand of someone who's just lost their significant other.  I, personally, would feel like an ass standing 6'+ away, exuding the message "I feel bad for you, but not bad enough to risk MY health". 

I really hope I don't to do that.  With my extended family and their risk factors and locations, it's a definite possibility.

It's not really YOUR health though, it's everyone's health. If even one person is sick, and each person hugs each other person... well you've all read the news so you know what happens. I had this discussion with my wife last night as we discussed their funeral.  Is it too much of a risk to have a funeral for your own father? Probably not as long as you're smart about it.  But 60 people all crying and hugging up on each other in a hot spot is a very, very bad idea.  If you must hug maybe just limit it to very close family members.  I'd be completely fine with no hugs at a funeral, I don't even know 3/4 of the people at any funeral I attend, even when it's a close family member, so I'd have no problem social distancing from most of those people. 


A lot of early predictions of the models were clearly bullshit, because they used the same mythical person that the 4% trinity study was based on.  They will withdraw 4% of their portfolio, never go back to work, never take social security, and basically never adapt no matter how dire the economic situation gets, just keep making withdraws as their stache gets decimated.  It's not realistic, almost no one would behave that way in real life.  I feel like the same is true of models that predicted 2M+ deaths in the USA.  The model only holds true if people robotically went about business as usual without adapting, but I have a hard time believing the vast majority of the population would continue with business as usual as the death toll kept climbing higher and higher, and I think we are already seeing people reacting of their own volition rather than because they are mandated.  Like who would would hit up a bar and go see a football game in a giant stadium with tens of thousands of other people as the death toll kept mounting ever higher?  It's completely unrealistic to think business could possibly continue "as usual" in the midst of this.

This applies to the economic costs as well.  An unsubstantiated premise of this thread is that the economic losses of keeping front-facing businesses closed is substantially higher than if we removed such policies now or never had them to begin with.  Even under present conditions (which has almost certainly reduced the spread and # of infected/dead) it seems certain to me that many people would not be going out-and-about "as usual".  There would be a crisis in confidence for many businesses that press people close together (bars, restaurants, sporting events) and people would be taking sick & bereavement leave in droves.  As we've seen, a number of large outbreaks have been traced back to specific large gatherings.

I think this issue is wrongly seen as: we either sacrifice lives or collapse our economy. But there was a third way all along. We use testing, quarantine of the sick and contact tracing to "box in" the virus. I think one can be critical of lockdown measures enacted without robust containment measures. We've done so much more damage than was necessary (on both public health and economic fronts). It's not an either-or issue. It's having a smart (and honestly, quite basic and cost-effective) strategy to stay ahead of the virus.

As long as we are using fantasy thinking why not just wish the virus was eradicated altogether?  We don't have the ability to do that testing.  It's not even a possibility in most areas of the world at this point, even though it's been going on for months at this point.  Hell most sick people aren't even getting tested, there is no way we could be doing testing on a mass scale.  Maybe if they had prepared for this months ago, but they didn't so it's not even an option at this point. 

In detroit right now if you are really sick, and it's obviously coronavirus, and you can still technically breath they won't test you.  They will advise you to stay home and rest until you cannot breath, and only at that point should you go to the hospital, and they might test you.

Why don't we have the ability to do that testing? Why is there no way we could be doing testing on a mass scale?

Abe

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Re: How long can we wait while flattening the curve?
« Reply #740 on: April 18, 2020, 12:09:26 AM »
Roche has developed an antibody test for covid-19. Per their specifications, the fastest machines can run 180 tests/hr. The total number of machines worldwide is 40,000. Thus if all testing for all other diseases were stopped and only covid testing was done, the theoretical fastest that the US and Europe could be tested is 1,000m population / 7.2m test/hr = 138 hrs = 5.7 days. Thereís only 1 machine per 25,000 population so you can see they arenít that common. This is clearly a extreme scenario since not everyone needs testing, but also not all the machines are in the US and Europe, not all of the rest of medicine has grounded to a halt, and there are collection/delivery bottlenecks. Still the antibody platform should be able to test a reasonable percentage of the population in a few weeks.

PCR testing, which detects viral RNA and thus active (or very recent) infection is significantly slower. Major medical centers like mine (which services a population of about 1 million people) can run about 100 samples a day. There are about 500 hospitals (mostly large academic centers), equipped to do this. Labcorp, Quest and Abbott together say they are ramping up to run 100,000 a day Nationwide. Thus total capacity is about to 150,000 a day, which comes to 2,000 days to test everyone in the US. Assuming we test 10% of the population to get a reasonable idea (weíve tested about 1%), itíll take 200 days!

Mariposa

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Re: How long can we wait while flattening the curve?
« Reply #741 on: April 18, 2020, 01:21:23 AM »
Why don't we have the ability to do that testing? Why is there no way we could be doing testing on a mass scale?

Here in NYC, the virus has spread faster than our testing capacity has expanded. There are probably *millions* infected in the NY metro area of ~20mil. We don't have the swabs. We don't have the viral culture media. We don't have the healthcare staff to swab while so many are out sick and the hospitals are over-capacity with critically-ill covid patients.

The good news is, (most of) the first wave of people have recovered, and are coming back to work.

Gin1984

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Re: How long can we wait while flattening the curve?
« Reply #742 on: April 18, 2020, 07:45:46 AM »
Roche has developed an antibody test for covid-19. Per their specifications, the fastest machines can run 180 tests/hr. The total number of machines worldwide is 40,000. Thus if all testing for all other diseases were stopped and only covid testing was done, the theoretical fastest that the US and Europe could be tested is 1,000m population / 7.2m test/hr = 138 hrs = 5.7 days. Thereís only 1 machine per 25,000 population so you can see they arenít that common. This is clearly a extreme scenario since not everyone needs testing, but also not all the machines are in the US and Europe, not all of the rest of medicine has grounded to a halt, and there are collection/delivery bottlenecks. Still the antibody platform should be able to test a reasonable percentage of the population in a few weeks.

PCR testing, which detects viral RNA and thus active (or very recent) infection is significantly slower. Major medical centers like mine (which services a population of about 1 million people) can run about 100 samples a day. There are about 500 hospitals (mostly large academic centers), equipped to do this. Labcorp, Quest and Abbott together say they are ramping up to run 100,000 a day Nationwide. Thus total capacity is about to 150,000 a day, which comes to 2,000 days to test everyone in the US. Assuming we test 10% of the population to get a reasonable idea (weíve tested about 1%), itíll take 200 days!
Except that does not include all the graduate students in labs with qPCR machines.  I know multiple research labs who could running, if they had permission. Using a 384 plate instead the 96 well plate (or in addition) could run 100 samples in two hours plus a little prep time.  If we had used January and February to plan, we could have used all those students.

Vapour

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Re: How long can we wait while flattening the curve?
« Reply #743 on: April 18, 2020, 08:11:53 AM »
I think this issue is wrongly seen as: we either sacrifice lives or collapse our economy. But there was a third way all along. We use testing, quarantine of the sick and contact tracing to "box in" the virus.
Umm, I'm pretty sure this is exactly the plan for how to start opening things back up.  It's not like this is some new idea that no one's thought of.  The reason we had to shut everything down is because we were barely able to test anyone at all in the US when this virus started spreading.  So we got behind and basically the only option was to shut down or let this spread uncontrollably and overwhelm the healthcare system (and honestly destroy the economy anyway).  We shut down to try and limit the spread and buy time until we have the capability of doing sufficient testing and contract tracing.  And to buy time to prepare hospitals with more ICU beds, PPE, and ventilators in case we fail to contain the spread and start to strain the healthcare system.

I think one can be critical of lockdown measures enacted without robust containment measures. We've done so much more damage than was necessary (on both public health and economic fronts). It's not an either-or issue. It's having a smart (and honestly, quite basic and cost-effective) strategy to stay ahead of the virus.
What do you think we should have done instead of shut down then??  We literally could not enact the testing and contact tracing that you're proposing 6-8 weeks ago when this first started really spreading in the US.  We can't even do it today.  We're doing a lot more testing now, but in most places it seems like you can still only get a test if you're in the hospital with respiratory problems and a high fever.  If we can't widely deploy testing to everyone with symptoms and everyone who's come in contact with someone who tests positive, then we can't just open things back up and have it be fine.  I think the only way we could have avoided the damage to the economy and public health would have been to take this more seriously early in the year and put serious time/money/effort into developing fast, accurate, readily available tests and a comprehensive strategy for the nation BEFORE the virus started spreading here.  Once we failed to do that, I think a lockdown became the only real option until we get our shit figured out.

Of course it's not some new idea. But I put it out there because this thread, as well as the national dialogue, still seems to focus on the false dichotomy of economy v lives, when that's not the real issue. I agree that, at a certain point, it was necessary to shut down. But I don't agree that it was our only option, as you say. We've had the option all along (and still have it) to prioritize testing, tracing and quarantine (which, in this context I mean isolation of the sick) while also enacting shut downs. It still doesn't seem like the priority is there (at least on a federal level).

Why couldn't we ramp up testing then and why can't we now? Haven't fast and accurate tests been available since mid-January? It's not like we're waiting for a scientific breakthrough. Readily-available is the more complicated part for the US, but that's mainly due to lack of federal mobilization, rather than the sheer impossibility of it. All I'm saying is that the discussion focusing on lockdown versus unmitigated spread as being our only two options is misleading. You ask what I think we should have done instead of shutting things down? I don't think at that point there was an "instead of". We should have shut things down while focusing on testing as if our lives depended on it. I think we still should do that.
Maybe because this thread was started in March and not January and since we don't have the ability to time-travel, it hasn't been focused on what we should have done in January.  That ship has sailed.  I don't believe fast, accurate tests have been available since then either.  I've read that people often have to wait a week for results.  I wouldn't exactly call that fast.  There's a lot of people they could infect in that week if they don't quarantine.  I've also read that the accuracy of the tests is being questioned since there's a lot of false negatives being reported especially in New York.

No, ramping up testing is not an impossible problem.  But our federal leadership leaves much to be desired.  Our president spent months talking about how we had this under control, how the cases would go down, not up, and how it would magically go away in April.  So is there really any surprise that we're in this situation now?  The governors are doing the best they can.  The president's basically left them to fend for themselves and says it's their job to acquire PPE and ventilators.  But they can't because most manufacturers are required to send their supply to the federal government first.  It's a shit-show.  So we can talk about what should be happening, but I think states are going to have to figure this out for themselves since I don't see the federal government stepping up.  This is why we're seeing governors making pacts.  They're trying to coordinate this for themselves since the federal government isn't doing it.  I think this crisis is showing us just how badly we need good leadership at the federal level and how we very much don't have it right now.  I really hope we can make a better decision come November, if we can hold out that long.

Abe

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Re: How long can we wait while flattening the curve?
« Reply #744 on: April 18, 2020, 08:51:06 AM »
Roche has developed an antibody test for covid-19. Per their specifications, the fastest machines can run 180 tests/hr. The total number of machines worldwide is 40,000. Thus if all testing for all other diseases were stopped and only covid testing was done, the theoretical fastest that the US and Europe could be tested is 1,000m population / 7.2m test/hr = 138 hrs = 5.7 days. Thereís only 1 machine per 25,000 population so you can see they arenít that common. This is clearly a extreme scenario since not everyone needs testing, but also not all the machines are in the US and Europe, not all of the rest of medicine has grounded to a halt, and there are collection/delivery bottlenecks. Still the antibody platform should be able to test a reasonable percentage of the population in a few weeks.

PCR testing, which detects viral RNA and thus active (or very recent) infection is significantly slower. Major medical centers like mine (which services a population of about 1 million people) can run about 100 samples a day. There are about 500 hospitals (mostly large academic centers), equipped to do this. Labcorp, Quest and Abbott together say they are ramping up to run 100,000 a day Nationwide. Thus total capacity is about to 150,000 a day, which comes to 2,000 days to test everyone in the US. Assuming we test 10% of the population to get a reasonable idea (weíve tested about 1%), itíll take 200 days!
Except that does not include all the graduate students in labs with qPCR machines.  I know multiple research labs who could running, if they had permission. Using a 384 plate instead the 96 well plate (or in addition) could run 100 samples in two hours plus a little prep time.  If we had used January and February to plan, we could have used all those students.

Thatís true, but we have what we have. Also youíd have to set up all those labs with significant biohazard setups (more than just a hood and some gloves), and distributing tests would be a bit of a logistic struggle. Not saying it canít be done, but the government shouldíve focused on ramping up testing at the major healthcare lab companies. They didnít and now weíre paying a price in lack of knowledge.

Also looking at the negative test rate, at least in California, we arenít good and identifying covid-19ís symptoms from other symptoms. About 90% of tests in SoCal have been negative. I think itís because everyone who has any upper respiratory symptoms is getting tested even if they have no exposure risk. Hopefully countries with better testing regimens can help make models to improve this issue.

OtherJen

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Re: How long can we wait while flattening the curve?
« Reply #745 on: April 18, 2020, 09:08:21 AM »
Roche has developed an antibody test for covid-19. Per their specifications, the fastest machines can run 180 tests/hr. The total number of machines worldwide is 40,000. Thus if all testing for all other diseases were stopped and only covid testing was done, the theoretical fastest that the US and Europe could be tested is 1,000m population / 7.2m test/hr = 138 hrs = 5.7 days. Thereís only 1 machine per 25,000 population so you can see they arenít that common. This is clearly a extreme scenario since not everyone needs testing, but also not all the machines are in the US and Europe, not all of the rest of medicine has grounded to a halt, and there are collection/delivery bottlenecks. Still the antibody platform should be able to test a reasonable percentage of the population in a few weeks.

PCR testing, which detects viral RNA and thus active (or very recent) infection is significantly slower. Major medical centers like mine (which services a population of about 1 million people) can run about 100 samples a day. There are about 500 hospitals (mostly large academic centers), equipped to do this. Labcorp, Quest and Abbott together say they are ramping up to run 100,000 a day Nationwide. Thus total capacity is about to 150,000 a day, which comes to 2,000 days to test everyone in the US. Assuming we test 10% of the population to get a reasonable idea (weíve tested about 1%), itíll take 200 days!
Except that does not include all the graduate students in labs with qPCR machines.  I know multiple research labs who could running, if they had permission. Using a 384 plate instead the 96 well plate (or in addition) could run 100 samples in two hours plus a little prep time.  If we had used January and February to plan, we could have used all those students.

Thatís true, but we have what we have. Also youíd have to set up all those labs with significant biohazard setups (more than just a hood and some gloves), and distributing tests would be a bit of a logistic struggle. Not saying it canít be done, but the government shouldíve focused on ramping up testing at the major healthcare lab companies. They didnít and now weíre paying a price in lack of knowledge.

Also looking at the negative test rate, at least in California, we arenít good and identifying covid-19ís symptoms from other symptoms. About 90% of tests in SoCal have been negative. I think itís because everyone who has any upper respiratory symptoms is getting tested even if they have no exposure risk. Hopefully countries with better testing regimens can help make models to improve this issue.

This. I used to run qPCR in a cancer research lab and would have happily gone back in to run tests, but most biological labs (including that one) are not in any way set up for BSL2 or higher and would also require the distribution of large quantities of PPE that is already in short supply. Not to mention reagent distribution and professional equipment calibration. The effort would be better spent on high-throughput efforts at central labs.

This is all assuming that the swab kits are even available in sufficient quantities to ramp up testing. They arenít in the hotspot where I live.

Hopefully public health authorities will start using symptoms like a sudden decrease/loss of smell and/or taste as a screening criteria for testing. Reports from around the world are increasingly suggesting that this is a much more specific symptom than fever/cough.

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #746 on: April 18, 2020, 10:04:47 AM »
We may have missed the boat in terms of prevention. But we still need testing to get ourselves out of the current stalemate (open the economy and a new wave hits, keep the economy closed and we risk creating excessive collateral damage).

Agreed. That's why I'm heartened to see us doing so much testing now. And I'm really excited about the potential of the NIH antibody study.

I like your optimism. I think the phrase of the year will be "flatten the curve".

Ooooh! That's a good guess too!

waltworks

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Re: How long can we wait while flattening the curve?
« Reply #747 on: April 18, 2020, 10:44:30 AM »
Here in UT they are basically begging asymptomatic people to go get tested, because the capacity for tests far exceeds the number of people getting tested. They're reopening most of the state parks and other outdoor stuff this weekend.

But it's sort of uneven. I was randomly selected (asymptomatic) to get tested, but the nearest testing location is a 35 minute drive. I will go do it, but that's a significant hurdle for a lot of people.

Very interesting to see the different outcomes in different areas. Here in Park City we initially had more cases per capita than NYC. But once the tourists all left town, it's been easy to social distance and cases have pretty much flatlined.

-W

JGS1980

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Re: How long can we wait while flattening the curve?
« Reply #748 on: April 18, 2020, 11:40:08 AM »
We may have missed the boat in terms of prevention. But we still need testing to get ourselves out of the current stalemate (open the economy and a new wave hits, keep the economy closed and we risk creating excessive collateral damage).

Agreed. That's why I'm heartened to see us doing so much testing now. And I'm really excited about the potential of the NIH antibody study.

I like your optimism. I think the phrase of the year will be "flatten the curve".

Ooooh! That's a good guess too!

In regards to testing, nationally the USA has been stuck on around 130K to 160K tests per day for the last 2 weeks, 25K to 35K positives per day.  National positive rates have remained at around 20% for this 2 week period. I repeat, the rate of infection has not gone down in the period, it has remained the same, indicating that we are not testing enough. We may have succeeded in flattening the curve ONLY BECAUSE we could not keep up with the testing.

Hey, I'm an optimist at heart, but I'm also a realist. This thing is a long way from being done, no matter how much I would like things to open up again.

https://covidtracking.com/data/us-daily

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #749 on: April 18, 2020, 12:55:59 PM »
We may have missed the boat in terms of prevention. But we still need testing to get ourselves out of the current stalemate (open the economy and a new wave hits, keep the economy closed and we risk creating excessive collateral damage).

Agreed. That's why I'm heartened to see us doing so much testing now. And I'm really excited about the potential of the NIH antibody study.

I like your optimism. I think the phrase of the year will be "flatten the curve".

Ooooh! That's a good guess too!

In regards to testing, nationally the USA has been stuck on around 130K to 160K tests per day for the last 2 weeks, 25K to 35K positives per day.  National positive rates have remained at around 20% for this 2 week period. I repeat, the rate of infection has not gone down in the period, it has remained the same, indicating that we are not testing enough. We may have succeeded in flattening the curve ONLY BECAUSE we could not keep up with the testing.

Hey, I'm an optimist at heart, but I'm also a realist. This thing is a long way from being done, no matter how much I would like things to open up again.

https://covidtracking.com/data/us-daily

Itís possible that testing is in part proportional to the number of people complaining of symptoms.