Author Topic: How long can we wait while flattening the curve?  (Read 248249 times)

waltworks

  • Magnum Stache
  • ******
  • Posts: 4265
Re: How long can we wait while flattening the curve?
« Reply #750 on: April 18, 2020, 01:00:55 PM »
UT's rate of positive tests has hovered around 5%, and that's been (until recently) only testing people with symptoms. Now we have testing capacity going unused.

The region to region differences are astounding to me.

-W

T-Money$

  • Stubble
  • **
  • Posts: 215
  • Location: New York
Re: How long can we wait while flattening the curve?
« Reply #751 on: April 18, 2020, 01:53:34 PM »
https://www.bostonglobe.com/2020/04/17/business/nearly-third-200-blood-samples-taken-chelsea-show-exposure-coronavirus/

https://www.masslive.com/coronavirus/2020/04/coronavirus-spread-testing-shows-stunning-asymptomatic-covid-19-rate-at-boston-homeless-shelter.html

New preliminary data from Boston indicate COVID-19 could already be endemic.  It seems the virus has spread faster than man can study and react to it.  If the above data is true, the curve likely wasn't flattened (at least in the metropolitan Northeast US).
« Last Edit: April 18, 2020, 02:01:42 PM by egillespie »

JGS1980

  • Bristles
  • ***
  • Posts: 429
Re: How long can we wait while flattening the curve?
« Reply #752 on: April 18, 2020, 02:30:52 PM »
https://www.bostonglobe.com/2020/04/17/business/nearly-third-200-blood-samples-taken-chelsea-show-exposure-coronavirus/

https://www.masslive.com/coronavirus/2020/04/coronavirus-spread-testing-shows-stunning-asymptomatic-covid-19-rate-at-boston-homeless-shelter.html

New preliminary data from Boston indicate COVID-19 could already be endemic.  It seems the virus has spread faster than THE UNITED STATES can study and react to it.  If the above data is true, the curve likely wasn't flattened (at least in the metropolitan Northeast US).

South Korea, Germany, New Zealand, Singapore, etc... have done fairly well. The US, on the other hand, has not done well thus far.

T-Money$

  • Stubble
  • **
  • Posts: 215
  • Location: New York
Re: How long can we wait while flattening the curve?
« Reply #753 on: April 18, 2020, 02:48:11 PM »
https://www.bostonglobe.com/2020/04/17/business/nearly-third-200-blood-samples-taken-chelsea-show-exposure-coronavirus/

https://www.masslive.com/coronavirus/2020/04/coronavirus-spread-testing-shows-stunning-asymptomatic-covid-19-rate-at-boston-homeless-shelter.html

New preliminary data from Boston indicate COVID-19 could already be endemic.  It seems the virus has spread faster than THE UNITED STATES can study and react to it.  If the above data is true, the curve likely wasn't flattened (at least in the metropolitan Northeast US).



South Korea, Germany, New Zealand, Singapore, etc... have done fairly well. The US, on the other hand, has not done well thus far.

Define well?  The United States is a geographically huge and diverse country.  I'd love to be more like an efficient and obedient Asian nation or remote island.  The US is also very unhealthy.

As of now the only way to end the pandemic is herd immunity through infection.  While trying to eliminate the infection is noble and may work for some, I believe until a vaccine or cure is found those nations are delaying the inevitable. 

As data comes out I think the US is long past the point of trying to "flatten the curve".  Time will tell.

Spud

  • Stubble
  • **
  • Posts: 161
  • Location: Southwest England, UK.
Re: How long can we wait while flattening the curve?
« Reply #754 on: April 18, 2020, 03:15:40 PM »
In Germany's case, well means less than 4,500 deaths even at this point. It has a population of 80 million, so not exactly small and just under 25% of the US population, yet its early and widespread testing in JANUARY helped it. What was the US doing in January? What was most of the rest of Europe doing in January? Fck all.

This thing is only just beginning to bite in South America, Africa and Asia. Those impoverished places really are screwed.

The national psyche of people in general in the US is not conducive to beating this. Somewhere like Germany, Finland or Norway is. The don't complain about their rights, they get what's happening. I watched reports coming in from Michigan the other day and the people they interviewed represent why the US will be hit as hard as a developing world nation, that and private healthcare plus obesity.

I'm still guessing that in the US, unless you can pay, you'd don't get treated even if you have COVID-19.

the_fixer

  • Pencil Stache
  • ****
  • Posts: 899
  • Location: Colorado
  • mind on my money money on my mind
Re: How long can we wait while flattening the curve?
« Reply #755 on: April 18, 2020, 03:25:53 PM »
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
Interesting I know several people that have all of the symptoms and are sick as hell but have been refused testing here in Colorado.

Even one that was in the hospital and told they should assume they have it but weíre not tested due to not being in an at risk group.

I really do not get it


Sent from my iPhone using Tapatalk

GardenerB

  • 5 O'Clock Shadow
  • *
  • Posts: 61
Re: How long can we wait while flattening the curve?
« Reply #756 on: April 18, 2020, 04:02:49 PM »
Very blunt explanation and Q&A that seems to sum it up quite well.

https://youtu.be/bfN2JWifLCY


AnnaGrowsAMustache

  • Handlebar Stache
  • *****
  • Posts: 1919
  • Location: Noo Zilind
Re: How long can we wait while flattening the curve?
« Reply #757 on: April 18, 2020, 04:11:04 PM »
I read every US news site that I can, including Fox news just to get the weird side of the coin. It really seems to me that Americans, even ones in high positions, just simply don't get what's happening in their country. This thing grows exponentially. There's no "missing the boat" on flattening the curve. Either you do something about it, or it will continue to grow exponentially. Stay at home. Limit things from now. Yes, you will still have the worst number of deaths in the world, but that will only increase. When will you guys get it? When you've lost more to covid than to the Vietnam War? Stay at home.

GuitarStv

  • Senior Mustachian
  • ********
  • Posts: 16600
  • Age: 39
  • Location: Toronto, Ontario, Canada
Re: How long can we wait while flattening the curve?
« Reply #758 on: April 18, 2020, 04:28:49 PM »
I read every US news site that I can, including Fox news just to get the weird side of the coin. It really seems to me that Americans, even ones in high positions, just simply don't get what's happening in their country. This thing grows exponentially. There's no "missing the boat" on flattening the curve. Either you do something about it, or it will continue to grow exponentially. Stay at home. Limit things from now. Yes, you will still have the worst number of deaths in the world, but that will only increase. When will you guys get it? When you've lost more to covid than to the Vietnam War? Stay at home.

I think it's really a testament to the crisis of leadership that the US is undergoing.  The president regularly lies during his covid briefings (or uses them as campaign rallies more recently).  He fails to answer basic questions from the press.  He has made wrong moves all along as this has unfolded, and continues to make wrong moves (encouraging people to break quarantine and hold covid rallies).

In the absence of leadership during crisis, there is chaos.

Paper Chaser

  • Bristles
  • ***
  • Posts: 315
Re: How long can we wait while flattening the curve?
« Reply #759 on: April 18, 2020, 07:25:49 PM »
New evidence from CA indicates the number of people that have contracted COVID-19 may be 50-85 times higher than the "confirmed cases" in the state:

https://www.theguardian.com/world/2020/apr/17/antibody-study-suggests-coronavirus-is-far-more-widespread-than-previously-thought#maincontent

Nothing truly groundbreaking, and it's not yet been peer reviewed, but it's an important step. Basically, a much larger percentage of people have already had COVID and either had minor symptoms or no symptoms at all. We already kind of knew this thanks to the Diamond Princess study that showed 50% of confirmed cases (among an older data set than the overall population) being asymptomatic.

If the numbers are similar elsewhere, it means the virus is far less lethal to the overall population than the data currently shows. In other words, the Infection fatality rate is much lower than the case fatality rate, which was assumed by many but now we have an idea just how much lower.

AnnaGrowsAMustache

  • Handlebar Stache
  • *****
  • Posts: 1919
  • Location: Noo Zilind
Re: How long can we wait while flattening the curve?
« Reply #760 on: April 18, 2020, 07:34:24 PM »
I read every US news site that I can, including Fox news just to get the weird side of the coin. It really seems to me that Americans, even ones in high positions, just simply don't get what's happening in their country. This thing grows exponentially. There's no "missing the boat" on flattening the curve. Either you do something about it, or it will continue to grow exponentially. Stay at home. Limit things from now. Yes, you will still have the worst number of deaths in the world, but that will only increase. When will you guys get it? When you've lost more to covid than to the Vietnam War? Stay at home.

I think it's really a testament to the crisis of leadership that the US is undergoing.  The president regularly lies during his covid briefings (or uses them as campaign rallies more recently).  He fails to answer basic questions from the press.  He has made wrong moves all along as this has unfolded, and continues to make wrong moves (encouraging people to break quarantine and hold covid rallies).

In the absence of leadership during crisis, there is chaos.

It's really appalling to watch. Other countries have certainly made mistakes and/or have a terrible situation, but the USA seems intent on screwing itself hard.

js82

  • Bristles
  • ***
  • Posts: 469
Re: How long can we wait while flattening the curve?
« Reply #761 on: April 18, 2020, 08:37:34 PM »
New evidence from CA indicates the number of people that have contracted COVID-19 may be 50-85 times higher than the "confirmed cases" in the state:

https://www.theguardian.com/world/2020/apr/17/antibody-study-suggests-coronavirus-is-far-more-widespread-than-previously-thought#maincontent

Nothing truly groundbreaking, and it's not yet been peer reviewed, but it's an important step. Basically, a much larger percentage of people have already had COVID and either had minor symptoms or no symptoms at all. We already kind of knew this thanks to the Diamond Princess study that showed 50% of confirmed cases (among an older data set than the overall population) being asymptomatic.

If the numbers are similar elsewhere, it means the virus is far less lethal to the overall population than the data currently shows. In other words, the Infection fatality rate is much lower than the case fatality rate, which was assumed by many but now we have an idea just how much lower.

I don't think that number can realistically be that high - unless you're dealing with areas with severe undertesting.  The 50-85x number doesn't close with some of the data sets we're seeing elsewhere.

A little math:
New York city + Long Island have ~15k deaths and ~191k cases for ~11.3 million population.  That works out to a 1.7% detected infection rate and a 0.13% mortality rate on the population level, or a ~7.8% mortality rate for reported cases.  The population-level mortality rate is clearly going to end up somewhere higher than that - maybe ~0.2-0.3% when this is all over.  That's not inconsistent with a 0.4-0.5% real mortality rate(which is consistent with estimates based on population-level sampling in Germany) when you consider where infections are likely to cap out due to herd immunity combined with social distancing.

All this means that the ratio of detected to real cases in NYC is probably 15-20x by my guess.  85x is mathematically impossible, and 50x is probably functionally impossible due to herd immunity mechanics.  I'd expect places with decent testing to be undercounting *less* than NYC (and hence have lower multipliers) since they're not overwhelming their testing capacity, and have more ability to test non-severe patients.

Abe

  • Handlebar Stache
  • *****
  • Posts: 1648
Re: How long can we wait while flattening the curve?
« Reply #762 on: April 18, 2020, 09:31:45 PM »
I think what's important to look at here is hospital bed usage. The infection rate is whatever it is, but there's a finite resource available.

So far, using data from Johns Hopkins' compilation and the American Hospital Association the current statistics are:

Total hospitalized in US: 111,966
Total US bed capacity:    924,000
Utilization: 12%

Est. ICU hospitalized: 6,000 (low end) to 12,000 (high end)
Total US ICU capacity: 106,000
Utilization: 5.6% - 11.3%

So approximately 10% of the US hospital capacity is being used for this one disease, in the space of 5 weeks. That's with fairly stringent social distancing in the hardest-hit areas.

New York State has 56,000 beds in normal circumstances, and 54,000 are being used for COVID cases currently.
States using 20% or more of their capacity for COVID-19:
Alabama 48%
Colorado 21%
Connecticut 22%
Maryland 24%
Massachusetts 25%
New Jersey 40%
New York 92%
Wisconsin 20%

Delaware, DC, Georgia, Illinois, Louisiana, Michigan, Missouri, Rhode Island are all using 10-20%

 


Paper Chaser

  • Bristles
  • ***
  • Posts: 315
Re: How long can we wait while flattening the curve?
« Reply #763 on: April 19, 2020, 08:21:08 AM »
New evidence from CA indicates the number of people that have contracted COVID-19 may be 50-85 times higher than the "confirmed cases" in the state:

https://www.theguardian.com/world/2020/apr/17/antibody-study-suggests-coronavirus-is-far-more-widespread-than-previously-thought#maincontent

Nothing truly groundbreaking, and it's not yet been peer reviewed, but it's an important step. Basically, a much larger percentage of people have already had COVID and either had minor symptoms or no symptoms at all. We already kind of knew this thanks to the Diamond Princess study that showed 50% of confirmed cases (among an older data set than the overall population) being asymptomatic.

If the numbers are similar elsewhere, it means the virus is far less lethal to the overall population than the data currently shows. In other words, the Infection fatality rate is much lower than the case fatality rate, which was assumed by many but now we have an idea just how much lower.

I don't think that number can realistically be that high - unless you're dealing with areas with severe undertesting.  The 50-85x number doesn't close with some of the data sets we're seeing elsewhere.

A little math:
New York city + Long Island have ~15k deaths and ~191k cases for ~11.3 million population.  That works out to a 1.7% detected infection rate and a 0.13% mortality rate on the population level, or a ~7.8% mortality rate for reported cases.  The population-level mortality rate is clearly going to end up somewhere higher than that - maybe ~0.2-0.3% when this is all over.  That's not inconsistent with a 0.4-0.5% real mortality rate(which is consistent with estimates based on population-level sampling in Germany) when you consider where infections are likely to cap out due to herd immunity combined with social distancing.

All this means that the ratio of detected to real cases in NYC is probably 15-20x by my guess.  85x is mathematically impossible, and 50x is probably functionally impossible due to herd immunity mechanics.  I'd expect places with decent testing to be undercounting *less* than NYC (and hence have lower multipliers) since they're not overwhelming their testing capacity, and have more ability to test non-severe patients.

Valid point that the number of undetected cases will vary by location, and that testing rate is a key factor. But if you look back at the Diamond Princess study, where 100% of the people on the ship were tested, they still found that basically half of the confirmed cases were asymptomatic:

https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.10.2000180

All 3711 people on the cruise ship were tested. There were 634 confirmed cases (17% infection rate), but only 306 were showing any symptoms (48.2%).


In a separate study, there were some Japanese citizens evacuated from Wuhan in Feb. All 565 evacuees were tested. There were 12 positive tests (2% infection rate) and 5 of the 12 confirmed cases were asymptomatic (41.6%).

https://www.medrxiv.org/content/10.1101/2020.02.03.20020248v2

Add those to the CA test, and we have different testing methods by different organizations in different locations all coming to similar conclusions that there are a bunch of people that have more or less been able to shrug off this virus.

The specific numbers might change by location, but the good news with all of these studies is that the infection fatality rate for the population as a whole is probably a decent amount lower than projected. I'm not a doctor, but I'd be pretty confident that the difference between the infection fatality rate and the case fatality rate will vary by demographic in a similar way to the raw number of deaths. So older age groups and those with comorbidities are almost certain to have higher infection fatality rates than others, and that rate is offset by much lower firs among younger demographics. In other words, the virus may be infecting the general population in pretty similar numbers across the board, but younger/healthier demographics simply aren't showing symptoms as frequently or severely as older demographics.

Since most of the workforce are younger, that could allow for some loosening of restrictions sooner than if we simply use the infection fatality rate for the whole population.

JGS1980

  • Bristles
  • ***
  • Posts: 429
Re: How long can we wait while flattening the curve?
« Reply #764 on: April 19, 2020, 10:24:39 AM »
In response to js82:

In the rosiest scenario where only 0.25% of folks in the US die of Covid, and it takes only 50% of the population to get infected to allow herd immunity, and that immunity actually persists past 3-4 months (unlike many typical viral infections), and that our medical system does not get overwhelmed again (like NYC or New Orleans), and that infections don't lead to some unknown long term lung, heart, kidney, or brain damage --> that still leaves 165.5 M x 0.25% = 413,750 total deaths if we open everything up again without sufficient testing/tracing/quarantining.

Yes to your point that most cases are mild to moderate, even asymptomatic. This does not change the numbers above.

Spud

  • Stubble
  • **
  • Posts: 161
  • Location: Southwest England, UK.
Re: How long can we wait while flattening the curve?
« Reply #765 on: April 19, 2020, 10:32:18 AM »
Very blunt explanation and Q&A that seems to sum it up quite well.

https://youtu.be/bfN2JWifLCY

People need to watch this video. It's a very good 35 minute with a Swedish epidemiologist who has all the heavyweight academic credentials someone would ever need to be taken seriously.

His stance is that lockdowns are simply delaying the inevitable in terms of the number of deaths at least the majority of them. You may prevent a lot of deaths initially, but as you begin to lift the restrictions, which he believes should be lifted one by one over a number of months, people may well die. It's unavoidable. He thinks that the full impact of COVID-19 will result in something like twice as many deaths as normal influenza, but it won't be 10 times as many deaths. When antibody testing finally arrives it will show that many people had the disease and weren't even aware of it.

He thinks that in a democracy, harsh lockdown measures can only last so long before people push back on them.

He does however think that what should be done with COVID-19 is shield the elderly and vulnerable, but otherwise carry on as normal.

He thinks his native Sweden could have done a better job with shielding the elderly and vulnerable, specifically by stopping visitors to nursing homes and care facilities earlier than they did. Other than that I get the impression that he's content with what some people may see as an alarmingly casual approach taken by Sweden. He suggests that although other countries may have a greater or smaller number of deaths per capita at the moment, in the end, many countries numbers will be broadly similar, difference will just be down to national age and health demographics.

From what he says easing of lockdown measures back to zero will take 3 months or longer to do properly. If you ease all measures at once, you have no way of telling which measures may have been the ones preventing the spike in new cases. Do them one at a time, cautiously, you can then assess the effect and re-close the schools again (or whatever it is).

He's very neutral during the interview, perhaps being a stoic Swede, and the interviewer does a very good job of remaining impartial and not being an outright d1ck with a hidden agenda.

It's definitely food for thought.

JGS1980

  • Bristles
  • ***
  • Posts: 429
Re: How long can we wait while flattening the curve?
« Reply #766 on: April 19, 2020, 10:47:27 AM »
In response to js82:

In the rosiest scenario where only 0.25% of folks in the US die of Covid, and it takes only 50% of the population to get infected to allow herd immunity, and that immunity actually persists past 3-4 months (unlike many typical viral infections), and that our medical system does not get overwhelmed again (like NYC or New Orleans), and that infections don't lead to some unknown long term lung, heart, kidney, or brain damage --> that still leaves 165.5 M x 0.25% = 413,750 total deaths if we open everything up again without sufficient testing/tracing/quarantining.

Yes to your point that most cases are mild to moderate, even asymptomatic. This does not change the numbers above.

Paging @Abe

It appears we came to the same conclusion via different methods. I saw this quote on the other thread:

Re: Coronavirus - How can people be so incredibly stupid?
ę Reply #787 on: April 18, 2020, 08:01:52 PM Ľ

Using the lowest IFR mentioned, weíre looking at 330m x 0.5 infection rate (low end of predicted exposure) x 0.001 = 165k deaths in the US. For comparison, about 40k people die of the flu per year. I guess we will see how well the parts of the country that open up before this peaks fare. If the country as a whole does as poorly as NYC/NJ weíre looking at several hundred thousand deaths (330m US population /16m NY/Nj population= 20, multiplied by 21,000 deaths = 420,000 deaths nationwide). My guess is itíll be somewhere in between. Thatís a lot of deaths just to avoid a few months of economic distress.

bacchi

  • Walrus Stache
  • *******
  • Posts: 5004
Re: How long can we wait while flattening the curve?
« Reply #767 on: April 19, 2020, 10:55:18 AM »
His stance is that lockdowns are simply delaying the inevitable in terms of the number of deaths at least the majority of them. You may prevent a lot of deaths initially, but as you begin to lift the restrictions, which he believes should be lifted one by one over a number of months, people may well die. It's unavoidable.

I think that's probably true.

Isn't that missing the point of "flattening the curve," though?

Imagine what would happen if NYC wasn't social isolating and people could go out to Central Park as usual. The 9% of ICU beds remaining would be filled very quickly.


js82

  • Bristles
  • ***
  • Posts: 469
Re: How long can we wait while flattening the curve?
« Reply #768 on: April 19, 2020, 11:01:37 AM »
In response to js82:

In the rosiest scenario where only 0.25% of folks in the US die of Covid, and it takes only 50% of the population to get infected to allow herd immunity, and that immunity actually persists past 3-4 months (unlike many typical viral infections), and that our medical system does not get overwhelmed again (like NYC or New Orleans), and that infections don't lead to some unknown long term lung, heart, kidney, or brain damage --> that still leaves 165.5 M x 0.25% = 413,750 total deaths if we open everything up again without sufficient testing/tracing/quarantining.

Yes to your point that most cases are mild to moderate, even asymptomatic. This does not change the numbers above.

Not disagreeing with you at all.  My perspective is that while the real death rate is well below the original ~3% estimate, 0.3-0.5% of 50-80% of the US Population is still a hell of a lot of people - and the potential unmitigated outcome is still absolutely terrible even at that mortality rate.

My point(which I seem to have articulated poorly) was intended to be that some of the people predicting that we're going to get off easy, are using numbers that(in my opinion) understate the danger the virus poses.  I was attempting to provide some numbers backed up by real-world data to refute others' estimates that understate the danger, not downplay the severity myself.  Sorry if it came across that way.

waltworks

  • Magnum Stache
  • ******
  • Posts: 4265
Re: How long can we wait while flattening the curve?
« Reply #769 on: April 19, 2020, 11:07:34 AM »
It's good that at least the death estimates are moving so much lower. We were initially hearing about 2 million, now it's sounding more like 1/5 of that even if things go poorly.

-W

mathlete

  • Handlebar Stache
  • *****
  • Posts: 1638
Re: How long can we wait while flattening the curve?
« Reply #770 on: April 19, 2020, 11:09:49 AM »
It's good that at least the death estimates are moving so much lower. We were initially hearing about 2 million, now it's sounding more like 1/5 of that even if things go poorly.

-W

Yes. Good news on two fronts. The virus is probably less deadly than initial estimates from January. And social distancing is working.

Abe

  • Handlebar Stache
  • *****
  • Posts: 1648
Re: How long can we wait while flattening the curve?
« Reply #771 on: April 19, 2020, 11:10:59 AM »
@JGS1980 you're right about coming to same conclusions with different methods. Another worrying article in NYTimes regarding capacity: not only are we pushing ICU capacity, but also dialysis capacity due to the high rate of kidney failure in the ICU patients. It will again not be just an issue of number of machines (which is already a problem at baseline in the US), but the expertise to run them. Dialysis machines are incredibly finicky when used on patients in shock for technical reasons I won't bore you with, but basically a dialysis-trained nurse has to be present 24/7 or the machine will clot off and it's a big PITA to restart. Having a patient in ARDS & on dialysis is a nightmare. There's a theory the virus directly infects the kidneys, but more likely it's just severe septic shock and even though their pulmonary function is stabilized by ventilation, they are going into multi-organ failure. That cycle is very hard to reverse. I expect the vast majority of these patients who're on dialysis now will die. Yet another reason to spread the pain out over several months.

JGS1980

  • Bristles
  • ***
  • Posts: 429
Re: How long can we wait while flattening the curve?
« Reply #772 on: April 19, 2020, 11:23:49 AM »
js82, Abe, Waltworks, mathlete -amazingly enough it appears we are all in agreement right now. Lets see how long this lasts :)

mathlete

  • Handlebar Stache
  • *****
  • Posts: 1638
Re: How long can we wait while flattening the curve?
« Reply #773 on: April 19, 2020, 11:30:12 AM »
js82, Abe, Waltworks, mathlete -amazingly enough it appears we are all in agreement right now. Lets see how long this lasts :)

I've changed my opinion!!! Kill grandma, I've got options that vest soon. :)

Luz

  • Bristles
  • ***
  • Posts: 455
Re: How long can we wait while flattening the curve?
« Reply #774 on: April 19, 2020, 12:42:25 PM »
https://www.bostonglobe.com/2020/04/17/business/nearly-third-200-blood-samples-taken-chelsea-show-exposure-coronavirus/

https://www.masslive.com/coronavirus/2020/04/coronavirus-spread-testing-shows-stunning-asymptomatic-covid-19-rate-at-boston-homeless-shelter.html

New preliminary data from Boston indicate COVID-19 could already be endemic.  It seems the virus has spread faster than THE UNITED STATES can study and react to it.  If the above data is true, the curve likely wasn't flattened (at least in the metropolitan Northeast US).



South Korea, Germany, New Zealand, Singapore, etc... have done fairly well. The US, on the other hand, has not done well thus far.

Define well?  The United States is a geographically huge and diverse country.  I'd love to be more like an efficient and obedient Asian nation or remote island.  The US is also very unhealthy.

As of now the only way to end the pandemic is herd immunity through infection.  While trying to eliminate the infection is noble and may work for some, I believe until a vaccine or cure is found those nations are delaying the inevitable. 

As data comes out I think the US is long past the point of trying to "flatten the curve".  Time will tell.

I would define "well" as their utilization of testing, contact tracing, and isolation of the sick + the use of social isolation measures to augment as needed. It's not about a less individualistic population (though that likely helps). It's about having a strategy. And the strategy isn't rocket science. It's the classic public health 101 approach to pandemics.

Ending the pandemic is one thing. But this thread is about balancing social distancing with (legitimate) economic concerns. The best way to balance reopening the economy with keeping people as safe as possible from the virus: test, trace and quarantine.

Luz

  • Bristles
  • ***
  • Posts: 455
Re: How long can we wait while flattening the curve?
« Reply #775 on: April 19, 2020, 12:56:56 PM »
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.

I'm not questioning why different areas are unable to get testing done. I'm questioning why, for example, those areas don't have swabs or viral culture media. There are a ridiculous amount of barriers to testing right now in the United States. But those barriers are largely unavoidable. They could be addressed swiftly with federal action. Say you're a leader of a country and you're faced with an economic depression on the one hand or an unacceptable amount of lives lost on the other. Wouldn't that be time to mobilize the shit out of the situation? Yes, it's a tall order, but it's not like we're incapable of doing it. The reason it's not happening is because we (leadership) are choosing not to do it. There's a difference between being unable and being unwilling.

Luz

  • Bristles
  • ***
  • Posts: 455
Re: How long can we wait while flattening the curve?
« Reply #776 on: April 19, 2020, 01:20:15 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.
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.

I totally agree with you about the shit show part and how with federal inaction, it's up to the state governors (who's hands are tied in many important ways exactly because of federal inaction). I just think it's important to acknowledge (like you just did) that it's far from impossible. And no matter what ships have sailed the past few months, it still is as important as ever. For the record, I posted in the "Coronavirus preparedness" thread on MMM in mid-February when SF counties started going to lockdown. I was concerned about the economic fallout from that decision. Not because of the lockdown per se, but because it didn't seem to have an accompanying strategy (test, trace, quarantine). I got a lot of flack for my questions on that thread (mainly due to the economy v lives paradigm many people seem to be stuck in). But it's eye-opening to see how testing, all these months later, still remains the core issue. Better late than never.

The CDC was offered a test developed by a German company in January. It decided to develop, from scratch, an ultimately faulty test on its own.

Luz

  • Bristles
  • ***
  • Posts: 455
Re: How long can we wait while flattening the curve?
« Reply #777 on: April 19, 2020, 01:36:02 PM »
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.

Maybe I'm idealistic, but aren't the costs great enough in terms of both the economy and loss of lives to not settle for making do with what we have?

I think part of the problem is that we're trying to reinvent the wheel. Haven't models of success been available for quite some time?

Abe

  • Handlebar Stache
  • *****
  • Posts: 1648
Re: How long can we wait while flattening the curve?
« Reply #778 on: April 19, 2020, 05:21:23 PM »
The main issue is providing enough PPE for the grad students who would run these machines. Why a moderately industrial country canít seem to convert enough factories to producing cloth masks and gloves is beyond my understanding since Iím not in manufacturing. I assume there are some good reasons and some not-so-good reasons. So yeah we should be trying to do more to ramp up but <shrug>. What I do know is we canít divert essential resources from current patients to deal with second-degree fallout from the pandemic. It is also not fair to research labs to be unnecessarily exposed to the virus just to test people faster. My guess is by the time enough PPE gets produced for that work, itíll be a non issue due to the antibody tests coming out.

Spud

  • Stubble
  • **
  • Posts: 161
  • Location: Southwest England, UK.
Re: How long can we wait while flattening the curve?
« Reply #779 on: April 19, 2020, 11:33:18 PM »
His stance is that lockdowns are simply delaying the inevitable in terms of the number of deaths at least the majority of them. You may prevent a lot of deaths initially, but as you begin to lift the restrictions, which he believes should be lifted one by one over a number of months, people may well die. It's unavoidable.
I think that's probably true.

Isn't that missing the point of "flattening the curve," though?

Imagine what would happen if NYC wasn't social isolating and people could go out to Central Park as usual. The 9% of ICU beds remaining would be filled very quickly.

Good points. This is where simple interviews or short internet articles don't really assess why certain approaches might work in some places and not others.

Look at what Sweden has done. Government has advocated working from home if at all possible, avoiding non-essential travel and the elderly are advised to avoid social contact. Regular hand washing has also been promoted. Restaurants, bars, cafťs and nightclubs only offer seated table service with tables spaced at least 6 feet apart. Gatherings of more than 50 people are banned. Universities and colleges are closed, but schools with students under 16 years of age remain open, i.e. the kids who are old enough to not need looking after by parents are the ones who are on leave.

It's all advisory and not enforced in any way at all. That's because Swedish culture is different from America. People are compliant. they trust the government. It's not that they're sheep or have given up on their right to bear arms or some nonsense. They're used to a government that is laissez faire. When it recommends something, people aren't paranoid about some new world order and being controlled. Instead they understand that the recommendation has been made to protect them, so many of them follow it.

If you look at the population distribution (Pop is just over 10 million) ~30% of it is centred around 3 large cities in the south of the country and the rest is scattered, very sparsely, over a massive area.

These cultural and geographical differences are what allow Sweden to "get away with" the kind of measures that would potentially be a riotous failure elsewhere.

It's interesting though. Will the theory hold up that Sweden is simply being hit by deaths now, but then won't experience much of a spike in death rate when it relaxes it's already relaxed measures, whereas countries that have undergone hard lockdown are avoid the deaths now but will see a spike in death rate when they attempt to go back to normal? At this point, nobody knows because different individuals in different nations across the world are going to behave differently when lockdown begins to reverse.

sarah102

  • 5 O'Clock Shadow
  • *
  • Posts: 4
Re: How long can we wait while flattening the curve?
« Reply #780 on: April 20, 2020, 06:15:49 AM »
We have been enforcing lockdown and strict work from home policies, but the question is until when can we contain people? At some point people need to go OUT. I'd say unless we have the vaccine, we may not expect the curve to go flat because there are several factors at play like the resistance of people to being confined in their homes and the actual necessity to go out.

T-Money$

  • Stubble
  • **
  • Posts: 215
  • Location: New York
Re: How long can we wait while flattening the curve?
« Reply #781 on: April 20, 2020, 06:24:20 AM »
I canít speak for Sweden, but for the (northern) European countries I am familiar with there is much less gaslighting with politicians than in the United States. 

The US has itís own cultural quirks, both of a good and bad variety.  I would argue that diversity causes lots of benefits and lots of problems.  While I trust the NHS or the Prime Minister of Denmark, I canít really name any current US politicians I would take seriously.

It is much easier to expect compliance with a moderated approach and have the backing of a strong social welfare state.   In the US, Iíd argue the response has been more rooted in emotion and unfortunately we do not have a strong social safety net or universal health care program.

There is scant epidemiological evidence that schools closings, park closings, outdoor event lockdowns provide much if any public health benefit.  Social distancing appears to have a moderate benefit in a work and school setting.

The curve has effectively been flattened.   Itís time to move to a moderated approach and acknowledge that without pharmaceuticals the only effective solution to end the pandemic is herd immunity through infection. 


JGS1980

  • Bristles
  • ***
  • Posts: 429
Re: How long can we wait while flattening the curve?
« Reply #782 on: April 20, 2020, 06:29:07 AM »
There is scant epidemiological evidence that schools closings, park closings, outdoor event lockdowns provide much if any public health benefit.  Social distancing appears to have a moderate benefit in a work and school setting.

The curve has effectively been flattened.   Itís time to move to a moderated approach and acknowledge that without pharmaceuticals the only effective solution to end the pandemic is herd immunity through infection.

Egilliepsie, it seems you have not read ANYTHING above in response to your repeated insistences on herd immunity (which takes generations). You are arguing in bad faith. Please stop spreading your personal misguided opinion as truth, in this forum or any other.

T-Money$

  • Stubble
  • **
  • Posts: 215
  • Location: New York
Re: How long can we wait while flattening the curve?
« Reply #783 on: April 20, 2020, 06:42:33 AM »
The claim that herd immunity takes generations is simply inaccurate.  Debating overly emotional responses and hypochondria is a futile effort.  The current iFR is estimated 0.10-0.36%, with such low iFR it is debatable that such disruptive policies are warranted.

https://www.jhsph.edu/covid-19/articles/achieving-herd-immunity-with-covid19.html

The most likely case is somewhere in the middle, where infection rates rise and fall over time; we may relax social distancing measures when numbers of infections fall, and then may need to re-implement these measures as numbers increase again. Prolonged effort will be required to prevent major outbreaks until a vaccine is developed. Even then, SARS-CoV-2 could still infect children before they can be vaccinated or adults after their immunity wanes. But it is unlikely in the long term to have the explosive spread that we are seeing right now because much of the population will be immune in the future.

I invite you to read this:

https://www.bmj.com/content/369/bmj.m1434/rr-14
« Last Edit: April 20, 2020, 06:54:02 AM by egillespie »

former player

  • Walrus Stache
  • *******
  • Posts: 5796
  • Location: Avalon
Re: How long can we wait while flattening the curve?
« Reply #784 on: April 20, 2020, 07:02:58 AM »
The claim that herd immunity takes generations is simply inaccurate.  Debating overly emotional responses and hypochondria is a futile effort.  The current iFR is estimated 0.10-0.36%, with such low iFR it is debatable that such disruptive policies are warranted.

https://www.jhsph.edu/covid-19/articles/achieving-herd-immunity-with-covid19.html

The most likely case is somewhere in the middle, where infection rates rise and fall over time; we may relax social distancing measures when numbers of infections fall, and then may need to re-implement these measures as numbers increase again. Prolonged effort will be required to prevent major outbreaks until a vaccine is developed. Even then, SARS-CoV-2 could still infect children before they can be vaccinated or adults after their immunity wanes. But it is unlikely in the long term to have the explosive spread that we are seeing right now because much of the population will be immune in the future.

I invite you to read this:

https://www.bmj.com/content/369/bmj.m1434/rr-14
Right.  But that is not "herd immunity", that is "everyone gets the virus and a percentage of them die of it until there is no one left who hasn't had it".

JGS1980

  • Bristles
  • ***
  • Posts: 429
Re: How long can we wait while flattening the curve?
« Reply #785 on: April 20, 2020, 08:40:06 AM »
The claim that herd immunity takes generations is simply inaccurate.  Debating overly emotional responses and hypochondria is a futile effort.  The current iFR is estimated 0.10-0.36%, with such low iFR it is debatable that such disruptive policies are warranted.

https://www.jhsph.edu/covid-19/articles/achieving-herd-immunity-with-covid19.html

The most likely case is somewhere in the middle, where infection rates rise and fall over time; we may relax social distancing measures when numbers of infections fall, and then may need to re-implement these measures as numbers increase again. Prolonged effort will be required to prevent major outbreaks until a vaccine is developed. Even then, SARS-CoV-2 could still infect children before they can be vaccinated or adults after their immunity wanes. But it is unlikely in the long term to have the explosive spread that we are seeing right now because much of the population will be immune in the future.

I invite you to read this:

https://www.bmj.com/content/369/bmj.m1434/rr-14
Right.  But that is not "herd immunity", that is "everyone gets the virus and a percentage of them die of it until there is no one left who hasn't had it".

Yup

Spud

  • Stubble
  • **
  • Posts: 161
  • Location: Southwest England, UK.
Re: How long can we wait while flattening the curve?
« Reply #786 on: April 20, 2020, 09:29:30 AM »
Right.  But that is not "herd immunity", that is "everyone gets the virus and a percentage of them die of it until there is no one left who hasn't had it".

My understanding is that herd immunity is when enough people in the population have immunity that it protects the people in the population who have no immunity simply because transmission through the community as a whole is slower.

Think of 100 people standing, holding hands in some group formation. Maybe it's like a web or network, not just a straight line. Think of electricity passing through them. They're all connected so it zaps them all. That's what happens if everyone has no immunity and is a conductor of the electricity (virus).

Think of people with immunity as being insulated, wearing big insulated gloves on each hand. The electricity (virus) doesn't pass through them and zap the people they are holding hands with.

Herd immunity is what happens when far more people in the group of 100 are wearing insulated gloves than are not. In such a group, even if you're a conductor with no gloves on your hands, you're far less like to get zapped because more people around you are cutting off the spread of the electricity (virus) because they are insulated both others immunity.

fattest_foot

  • Pencil Stache
  • ****
  • Posts: 844
Re: How long can we wait while flattening the curve?
« Reply #787 on: April 20, 2020, 09:50:52 AM »
In response to js82:

In the rosiest scenario where only 0.25% of folks in the US die of Covid, and it takes only 50% of the population to get infected to allow herd immunity, and that immunity actually persists past 3-4 months (unlike many typical viral infections), and that our medical system does not get overwhelmed again (like NYC or New Orleans), and that infections don't lead to some unknown long term lung, heart, kidney, or brain damage --> that still leaves 165.5 M x 0.25% = 413,750 total deaths if we open everything up again without sufficient testing/tracing/quarantining.

Yes to your point that most cases are mild to moderate, even asymptomatic. This does not change the numbers above.

People are going to die of this. There's nothing that will change that. The treatments we have are the treatments we will have.

The entire point of flattening the curve was so we didn't get additional deaths, because the hospitals couldn't handle the load (or at least, this is what we were sold on).

This idea that we need to keep everyone locked up is baffling to me. At best, that just delays the inevitable deaths a couple weeks.

I keep seeing people say, "But people will die!" I'm sorry you're having to face the reality that people die. It happens. It sucks that this virus is as deadly as it is, but locking up healthy people doesn't do anyone any good. We'll eventually have to face the music here. We should cut our economic losses and maybe we can develop some herd immunity before it gets cold again and flu season hits and we don't get a double whammy of viruses.

Edit: Apparently I should've kept reading before responding as the very next post addressed this.
« Last Edit: April 20, 2020, 09:52:24 AM by fattest_foot »

Bloop Bloop

  • Handlebar Stache
  • *****
  • Posts: 2140
  • Location: Melbourne, Australia
Re: How long can we wait while flattening the curve?
« Reply #788 on: April 20, 2020, 10:06:42 AM »
A good starting point would be to agree on a rough economic value for each life-year lost either to covid or to financial strain and then try to do the modelling for covid-19 life years lost versus financial strain/bankruptcy/suicide life years lost. We really do need to have a proper estimate. No sense saying we need to protect lives at all costs because nowhere in society do we truly aim to protect all lives at all costs. There is always an allocation of resources issue.

former player

  • Walrus Stache
  • *******
  • Posts: 5796
  • Location: Avalon
Re: How long can we wait while flattening the curve?
« Reply #789 on: April 20, 2020, 10:08:54 AM »
Quote from this article -
https://www.jhsph.edu/covid-19/articles/achieving-herd-immunity-with-covid19.html

"Depending how contagious an infection is, usually 70% to 90% of a population needs immunity to achieve herd immunity."

So the minimum infection rate for covid-19 is probably 70%.  There is no known maximum: the contagion is easily passed on and length (if any) of immunity after contagion is unknown so it is entirely possible that 90% or even more of the population will get this disease.

In that context what "herd immunity" pretty much means is "everyone is susceptible to this disease and it is likely to hang around until just about everyone has had it".  Again, as the article referenced above states "But unless we want hundreds of millions of Americans to get infected with SARS-CoV-2 (what it would take to establish herd immunity in this country), life is not likely to be completely ďnormalĒ again until a vaccine can be developed and widely distributed."

If hundreds of millions of Americans (billions of people all around the world) get the virus then the chances of it dying out naturally through "herd immunity" are pretty much nil: pockets of infection will keep coming up and spreading around.

"Herd immunity" will not save any of us from this disease.  What might save us is the availability of medical treatments and in due course a vaccine.



mathlete

  • Handlebar Stache
  • *****
  • Posts: 1638
Re: How long can we wait while flattening the curve?
« Reply #790 on: April 20, 2020, 10:09:36 AM »
People are going to die of this. There's nothing that will change that. The treatments we have are the treatments we will have.

The entire point of flattening the curve was so we didn't get additional deaths, because the hospitals couldn't handle the load (or at least, this is what we were sold on).

This idea that we need to keep everyone locked up is baffling to me. At best, that just delays the inevitable deaths a couple weeks.

I keep seeing people say, "But people will die!" I'm sorry you're having to face the reality that people die. It happens. It sucks that this virus is as deadly as it is, but locking up healthy people doesn't do anyone any good. We'll eventually have to face the music here. We should cut our economic losses and maybe we can develop some herd immunity before it gets cold again and flu season hits and we don't get a double whammy of viruses.

Edit: Apparently I should've kept reading before responding as the very next post addressed this.

Two things. One, "locking up healthy people" absolutely does good. It keeps them from, wittingly or not, becoming disease vectors that could kill the elderly and immunocompromised. Two is that I object to the terminology, "locking people up". I think it's pretty severe hyperbole.

And the general consensus seems to be that we should be finding ways to open up safely. The US government definitely wants to do it at the Federal level. I'm a pretty "pro lockdown" poster here and I'm not opposed to phasing back in "normalcy". The lockdown has done and is doing good things. It's brought R0 down. It's prevented hospitals from being overloaded as you mentioned. It's bought us time to develop treatments. It's (we'll see how important this is) gotten us through respiratory illness season in the northern hemisphere.

If scientific consensus is that we've gained most of the marginal benefits from locking down and we can start opening up, then great. What I object to, especially in the United States, is that we need to lean on hyperbole to get people out of their homes ASAP so they can... continue to serve capital interests. The US Central Bank can fabricate money out of thin air and the government can borrow it at near zero interest rates. We have the tools to combat the economic issues here if we want to use them.

mathlete

  • Handlebar Stache
  • *****
  • Posts: 1638
Re: How long can we wait while flattening the curve?
« Reply #791 on: April 20, 2020, 10:14:18 AM »
A good starting point would be to agree on a rough economic value for each life-year lost either to covid or to financial strain and then try to do the modelling for covid-19 life years lost versus financial strain/bankruptcy/suicide life years lost. We really do need to have a proper estimate. No sense saying we need to protect lives at all costs because nowhere in society do we truly aim to protect all lives at all costs. There is always an allocation of resources issue.

The government does this. The number is about $10 million per life. https://www.npr.org/transcripts/835571843

In that context, every 100K lives saved is worth a trillion dollars. After that, you can quibble over how much we're actually spending to save these lives. e.g., is it really spending a trillion dollars if you borrow it at zero percent interest and you expect a lot of it to be paid back? Is a 3% decline in GDP spent money if we expect a big rebound after this is over?

The weakness in the government number, if you want to call it a weakness, is that it values all life equally. So saving a 75 year old from dying from COVID is worth as much as saving a child from drinking bleach or something.

mm1970

  • Walrus Stache
  • *******
  • Posts: 8290
Re: How long can we wait while flattening the curve?
« Reply #792 on: April 20, 2020, 10:17:52 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
Interesting I know several people that have all of the symptoms and are sick as hell but have been refused testing here in Colorado.

Even one that was in the hospital and told they should assume they have it but weíre not tested due to not being in an at risk group.

I really do not get it


Sent from my iPhone using Tapatalk
Same here, not enough testing available.  Plenty of people think they have it or did, but haven't been tested.

Our positive rate, however, is about 20-25%.  So that means, most likely, among all sick people who think they have COVID-19, probably only 20-25% actually do/ did.

mathlete

  • Handlebar Stache
  • *****
  • Posts: 1638
Re: How long can we wait while flattening the curve?
« Reply #793 on: April 20, 2020, 10:20:03 AM »
Same here, not enough testing available.  Plenty of people think they have it or did, but haven't been tested.

Our positive rate, however, is about 20-25%.  So that means, most likely, among all sick people who think they have COVID-19, probably only 20-25% actually do/ did.

At most, IMO. Unless our triage / prioritizing is terrible, I would guess that the people getting tested are more likely to have it than people not getting tested.

Bloop Bloop

  • Handlebar Stache
  • *****
  • Posts: 2140
  • Location: Melbourne, Australia
Re: How long can we wait while flattening the curve?
« Reply #794 on: April 20, 2020, 10:40:08 AM »
A good starting point would be to agree on a rough economic value for each life-year lost either to covid or to financial strain and then try to do the modelling for covid-19 life years lost versus financial strain/bankruptcy/suicide life years lost. We really do need to have a proper estimate. No sense saying we need to protect lives at all costs because nowhere in society do we truly aim to protect all lives at all costs. There is always an allocation of resources issue.

The government does this. The number is about $10 million per life. https://www.npr.org/transcripts/835571843

In that context, every 100K lives saved is worth a trillion dollars. After that, you can quibble over how much we're actually spending to save these lives. e.g., is it really spending a trillion dollars if you borrow it at zero percent interest and you expect a lot of it to be paid back? Is a 3% decline in GDP spent money if we expect a big rebound after this is over?

The weakness in the government number, if you want to call it a weakness, is that it values all life equally. So saving a 75 year old from dying from COVID is worth as much as saving a child from drinking bleach or something.

So in that case, using Australia as an example, our total stimulus has been around $200 billion. So that's 20,000 lives saved. I'm not sure what the modelling shows would have been the opportunity cost of not locking down at all versus a partial lockdown etc but I know that for my state, which has about 1/4 the population of Australia, the "no lockdown at all, worst case" scenario was for about 36,000 deaths so if we apply that to all of Australia (=150,000 deaths), the money spent (to date) has been much less than the economic impact of the absolute worst case scenario.

 https://www.abc.net.au/news/2020-04-20/victoria-records-one-new-confirmed-coronavirus-case/12163658

However, it is notable that with just 5 weeks of staggered lockdowns (at worst stage 3, not approaching the stage 4 of total lockdown e.g. New Zealand), we have reduced the death toll in my state to 15. That suggests that perhaps we have gone in too hard, because spending $200 billion (in economic costs ) to save 75 lives nationwide doesn't really gel with the actuarial picture.

So it seems like a "let it all blow over" mentality would have been a terrible waste of lives, but our fairly stringent lockdown (with devastating effects on the economy) has been perhaps a step too far. I accept that it is hard to know when a lockdown is going to work so it makes sense to go hard, but now it makes more sense to lift lockdown quickly, as countries all over the world are doing. You lift it based on the economic matrix, not based on trying to prevent anyone at all from dying.

Of course, you might say that the total economic cost of X deaths would have been greater because it would have also led to lots of severe respiratory ailments and added stress on the healthcare system, but by the same token most of those deaths would have been people whose life-years left would be significantly less than median (since they're likely to be old).

In any case, I would have liked to have seen robust discussion on the topic with some input from actuaries, scientists and epidemiologists. Instead, the government refused to give us any of its modelling (best case/worst case) at all, till now, when it's all over red rover.
« Last Edit: April 20, 2020, 10:46:04 AM by Bloop Bloop »

mathlete

  • Handlebar Stache
  • *****
  • Posts: 1638
Re: How long can we wait while flattening the curve?
« Reply #795 on: April 20, 2020, 10:48:58 AM »
A good starting point would be to agree on a rough economic value for each life-year lost either to covid or to financial strain and then try to do the modelling for covid-19 life years lost versus financial strain/bankruptcy/suicide life years lost. We really do need to have a proper estimate. No sense saying we need to protect lives at all costs because nowhere in society do we truly aim to protect all lives at all costs. There is always an allocation of resources issue.

The government does this. The number is about $10 million per life. https://www.npr.org/transcripts/835571843

In that context, every 100K lives saved is worth a trillion dollars. After that, you can quibble over how much we're actually spending to save these lives. e.g., is it really spending a trillion dollars if you borrow it at zero percent interest and you expect a lot of it to be paid back? Is a 3% decline in GDP spent money if we expect a big rebound after this is over?

The weakness in the government number, if you want to call it a weakness, is that it values all life equally. So saving a 75 year old from dying from COVID is worth as much as saving a child from drinking bleach or something.

So in that case, using Australia as an example, our total stimulus has been around $200 billion. So that's 20,000 lives saved. I'm not sure what the modelling shows would have been the opportunity cost of not locking down at all versus a partial lockdown etc but I know that for my state, which has about 1/4 the population of Australia, the "no lockdown at all, worst case" scenario was for about 36,000 deaths so if we apply that to all of Australia (=150,000 deaths), the money spent (to date) has been much less than the economic impact of the absolute worst case scenario.

 https://www.abc.net.au/news/2020-04-20/victoria-records-one-new-confirmed-coronavirus-case/12163658

However, it is notable that with just 5 weeks of staggered lockdowns (at worst stage 3, not approaching the stage 4 of total lockdown e.g. New Zealand), we have reduced the death toll in my state to 15. That suggests that perhaps we have gone in too hard, because spending $200 billion (in economic costs ) to save 75 lives nationwide doesn't really gel with the actuarial picture.

So it seems like a "let it all blow over" mentality would have been a terrible waste of lives, but our fairly stringent lockdown (with devastating effects on the economy) has been perhaps a step too far. I accept that it is hard to know when a lockdown is going to work so it makes sense to go hard, but now it makes more sense to lift lockdown quickly, as countries all over the world are doing. You lift it based on the economic matrix, not based on trying to prevent anyone at all from dying.

Of course, you might say that the total economic cost of X deaths would have been greater because it would have also led to lots of severe respiratory ailments and added stress on the healthcare system, but by the same token most of those deaths would have been people whose life-years left would be significantly less than median (since they're likely to be old).

In any case, I would have liked to have seen robust discussion on the topic with some input from actuaries, scientists and epidemiologists. Instead, the government refused to give us any of its modelling (best case/worst case) at all, till now, when it's all over red rover.

Gosh, so many Australians here! I really do try my best to put in modifiers when I know I'm in a global audience. I should have said that the US Government's number is $10 mil. I try not to be America-centric but it's hard when you're raised to believe the world revolves around your country. ;)

Kris

  • Walrus Stache
  • *******
  • Posts: 5664
Re: How long can we wait while flattening the curve?
« Reply #796 on: April 20, 2020, 10:53:56 AM »
I read every US news site that I can, including Fox news just to get the weird side of the coin. It really seems to me that Americans, even ones in high positions, just simply don't get what's happening in their country. This thing grows exponentially. There's no "missing the boat" on flattening the curve. Either you do something about it, or it will continue to grow exponentially. Stay at home. Limit things from now. Yes, you will still have the worst number of deaths in the world, but that will only increase. When will you guys get it? When you've lost more to covid than to the Vietnam War? Stay at home.

I think it's really a testament to the crisis of leadership that the US is undergoing.  The president regularly lies during his covid briefings (or uses them as campaign rallies more recently).  He fails to answer basic questions from the press.  He has made wrong moves all along as this has unfolded, and continues to make wrong moves (encouraging people to break quarantine and hold covid rallies).

In the absence of leadership during crisis, there is chaos.

Agreed. I keep thinking how much better a position we would have been in if Obama were still president right now.

Itís depressing.

mathlete

  • Handlebar Stache
  • *****
  • Posts: 1638
Re: How long can we wait while flattening the curve?
« Reply #797 on: April 20, 2020, 10:57:13 AM »

I think it's really a testament to the crisis of leadership that the US is undergoing.  The president regularly lies during his covid briefings (or uses them as campaign rallies more recently).  He fails to answer basic questions from the press.  He has made wrong moves all along as this has unfolded, and continues to make wrong moves (encouraging people to break quarantine and hold covid rallies).

In the absence of leadership during crisis, there is chaos.

Agreed. I keep thinking how much better a position we would have been in if Obama were still president right now.

Itís depressing.

I think it would be bad no matter what. For context, that means severe economic disruption and five figure deaths.

One thing that absolutely would be better though, is consistency of messaging. Some days, he strikes a somber tone and talks of extending lockdown guidance. Then he wants churches packed for Easter. Then it's back to extending lockdown guidance. Now it's, "LIBERATE MICHIGAN" or whatever. All this does is create confusion and angst.

aspiringnomad

  • Pencil Stache
  • ****
  • Posts: 936
Re: How long can we wait while flattening the curve?
« Reply #798 on: April 20, 2020, 11:22:22 AM »
The president is a self-aggrandizing moron, but when push comes to shove he has listened to the experts, and lucky for us, Dr. Fauci and Dr. Birx are the experts we want in his ear. They and other experts have kept the administration's response from veering into complete catastrophe. An Obama administration would have had a plan in place sooner and certainly more consistent messaging of that plan, and that likely would have led to better mortality outcomes, but as mathlete says things would still be bad. Beyond the difference in health outcomes, there would likely be no semblance of bipartisanship from the opposition (especially in an election year) as the GOP would be screaming bloody murder about the lockdowns and the government's monetary and fiscal stimulus. So, yes, probably somewhat better health outcomes under Obama, but things would still be very ugly.

In hopeful news, I found this Q&A on the Oxford vaccine candidate to be promising (free to read but registration required):
https://www.medscape.com/viewarticle/928941

nereo

  • Senior Mustachian
  • ********
  • Posts: 13536
  • Location: Just south of Canada
    • Here's how you can support science today:
Re: How long can we wait while flattening the curve?
« Reply #799 on: April 20, 2020, 11:42:08 AM »


People are going to die of this. There's nothing that will change that. The treatments we have are the treatments we will have.

The entire point of flattening the curve was so we didn't get additional deaths, because the hospitals couldn't handle the load (or at least, this is what we were sold on).


Again, you are mistaken that the only reason for the isolation policies is to prevent additional deaths from overwhelmed hospitals.
Simply put, if only a small percentage of your population is infectious, the number of new infections remains small, and an individuals' ability to avoid becoming infected is much, much better.

By isolating many communities have brought infections down markedly (i.e. most infected people move to 'recovered').  that means total infections drops.