Author Topic: How long can we wait while flattening the curve?  (Read 253717 times)

Slee_stack

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Re: How long can we wait while flattening the curve?
« Reply #850 on: April 21, 2020, 07:56:14 AM »
I still don't understand why the "shut down" is being blamed for all the economic consequences as if the economy would just be humming along if we let this virus run wild.  As if consumers would still be packing cruise ships and stadiums, and all local restaurants would be filled to capacity with healthy consumers spending recklessly, everyone would retain their jobs, and your networth would be inching ever higher unimpeded.  As if we wouldn't have droves and droves of productive workers getting sick and taking multiple weeks off work, or worse yet dying.  I know I've stated it before, but there is absolutely no scenario where this didn't have a major economic impact resulting in a recession/depression.  The economy tanking is a result of the VIRUS not the SHUTDOWN.  It's a forgone conclusion. 

Deaths are almost certainly being vastly under reported everywhere and we won't know the real numbers until sometime in the future, but we know they will go up.  There will be a significant number of mysterious unexplained deaths that will end up being attributed to covid-19, and in contrast there will be no currently confirmed positive deaths that will be later retracted.  Even with us under reporting the deaths, and having stringent enough lockdowns to draw protests in multiple states, this thing has still gone from not even being on the radar 6 weeks ago to being the leading cause of death in the USA.
Are people blaming the economic consequences 100% on it?

How much do you attribute it to?

Why do so many people require a black and white?

I am beginning to think we will be in a darker grey place overall if a general shutdown continues.

I also believe that that is what most rational arguers are also saying.

Personally, I don't go to sporting events or concerts or go on cruises anyway.  Do the majority of people?  Regardless, a large portion of folks that indeed do do so, would go anyway...risk or no risk.  Maybe half of all people would never be out sick from work anyhow because they were asymptomatic.

The conservative side here is arguing quite a bit with little accounting for the more difficult to gauge negative side of a general lockdown.

Beyond the direct benefit of some number of immediate lives saved, there seems to be no further argument.  That sounds a bit overzealous to me.

What is your personal opinion on what we wait for and how much longer would provide an overall positive long term net outcome?

« Last Edit: April 21, 2020, 07:58:12 AM by Slee_stack »

Wolfpack Mustachian

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Re: How long can we wait while flattening the curve?
« Reply #851 on: April 21, 2020, 08:07:59 AM »
I still don't understand why the "shut down" is being blamed for all the economic consequences as if the economy would just be humming along if we let this virus run wild.  As if consumers would still be packing cruise ships and stadiums, and all local restaurants would be filled to capacity with healthy consumers spending recklessly, everyone would retain their jobs, and your networth would be inching ever higher unimpeded.  As if we wouldn't have droves and droves of productive workers getting sick and taking multiple weeks off work, or worse yet dying.  I know I've stated it before, but there is absolutely no scenario where this didn't have a major economic impact resulting in a recession/depression.  The economy tanking is a result of the VIRUS not the SHUTDOWN.  It's a forgone conclusion. 

Deaths are almost certainly being vastly under reported everywhere and we won't know the real numbers until sometime in the future, but we know they will go up.  There will be a significant number of mysterious unexplained deaths that will end up being attributed to covid-19, and in contrast there will be no currently confirmed positive deaths that will be later retracted.  Even with us under reporting the deaths, and having stringent enough lockdowns to draw protests in multiple states, this thing has still gone from not even being on the radar 6 weeks ago to being the leading cause of death in the USA.
Are people blaming the economic consequences 100% on it?

How much do you attribute it to?

Why do so many people require a black and white?

I am beginning to think we will be in a darker grey place overall if a general shutdown continues.

I also believe that that is what most rational arguers are also saying.

Personally, I don't go to sporting events or concerts or go on cruises anyway.  Do the majority of people?  Regardless, a large portion of folks that indeed do do so, would go anyway...risk or no risk.  Maybe half of all people would never be out sick from work anyhow because they were asymptomatic.

The conservative side here is arguing quite a bit with little accounting for the more difficult to gauge negative side of a general lockdown.

Beyond the direct benefit of some number of immediate lives saved, there seems to be no further argument.  That sounds a bit overzealous to me.

What is your personal opinion on what we wait for and how much longer would provide an overall positive long term net outcome?

To this point, even if you can say, current conditions right now, it's not good enough, what do you or anyone say is the point when it is good enough? What metric would you favor to use to determine this? I have certainly not exhaustively researched this, but in my limited reading, I have not seen anything (well one thing maybe - the vaccine) that's been proposed as a goal post for when we can remove the shutdown (even if still not allowing large scale events). That's a huge challenge, imo, for many in terms of the shutdown. It's the same reason why people on here in arguments get frustrated when people move the goal posts in a debate. We all want to have an end and know what it is we're going towards/arguing about/etc. So what is that end? The only one I've heard hard and fast and then not completely hard and fast but pretty much so is a vaccine. Is that the end goal? If so, we need to face some harsh realities if we're going to be full on shutdown until a vaccine is completely rolled out. I completely admit I may be missing this information if it's out there somewhere, so if so, please educate me.

Slee_stack

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Re: How long can we wait while flattening the curve?
« Reply #852 on: April 21, 2020, 08:24:38 AM »
I absolutely agree with you Wolfpack.

I HOPE a very effective treatment becomes the widely accepted trigger, but if it doesn't?

Would a 12 month lockdown truly be a net long term positive?  I wouldn't personally wager so.

Incidentally, I started a poll for opinions here: https://forum.mrmoneymustache.com/welcome-to-the-forum/opinion-on-how-long-lockdown-must-last/.

frugalnacho

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Re: How long can we wait while flattening the curve?
« Reply #853 on: April 21, 2020, 08:26:01 AM »
I still don't understand why the "shut down" is being blamed for all the economic consequences as if the economy would just be humming along if we let this virus run wild.  As if consumers would still be packing cruise ships and stadiums, and all local restaurants would be filled to capacity with healthy consumers spending recklessly, everyone would retain their jobs, and your networth would be inching ever higher unimpeded.  As if we wouldn't have droves and droves of productive workers getting sick and taking multiple weeks off work, or worse yet dying.  I know I've stated it before, but there is absolutely no scenario where this didn't have a major economic impact resulting in a recession/depression.  The economy tanking is a result of the VIRUS not the SHUTDOWN.  It's a forgone conclusion. 

Deaths are almost certainly being vastly under reported everywhere and we won't know the real numbers until sometime in the future, but we know they will go up.  There will be a significant number of mysterious unexplained deaths that will end up being attributed to covid-19, and in contrast there will be no currently confirmed positive deaths that will be later retracted.  Even with us under reporting the deaths, and having stringent enough lockdowns to draw protests in multiple states, this thing has still gone from not even being on the radar 6 weeks ago to being the leading cause of death in the USA.
Are people blaming the economic consequences 100% on it?

How much do you attribute it to?

Why do so many people require a black and white?

I am beginning to think we will be in a darker grey place overall if a general shutdown continues.

I also believe that that is what most rational arguers are also saying.

Personally, I don't go to sporting events or concerts or go on cruises anyway.  Do the majority of people?  Regardless, a large portion of folks that indeed do do so, would go anyway...risk or no risk.  Maybe half of all people would never be out sick from work anyhow because they were asymptomatic.

The conservative side here is arguing quite a bit with little accounting for the more difficult to gauge negative side of a general lockdown.

Beyond the direct benefit of some number of immediate lives saved, there seems to be no further argument.  That sounds a bit overzealous to me.

What is your personal opinion on what we wait for and how much longer would provide an overall positive long term net outcome?

I'm not saying the shutdown has no effect, but it's a fallacy to say it's causing it.  The virus by and large is what is causing it.  Who attends sporting events and cruises, etc? Hundreds of millions of people.  The size of the sports industry is measured in the trillions of dollars per year. I seriously doubt that a large portion would continue to do so if there were no restrictions.  Certainly not a large enough portion to sustain them economically.  And if large portions of untested people actually did continue to attend it would only exacerbate the current problem. And if 50% of people are asymptomatic that means that 50% are symptomatic, and having all those asymptomatic people walking around in concerts and sporting events spreading the virus would be an absolute disaster.  I mean it's already an absolute disaster with all these restrictions in place, it's almost unimaginable what the carnage would be if everyone just continued with business as usual. 

How much longer should we wait? Until they can get some fucking tests.  I know people that are literally dying (and some that have died) and still can't get tested, so I certainly don't want to walk around hundreds or thousands of untested asymptomatic people that could infect me and my family.  This isn't some abstract number of lives in some far off country, this is literally my life, my friend's lives, and my loved ones and family's lives that are potentially being saved.

I'm not saying we can't all get back in the water, but maybe let's check if it's shark infested first?

skp

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Re: How long can we wait while flattening the curve?
« Reply #854 on: April 21, 2020, 08:30:21 AM »
Maybe I'm stupid but I don't get how testing people is going to make a huge difference. OK.. so you test a person and they are negative... for that moment.  They walk out the door and are exposed.  Now they are infectious.  How often are you going to test them?   Adding... IMO an effective treatment would be more beneficial. 

former player

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Re: How long can we wait while flattening the curve?
« Reply #855 on: April 21, 2020, 08:30:43 AM »
NZ is moving into a very strict level 3 lockdown, we have single digit cases per day, we have 13 deaths in total, and we have no evidence of community spread despite quite significant testing. Unless other countries have that picture, it's ridiculous to suggest that they reopen. Your train of thought may well be shared by the USA. We'll see how well that works for them.

I think this is the fallacy of looking at the US as a whole, instead of regions (or states, but even our states vary in size dramatically).

I've mentioned it before, but my county in California has nearly a million people (1/4 the population of NZ). We've had 3 deaths. It's been at 3 for over 2 weeks now.

If you take NYC out of the picture, the US doesn't look quite as bad. We're applying policy to an entire country based on a situation in a tiny region of the country.
I thought the USA did have restrictions imposed State by State rather than federally?

I also live in an area, in the UK, which hasn't been badly affected.  But we are only two hundred miles from an area which has been badly affected, from which people regularly travel to my area for business and holidays.  Without the lockdown in place there are no border controls between the two. Do we loosen the lockdown here on the grounds that we are not badly affected, or do we retain it until the neighbouring area is under control so that significant levels of infection don't come down here?  Looking only at our area then it would seem that lockdown could be (gradually) lifted but how do we deal with the risk of people bringing the virus with them?

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #856 on: April 21, 2020, 08:33:57 AM »
Maybe I'm stupid but I don't get how testing people is going to make a huge difference. OK.. so you test a person and they are negative... for that moment.  They walk out the door and are exposed.  Now they are infectious.  How often are you going to test them?   Adding... IMO an effective treatment would be more beneficial.

By testing, you find out where the outbreaks are and you can tailor precautions accordingly.

Slee_stack

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Re: How long can we wait while flattening the curve?
« Reply #857 on: April 21, 2020, 08:34:23 AM »
I still don't understand why the "shut down" is being blamed for all the economic consequences as if the economy would just be humming along if we let this virus run wild.  As if consumers would still be packing cruise ships and stadiums, and all local restaurants would be filled to capacity with healthy consumers spending recklessly, everyone would retain their jobs, and your networth would be inching ever higher unimpeded.  As if we wouldn't have droves and droves of productive workers getting sick and taking multiple weeks off work, or worse yet dying.  I know I've stated it before, but there is absolutely no scenario where this didn't have a major economic impact resulting in a recession/depression.  The economy tanking is a result of the VIRUS not the SHUTDOWN.  It's a forgone conclusion. 

Deaths are almost certainly being vastly under reported everywhere and we won't know the real numbers until sometime in the future, but we know they will go up.  There will be a significant number of mysterious unexplained deaths that will end up being attributed to covid-19, and in contrast there will be no currently confirmed positive deaths that will be later retracted.  Even with us under reporting the deaths, and having stringent enough lockdowns to draw protests in multiple states, this thing has still gone from not even being on the radar 6 weeks ago to being the leading cause of death in the USA.
Are people blaming the economic consequences 100% on it?

How much do you attribute it to?

Why do so many people require a black and white?

I am beginning to think we will be in a darker grey place overall if a general shutdown continues.

I also believe that that is what most rational arguers are also saying.

Personally, I don't go to sporting events or concerts or go on cruises anyway.  Do the majority of people?  Regardless, a large portion of folks that indeed do do so, would go anyway...risk or no risk.  Maybe half of all people would never be out sick from work anyhow because they were asymptomatic.

The conservative side here is arguing quite a bit with little accounting for the more difficult to gauge negative side of a general lockdown.

Beyond the direct benefit of some number of immediate lives saved, there seems to be no further argument.  That sounds a bit overzealous to me.

What is your personal opinion on what we wait for and how much longer would provide an overall positive long term net outcome?

I'm not saying the shutdown has no effect, but it's a fallacy to say it's causing it.  The virus by and large is what is causing it.  Who attends sporting events and cruises, etc? Hundreds of millions of people.  The size of the sports industry is measured in the trillions of dollars per year. I seriously doubt that a large portion would continue to do so if there were no restrictions.  Certainly not a large enough portion to sustain them economically.  And if large portions of untested people actually did continue to attend it would only exacerbate the current problem. And if 50% of people are asymptomatic that means that 50% are symptomatic, and having all those asymptomatic people walking around in concerts and sporting events spreading the virus would be an absolute disaster.  I mean it's already an absolute disaster with all these restrictions in place, it's almost unimaginable what the carnage would be if everyone just continued with business as usual. 

How much longer should we wait? Until they can get some fucking tests.  I know people that are literally dying (and some that have died) and still can't get tested, so I certainly don't want to walk around hundreds or thousands of untested asymptomatic people that could infect me and my family.  This isn't some abstract number of lives in some far off country, this is literally my life, my friend's lives, and my loved ones and family's lives that are potentially being saved.

I'm not saying we can't all get back in the water, but maybe let's check if it's shark infested first?
What tests?  Antibody tests?

What about the people who don't have antibodies?  Do they isolate until there's a vaccine?  What if there isn't ever an effective vaccine?

A test just won't solve the larger problem.

Maybe folks don't want to admit it, but barring an accepted, effective treatment...or waiting 12 months for a hoped vaccine.... there really needs to be acceptance that more deaths will have to occur. ...

Unless someone truly believes a suppressed economy is not a problem long term.

bacchi

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Re: How long can we wait while flattening the curve?
« Reply #858 on: April 21, 2020, 08:34:37 AM »
I absolutely agree with you Wolfpack.

I HOPE a very effective treatment becomes the widely accepted trigger, but if it doesn't?

Would a 12 month lockdown truly be a net long term positive?  I wouldn't personally wager so.

Incidentally, I started a poll for opinions here: https://forum.mrmoneymustache.com/welcome-to-the-forum/opinion-on-how-long-lockdown-must-last/.

What we're desperately missing before we reopen is tests. We need millions of tests. Only then can we figure out who is sick and who has had it instead of reopening because of a vague feeling of, "It's time to start working again!"

This is what governments should be doing but we're strangely resistant to it. Georgia is reopening movie theaters and gyms next week and is in the bottom 10 states of testing.

We'll know if it works in 3-4 weeks. We'll also see if the "YOLO" approach to reopening lasts if/when the numbers spike.

frugalnacho

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Re: How long can we wait while flattening the curve?
« Reply #859 on: April 21, 2020, 08:34:54 AM »
I absolutely agree with you Wolfpack.

I HOPE a very effective treatment becomes the widely accepted trigger, but if it doesn't?

Would a 12 month lockdown truly be a net long term positive?  I wouldn't personally wager so.

Incidentally, I started a poll for opinions here: https://forum.mrmoneymustache.com/welcome-to-the-forum/opinion-on-how-long-lockdown-must-last/.

It's testing man.  The top experts have been saying it for months, and everyone else has been saying it for months as well.  You have to perform lots and lots of testing to understand the risk level.  A vaccine and a treatment are long term options, but they aren't here now, so you have to minimize risk by minimizing your exposure, and you can't possibly do that if you have no idea who is infected.  Opening the economy and going back to business as usual without knowing how many infected people there are could be a potentially catastrophic mistake.  It could marginally improve your economy as well, but unfortunately there is no take backs.  If you open prematurely and tens of thousands of people get sick and continue spreading the virus, there is no going back to a previous save point, you just have to deal with an overloaded healthcare system and tons of dead bodies like so many countries and states are currently doing.

GuitarStv

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Re: How long can we wait while flattening the curve?
« Reply #860 on: April 21, 2020, 08:37:25 AM »
Maybe I'm stupid but I don't get how testing people is going to make a huge difference. OK.. so you test a person and they are negative... for that moment.  They walk out the door and are exposed.  Now they are infectious.  How often are you going to test them?   Adding... IMO an effective treatment would be more beneficial.

If we have fast and easy to access tests then we can protect those who are most vulnerable.  Every health care worker in an old age home should be tested daily for example.  That should mean that we can more safely open things up.

If we have no tests like that, then every time a health care worker enters an old age home, it could spell the death of 80% of the residents in the home.  Or it might not.  We don't know.

JGS1980

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Re: How long can we wait while flattening the curve?
« Reply #861 on: April 21, 2020, 08:42:22 AM »
Not just more tests, but high quality tests with low false positive rates and even lower false negative rates.

What happens if the test is negative, but the patient actually has Covid? Well, that patient will continue spreading it to everyone around them.

Right now, some of the tests actually have high false negative rates, which can spell doom for large populations.

The current most rapid test has a 14.8% false negative rate --> uh oh!!!

https://www.npr.org/sections/health-shots/2020/04/21/838794281/study-raises-questions-about-false-negatives-from-quick-covid-19-test

frugalnacho

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Re: How long can we wait while flattening the curve?
« Reply #862 on: April 21, 2020, 08:43:22 AM »
Maybe I'm stupid but I don't get how testing people is going to make a huge difference. OK.. so you test a person and they are negative... for that moment.  They walk out the door and are exposed.  Now they are infectious.  How often are you going to test them?   Adding... IMO an effective treatment would be more beneficial.

Because if you know someone is positive (even without symptoms) you can take appropriate precautions and stop them from spreading the virus to other people who might not be asymptomatic.  We have over 32k cases in michigan, most of them concentrated in the metro detroit region.  I personally know a bunch of people that are presumed positive but can't get tested because they only have enough tests to test the gravely ill.  So the number of infected here is certainly much more than the official 32k count.  People that are asymptomatic are not being tested either, because we don't even have enough tests for people are very symptomatic, so if 50% of people are asymptomatic that means we have at least 32k assholes walking around the detroit area right now spreading this virus.  If we had concerts, sporting events, restaurants, etc open it would be a catastrophic disaster because all of those people would be breathing and in close proximity to uninfected people. 

"They walk out the door and they are exposed.  Now they are infectious."  Yes, that is exactly the problem, and that is exactly what is trying to be stopped by the shutdowns.  We don't know who is infectious because we can't test them, so it's prudent to assume everyone is infected.

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #863 on: April 21, 2020, 08:46:51 AM »
I must sound like a broken record at this point, but areas that have been less impacted in the United States have been so because of precautions. Characterizing this as a New York problem (really a Tri-state + Midwest + Louisiana problem) shows a fundamental misunderstanding of how viruses work. The Tri-state area got it the worst because of travel from Europe. If we didn't severely curtail interstate travel, and if Texans and Californians were gathering in large groups and going to crowded bars and restaurants, the numbers would be much worse.

If Texans and Californians had it as bad as Louisiana does, we'd be looking at another 20,000 deaths. If, god forbid, they had it as bad as New York, we'd be looking at another 65,000 deaths.

The precautions are working, and because they're working, you're getting a lot of cheap second guessing, which is unsurprising. I want to get back to normal too. And we will. But we gotta get this right.

frugalnacho

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Re: How long can we wait while flattening the curve?
« Reply #864 on: April 21, 2020, 08:49:32 AM »
What tests?  Antibody tests?

What about the people who don't have antibodies?  Do they isolate until there's a vaccine?  What if there isn't ever an effective vaccine?

A test just won't solve the larger problem.

Maybe folks don't want to admit it, but barring an accepted, effective treatment...or waiting 12 months for a hoped vaccine.... there really needs to be acceptance that more deaths will have to occur. ...

Unless someone truly believes a suppressed economy is not a problem long term.

No one is trying to stop all deaths.  That's not a realistic goal, and no one is claiming it is.  But it's completely asinine to say since some deaths are inevitable there is no point in trying to minimize them.  100k deaths is better than 1M, no?

Slee_stack

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Re: How long can we wait while flattening the curve?
« Reply #865 on: April 21, 2020, 08:51:26 AM »
OK.  I am buying a testing argument, but do have a caveat.

Obviously these tests would need to ubiquitous and fast.

Additionally everyone would need to be tested repeatedly (daily?) until they have an 'Antibody Passport'.

Setting aside how feasible this type of testing regime would be to enforce, how long would it take to get these tests distributed?

Where would these tests need to be beyond Nursing Homes and hospitals (and other immediate high risk centers)?

Again, what does this look like time wise, and what can we afford LT outcome wise?

What do all other places do in the interim?

If testing can be effectively deployed and implemented within the next few months, I'll flip back to the conservative side.

I'm a bit suspect at present though.

Shane

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Re: How long can we wait while flattening the curve?
« Reply #866 on: April 21, 2020, 08:52:16 AM »
Given the stakes, it seems like it would be worthwhile for the US government to administer tests to all 330MM+ residents, separate out everyone who tests positive and put them into field hospitals for two weeks or until the test negative. Then, go back and test everybody in the country, again. Rinse and repeat, until everyone tests negative. Sure, it would cost billions of dollars, but so what? Seems like the alternative is going to end up costing a lot more.

frugalnacho

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Re: How long can we wait while flattening the curve?
« Reply #867 on: April 21, 2020, 08:53:43 AM »
I must sound like a broken record at this point, but areas that have been less impacted in the United States have been so because of precautions. Characterizing this as a New York problem (really a Tri-state + Midwest + Louisiana problem) shows a fundamental misunderstanding of how viruses work. The Tri-state area got it the worst because of travel from Europe. If we didn't severely curtail interstate travel, and if Texans and Californians were gathering in large groups and going to crowded bars and restaurants, the numbers would be much worse.

If Texans and Californians had it as bad as Louisiana does, we'd be looking at another 20,000 deaths. If, god forbid, they had it as bad as New York, we'd be looking at another 65,000 deaths.

The precautions are working, and because they're working, you're getting a lot of cheap second guessing, which is unsurprising. I want to get back to normal too. And we will. But we gotta get this right.

It's truly baffling.  It's like claiming your roof is an overzealous precaution because you never even get rain in your house. 

Slee_stack

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Re: How long can we wait while flattening the curve?
« Reply #868 on: April 21, 2020, 08:54:07 AM »
What tests?  Antibody tests?

What about the people who don't have antibodies?  Do they isolate until there's a vaccine?  What if there isn't ever an effective vaccine?

A test just won't solve the larger problem.

Maybe folks don't want to admit it, but barring an accepted, effective treatment...or waiting 12 months for a hoped vaccine.... there really needs to be acceptance that more deaths will have to occur. ...

Unless someone truly believes a suppressed economy is not a problem long term.

No one is trying to stop all deaths.  That's not a realistic goal, and no one is claiming it is.  But it's completely asinine to say since some deaths are inevitable there is no point in trying to minimize them.  100k deaths is better than 1M, no?
I presume that 100k deaths is better, but I don't know the other side of the ledger.  Do you?

Is 100k additional COVID deaths better than 100k closed economy related deaths and whatever other hardship impact.

Its also completely asinine to ignore the impact on the flip side of the equation.

Slee_stack

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Re: How long can we wait while flattening the curve?
« Reply #869 on: April 21, 2020, 08:55:43 AM »
I must sound like a broken record at this point, but areas that have been less impacted in the United States have been so because of precautions. Characterizing this as a New York problem (really a Tri-state + Midwest + Louisiana problem) shows a fundamental misunderstanding of how viruses work. The Tri-state area got it the worst because of travel from Europe. If we didn't severely curtail interstate travel, and if Texans and Californians were gathering in large groups and going to crowded bars and restaurants, the numbers would be much worse.

If Texans and Californians had it as bad as Louisiana does, we'd be looking at another 20,000 deaths. If, god forbid, they had it as bad as New York, we'd be looking at another 65,000 deaths.

The precautions are working, and because they're working, you're getting a lot of cheap second guessing, which is unsurprising. I want to get back to normal too. And we will. But we gotta get this right.

It's truly baffling.  It's like claiming your roof is an overzealous precaution because you never even get rain in your house.
That's a great analogy.  If you lived in a place that never has rain, would you need a roof to keep water out.

Abe

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Re: How long can we wait while flattening the curve?
« Reply #870 on: April 21, 2020, 08:56:38 AM »
Ok here you all go:

Goalpost 1: in areas that already have an outbreak, this needs to be coming down, rather than increasing (as it is in SC and GA, both of which are reopening anyway - theyíll be a good experiment I guess).

Goalpost 2: enough testing capacity to determine the true sites of outbreaks (including asymptomatic cases, which could blow up into a local peak in symptomatic cases), and also test high-risk populations regularly to stop outbreaks before they start. Then we can start reopening some businesses with low volume of traffic (i.e. not sporting events, gyms, etc where people are in close proximity for extended periods).

Goalpost 3: vaccinations for the general public. If it is effective, then everything will go back to somewhat normal.

Abe

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Re: How long can we wait while flattening the curve?
« Reply #871 on: April 21, 2020, 08:58:55 AM »
I must sound like a broken record at this point, but areas that have been less impacted in the United States have been so because of precautions. Characterizing this as a New York problem (really a Tri-state + Midwest + Louisiana problem) shows a fundamental misunderstanding of how viruses work. The Tri-state area got it the worst because of travel from Europe. If we didn't severely curtail interstate travel, and if Texans and Californians were gathering in large groups and going to crowded bars and restaurants, the numbers would be much worse.

If Texans and Californians had it as bad as Louisiana does, we'd be looking at another 20,000 deaths. If, god forbid, they had it as bad as New York, we'd be looking at another 65,000 deaths.

The precautions are working, and because they're working, you're getting a lot of cheap second guessing, which is unsurprising. I want to get back to normal too. And we will. But we gotta get this right.

It's truly baffling.  It's like claiming your roof is an overzealous precaution because you never even get rain in your house.
That's a great analogy.  If you lived in a place that never has rain, would you need a roof to keep water out.

Thatís a flawed argument because no area in the US has not had rain.

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Re: How long can we wait while flattening the curve?
« Reply #872 on: April 21, 2020, 08:59:41 AM »
I must sound like a broken record at this point, but areas that have been less impacted in the United States have been so because of precautions. Characterizing this as a New York problem (really a Tri-state + Midwest + Louisiana problem) shows a fundamental misunderstanding of how viruses work. The Tri-state area got it the worst because of travel from Europe. If we didn't severely curtail interstate travel, and if Texans and Californians were gathering in large groups and going to crowded bars and restaurants, the numbers would be much worse.

If Texans and Californians had it as bad as Louisiana does, we'd be looking at another 20,000 deaths. If, god forbid, they had it as bad as New York, we'd be looking at another 65,000 deaths.

The precautions are working, and because they're working, you're getting a lot of cheap second guessing, which is unsurprising. I want to get back to normal too. And we will. But we gotta get this right.

It's truly baffling.  It's like claiming your roof is an overzealous precaution because you never even get rain in your house.
That's a great analogy.  If you lived in a place that never has rain, would you need a roof to keep water out.

Depends.  Are the skies clear, or did several of people nearby just have a downpour?

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Re: How long can we wait while flattening the curve?
« Reply #873 on: April 21, 2020, 09:04:08 AM »
If a few states over, people have been stricken really bad with the rain virus, a communicable disease that causes it to rain, then curtailing interstate travel by 90% while you build some roofs and do some testing is probably a good diea.

There. The analogy is perfect now.

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Re: How long can we wait while flattening the curve?
« Reply #874 on: April 21, 2020, 09:05:45 AM »
I must sound like a broken record at this point, but areas that have been less impacted in the United States have been so because of precautions. Characterizing this as a New York problem (really a Tri-state + Midwest + Louisiana problem) shows a fundamental misunderstanding of how viruses work. The Tri-state area got it the worst because of travel from Europe. If we didn't severely curtail interstate travel, and if Texans and Californians were gathering in large groups and going to crowded bars and restaurants, the numbers would be much worse.

If Texans and Californians had it as bad as Louisiana does, we'd be looking at another 20,000 deaths. If, god forbid, they had it as bad as New York, we'd be looking at another 65,000 deaths.

The precautions are working, and because they're working, you're getting a lot of cheap second guessing, which is unsurprising. I want to get back to normal too. And we will. But we gotta get this right.

It's truly baffling.  It's like claiming your roof is an overzealous precaution because you never even get rain in your house.
That's a great analogy.  If you lived in a place that never has rain, would you need a roof to keep water out.

Depends.  Are the skies clear, or did several of people nearby just have a downpour?
What if you had finite resources and lived by the sea?

If you get wet you die.  Do you build a seawall or a roof?

Lets be honest with the analogies...

COVID Deaths and Economy related deaths/hardship are intertwined right now.

Slee_stack

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Re: How long can we wait while flattening the curve?
« Reply #875 on: April 21, 2020, 09:10:10 AM »
If a few states over, people have been stricken really bad with the rain virus, a communicable disease that causes it to rain, then curtailing interstate travel by 90% while you build some roofs and do some testing is probably a good diea.

There. The analogy is perfect now.
Does how long it takes to build the roof matter?

...or is the analogy perfect the way it is?

I do like the cleverness posted herein.  Its too bad it comes with willful ignoring of consequences.
« Last Edit: April 21, 2020, 09:12:41 AM by Slee_stack »

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Re: How long can we wait while flattening the curve?
« Reply #876 on: April 21, 2020, 09:10:33 AM »
I don't think anybody here is really saying that we shutdown until we have an effective vaccine (and have vaccinated a large proportion of the population)?  That's clear a straw man.

I hope that also very few (if any) are saying that a shutdown should not have been implemented at all.  Clearly it has been effective and has converted this from something that would have led to people dying unnecessarily (i.e. people who could have survived if hospital capacity had been available to not surviving) to something awful but generally within the capacity of our health care systems.

What a shutdown gives you is that initial "hammer blow" that allows you then to do the "dance" to manage numbers from there on in, until you (hopefully) have an effective vaccine and/or treatments (e.g. we still do not have a vaccine for HIV, but we do have effective treatments).

By locking down we bought time not only to avoid overwhelming our hospitals in the short term (by and large) but also hopefully to:
- Build our supply routes/manufacturing capacity for PPE, hand sanitiser, etc.
- Build our stock of ventilators and CPAPs.
- Build our knowledge of the disease and how to treat it (e.g. in the UK from what I read we seem to be finding CPAPs effective in more cases than expected, rather than going all the way to ventilation).
- Build our testing capacity (including lab capacity, swab capacity, staffing, and all the systems needed to join those things up: not a trivial task).
- Build our systems for managing localised outbreaks etc. once lockdown is loosened).
- Build our data and knowledge systems for tracking the virus and how it spreads under different social distancing interventions.

How long you should do this for, in order to maximise those benefits (while minimising the economic cost) is the key question.

I imagine we will start lifting the lockdown at some point, and at that point infections and deaths will increase.  As that Angela Merkel excerpt above pointed out, if you want to avoid another hard lockdown later (possibly many more than one) you need a lot more healthcare capacity, and/or you need to keep the R0 well below its natural level even post-lockdown (i.e. you still need to keep a lot of social distancing in place: not just among the vulnerable population but also the rest of us, to limit the number of infected people that the vulnerable inevitably come into contact with - whether directly through caregivers or indirectly through groceries, mail, etc.)   If we find the R0 with all our social distancing has fallen to 0.5 or lower, then we can afford to loosen quite a bit and maintain the R0 close to 1.  If it turns out that all the interventions so far have only brought the R0 down to 1 then.... well, I hope we are not in that world (and in fact, infections seem to be declining most places in the US and Europe I believe, so hopefully we are not in that world).

As somebody who can work from home at relatively limited cost (the cost of a printer plus maybe say a 20% hit to my productivity), I would expect to be WFH at least 90% of the time until we have a vaccine or really good treatments (I would love to be wrong - I do not love WFH).  For people who can't work from home, I hope we can get all the other facilities back in place to allow them to go back to work much sooner.  For my money things like restaurants and cinemas will have to come pretty close to the bottom of the list for things we "switch back on" - at least without very significant social distancing measures (e.g. temperature checks on the door, physically distanced seating/tables).  I would rather "spend" any slack in the R0 sending schools back, or allowing some limited social contact in small groups, before opening up gyms and such.  But if the majority disagree then doubtless politicians will open these places and I will just have to deal with the consequences.  But realistically we cannot let the R0 drift back up to 3 or 5 or whatever the natural level turns out to be without many people dying needlessly not only of covid but also heart attack, stroke, cancer, etc. due to hospitals being overwhelmed.  So we are going to be constrained. 

The thing we have to do as best we can is to find a way out of this that preserves life and the economy.  As others have pointed out, if you swing the balance too far in either direction you will have deaths as a result of that decision (in addition to the inevitable deaths coming from this virus no matter what we do). 

It will be 5-10 years before we can estimate what the absolute "optimal path out" would have been from a health and economic perspective (and then only with the benefit of hindsight, and people will still argue about it).  My guess is applying these two lenses will not give too different an answer in the end, but we'll see.  All we can do is our best, based on the data available to us, and in a spirit of goodwill towards our fellow citizens.  I am confident "the answer" won't turn out to have been a 2 year lock-down or a 2 year free-for-all.  I trust there are many smart people with a lot of expertise working and debating right now during this suppression phase to figure this out.


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Re: How long can we wait while flattening the curve?
« Reply #877 on: April 21, 2020, 09:12:52 AM »
Given the stakes, it seems like it would be worthwhile for the US government to administer tests to all 330MM+ residents, separate out everyone who tests positive and put them into field hospitals for two weeks or until the test negative. Then, go back and test everybody in the country, again. Rinse and repeat, until everyone tests negative. Sure, it would cost billions of dollars, but so what? Seems like the alternative is going to end up costing a lot more.

That's what Iceland is in the process of doing, and that's what Germany will begin to roll out now. Of course, Germany has the capacity to do 600K tests per day for a population of 80 millions people, so 1st run through the population will take 133 days.

Now the good ol' US of A has test capacity of around 150K tests per day [lack of reagents] and a 330 million population. 1st run in 2,200 days

Conclusion -> let's get some more tests !!!

More likely, USA will need to focus testing on more high risk groups, and then randomly sample the general population (nationally, but also more specific studies in each county) to get a better idea of each locality's Covid prevalence. The prevalence will lead to improved localized CLOSE vs OPEN instructions as per @Abe

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Re: How long can we wait while flattening the curve?
« Reply #878 on: April 21, 2020, 09:15:17 AM »
What if you had finite resources and lived by the sea?

If you get wet you die.  Do you build a seawall or a roof?

Lets be honest with the analogies...

COVID Deaths and Economy related deaths/hardship are intertwined right now.

Tests are finite resources. PPE is as well. The United States's ability to print and borrow money is a resource that in my view, is comparatively much less finite.

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Re: How long can we wait while flattening the curve?
« Reply #879 on: April 21, 2020, 09:18:41 AM »
I don't think anybody here is really saying that we shutdown until we have an effective vaccine (and have vaccinated a large proportion of the population)?  That's clear a straw man.

I hope that also very few (if any) are saying that a shutdown should not have been implemented at all.  Clearly it has been effective and has converted this from something that would have led to people dying unnecessarily (i.e. people who could have survived if hospital capacity had been available to not surviving) to something awful but generally within the capacity of our health care systems.

What a shutdown gives you is that initial "hammer blow" that allows you then to do the "dance" to manage numbers from there on in, until you (hopefully) have an effective vaccine and/or treatments (e.g. we still do not have a vaccine for HIV, but we do have effective treatments).

By locking down we bought time not only to avoid overwhelming our hospitals in the short term (by and large) but also hopefully to:
- Build our supply routes/manufacturing capacity for PPE, hand sanitiser, etc.
- Build our stock of ventilators and CPAPs.
- Build our knowledge of the disease and how to treat it (e.g. in the UK from what I read we seem to be finding CPAPs effective in more cases than expected, rather than going all the way to ventilation).
- Build our testing capacity (including lab capacity, swab capacity, staffing, and all the systems needed to join those things up: not a trivial task).
- Build our systems for managing localised outbreaks etc. once lockdown is loosened).
- Build our data and knowledge systems for tracking the virus and how it spreads under different social distancing interventions.

How long you should do this for, in order to maximise those benefits (while minimising the economic cost) is the key question.

I imagine we will start lifting the lockdown at some point, and at that point infections and deaths will increase.  As that Angela Merkel excerpt above pointed out, if you want to avoid another hard lockdown later (possibly many more than one) you need a lot more healthcare capacity, and/or you need to keep the R0 well below its natural level even post-lockdown (i.e. you still need to keep a lot of social distancing in place: not just among the vulnerable population but also the rest of us, to limit the number of infected people that the vulnerable inevitably come into contact with - whether directly through caregivers or indirectly through groceries, mail, etc.)   If we find the R0 with all our social distancing has fallen to 0.5 or lower, then we can afford to loosen quite a bit and maintain the R0 close to 1.  If it turns out that all the interventions so far have only brought the R0 down to 1 then.... well, I hope we are not in that world (and in fact, infections seem to be declining most places in the US and Europe I believe, so hopefully we are not in that world).

As somebody who can work from home at relatively limited cost (the cost of a printer plus maybe say a 20% hit to my productivity), I would expect to be WFH at least 90% of the time until we have a vaccine or really good treatments (I would love to be wrong - I do not love WFH).  For people who can't work from home, I hope we can get all the other facilities back in place to allow them to go back to work much sooner.  For my money things like restaurants and cinemas will have to come pretty close to the bottom of the list for things we "switch back on" - at least without very significant social distancing measures (e.g. temperature checks on the door, physically distanced seating/tables).  I would rather "spend" any slack in the R0 sending schools back, or allowing some limited social contact in small groups, before opening up gyms and such.  But if the majority disagree then doubtless politicians will open these places and I will just have to deal with the consequences.  But realistically we cannot let the R0 drift back up to 3 or 5 or whatever the natural level turns out to be without many people dying needlessly not only of covid but also heart attack, stroke, cancer, etc. due to hospitals being overwhelmed.  So we are going to be constrained. 

The thing we have to do as best we can is to find a way out of this that preserves life and the economy.  As others have pointed out, if you swing the balance too far in either direction you will have deaths as a result of that decision (in addition to the inevitable deaths coming from this virus no matter what we do). 

It will be 5-10 years before we can estimate what the absolute "optimal path out" would have been from a health and economic perspective (and then only with the benefit of hindsight, and people will still argue about it).  My guess is applying these two lenses will not give too different an answer in the end, but we'll see.  All we can do is our best, based on the data available to us, and in a spirit of goodwill towards our fellow citizens.  I am confident "the answer" won't turn out to have been a 2 year lock-down or a 2 year free-for-all.  I trust there are many smart people with a lot of expertise working and debating right now during this suppression phase to figure this out.

Excellent post LightTripper. Thank you for taking the time to write it. I underlined your last sentence because I'm concerned that the politicians and decision makers won't listen to the smart people with appropriate expertise. This has happened in many countries already. It will happen again soon as things start opening up without appropriate preparation. The unnecessary casualties and suffering that will be caused by this just breaks my heart.

Slee_stack

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Re: How long can we wait while flattening the curve?
« Reply #880 on: April 21, 2020, 09:26:01 AM »
What if you had finite resources and lived by the sea?

If you get wet you die.  Do you build a seawall or a roof?

Lets be honest with the analogies...

COVID Deaths and Economy related deaths/hardship are intertwined right now.

Tests are finite resources. PPE is as well. The United States's ability to print and borrow money is a resource that in my view, is comparatively much less finite.
I agree that the US government can print money.

I don't believe there would be no negative consequences in doing so.  Those consequences may be minor up to a point.  What that point is worries me.  Could they print money for a year so to speak?  I'm going to guess 'No, there would likely be very bad consequences of a year lost.'

Ad nauseum...how much longer can we flatten the curve.

Early poll here says 1-3 months.  I agree with that.

Many posts in this thread attack reopening until.

Its all I've ever asked, but it seems most of us really agree anyway.

Its easier to be on the 'save immediate lives' side of course.  I was only ever on the fence so I'm not nearly as saintly.
« Last Edit: April 21, 2020, 09:29:27 AM by Slee_stack »

Shane

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Re: How long can we wait while flattening the curve?
« Reply #881 on: April 21, 2020, 09:27:55 AM »
Given the stakes, it seems like it would be worthwhile for the US government to administer tests to all 330MM+ residents, separate out everyone who tests positive and put them into field hospitals for two weeks or until the test negative. Then, go back and test everybody in the country, again. Rinse and repeat, until everyone tests negative. Sure, it would cost billions of dollars, but so what? Seems like the alternative is going to end up costing a lot more.

That's what Iceland is in the process of doing, and that's what Germany will begin to roll out now. Of course, Germany has the capacity to do 600K tests per day for a population of 80 millions people, so 1st run through the population will take 133 days.

Now the good ol' US of A has test capacity of around 150K tests per day [lack of reagents] and a 330 million population. 1st run in 2,200 days

Conclusion -> let's get some more tests !!!

More likely, USA will need to focus testing on more high risk groups, and then randomly sample the general population (nationally, but also more specific studies in each county) to get a better idea of each locality's Covid prevalence. The prevalence will lead to improved localized CLOSE vs OPEN instructions as per @Abe

How about using the military to administer a testing program? I don't see why we couldn't test everyone in the country within a reasonable amount of time. It's hard to believe soldiers and sailors and marines couldn't be properly trained to produce, administer and read the tests. If Germany can test 600K per day, why can't the US test 60MM/day? We could if we wanted to, I think. It's just because of lack of leadership that it's not getting done.

Slee_stack

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Re: How long can we wait while flattening the curve?
« Reply #882 on: April 21, 2020, 09:43:46 AM »
In a lightspirited change...

...and apolgies if I offend some of you that may be here...

If/when a vaccine ends up being the final solution...what happens to anti-vaxxers?

Shane

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Re: How long can we wait while flattening the curve?
« Reply #883 on: April 21, 2020, 09:45:15 AM »
Right now, I'm reading The Great Influenza: The Story of the Deadliest Pandemic in History, by John M. Barry. The book was published in 2005, so long before the current pandemic started. It's a fascinating story that has so many parallels to our current situation it's kind of scary. Rightfully so, many Americans are critical of Trump's lack of leadership of our country's response to the current Covid-19 pandemic. In comparison, though, Woodrow Wilson's response to the proportionally much larger pandemic of 1918 was waaaaaaaaaaaay, waaaaaaaaaaaaaay worse. Not only did Wilson and his administration fail to provide leadership, they literally didn't even mention that a pandemic was taking place, at all. Nada. Zilch. Not even a press release. Doctors and researchers at the Rockefeller Institute and other private research labs around the country were working their asses off trying to come up with a serum or vaccine or anything to try to slow down or stop the influenza pandemic, but their pleas to the Surgeon Generals of the Army and Navy, as well as the U.S. Surgeon General were completely ignored. Doctors were begging the military to please stop drafting more fresh troops and bringing them onto military bases around the country that were in complete and utter chaos due to the influenza pandemic. Prominent researchers managed to get word directly to President Wilson, through his personal physician, to let him know that it was a giant mistake to keep packing ships full of young, fresh troops and sending them off to France, because thousands and thousands of them were dying from influenza, and having to be buried at sea, before they even reached Europe. Wilson asked his military commanders about what he had heard, and they told him not to worry. They said they had everything under control...
« Last Edit: April 21, 2020, 09:53:05 AM by Shane »

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Re: How long can we wait while flattening the curve?
« Reply #884 on: April 21, 2020, 09:48:31 AM »
In a lightspirited change...

...and apolgies if I offend some of you that may be here...

If/when a vaccine ends up being the final solution...what happens to anti-vaxxers?

Dunno. Anti-vaxx friends have already been posting on FB, for weeks, about how the big, bad Bill Gates is conspiring to FORCE them all to buy vaccines from him, because, of course, he is a greedy capitalist who is just looking at this whole pandemic thing as an opportunity to make more money for himself...

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Re: How long can we wait while flattening the curve?
« Reply #885 on: April 21, 2020, 09:49:10 AM »
anti-vaxxers?

Even they tend to get things like the measles vaccine when it is their own kids suffering. Either one of their own children or an outbreak within their community and suddenly "vaccines are evil" isn't a core-belief any more for all but the most diehard anti-vaxxers.

Some people need the bodies in their front lawn to understand. To that end, I'd suggest that anyone who showed up to one of these anti-lock-down protests should have their home address on the short-list of "where to park the cold trucks" if it comes to that in their area.

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Re: How long can we wait while flattening the curve?
« Reply #886 on: April 21, 2020, 09:51:30 AM »
Hereís are some thoughts.

Lockdown is all about social distancing, because social distancing is the only weapon we really have.

Lockdown basically says that the government in your country canít trust you to stay *at least* 6 feet away from everyone, 100% of the time when you are anywhere other than your own property. If the government could guarantee that every person in the world would stay at least 6 feet from every other person and nobody would ever break that rule, and that everybody then we wouldnít need lockdowns. The reality is thatís a completely unrealistic expectation, hence lockdowns. Itís the only way the governments of this world to kind of guarantee that most of their people are not just milling about spreading this virus. We could re-open much of the economy tomorrow if we could guarantee that everyone was very disciplined in adhering to social distancing guidelines and that everybody would wash their hands regularly and thoroughly, so touching of handrails and door handles wasnít a problem. But again, you canít guarantee it. I personally can in a miniscule way. I can vouch for me as an individual, but I canít vouch for the tens of millions of potential idiots out there who will get within 6 feet of you and thinking nothing of it and never wash their damn hands.

Testing on its own doesnít do anything. Testing + social distancing does. Imagine, you get tested. It takes 48 hours for the results to come back and in that 48 hours you infect 15 people because there is absolutely no lockdown in place and social distancing doesnít happen at all. You go into a bar, have a few drinks have a laugh, chat with a load of people, hug some of them, whatever.

A vaccine or cure of some kind is the only way we will get back to normal quickly. A vaccine might be available by Christmas if weíre lucky. I mean one that is proven to work and has undergone extensive human trials that havenít rushed because the situation is urgent or some nonsense.

Pretty much every country is experiencing lots of deaths in care homes/nursing homes/care facilities. Itís hard to know what proportion of these deaths is being reported by each country. Some of them are allegedly being diligent and reporting them. Others are not. Here in the UK, we could be looking at 7,000 to 10,000 unreported care home deaths. 7,500 was the number I had read, but that was in an article published at least 10 days ago. The elderly and vulnerable are the ones that need protection. They know who they are and most of us know who they are. They should be protected but restrictions should be more lenient for everyone else.

My 70 year old mother is dying, slowly, of lung cancer. I know that she is incredibly vulnerable. She knows it as well. But sheís still having a carer go into her home for an hour a day most weekdays. They have PPE. But have they been using that PPE for a week already with 60 other patients or is it fresh PPE for every house they go into? If I ask, will they be honest or will they lie? Iíve had this discussion with my Mum and she, not me, she, is happy to accept the risks. She understands this will finish her within days if she gets it.

Iím 37 and Iím very fit and healthy. Do I wonít to get COVID-19? No. Iím not totally sure that Iíd be ok, regardless of my mother. Have already had it? Maybe in early March, but they would have been incredibly mild symptoms that lasted about 2 days in total.

Am I desperate to get tested to find out if I have had it, or if I have it now? No. Why? Because if I have it now and I get sick enough to warrant going to a hospital, I wonít need a test to tell me I have it. Equally, if I have it now and I never get sick enough to go to a hospital and I fight it off at home, then I will know that I have been very ill or just slightly ill, but I will fight it off and eventually recover, hopefully with no lasting damage.

Do I care if I have antibodies as a result of getting it? No. Why? Because nobody, can, at present, definitely say that I am 100% immune as a result, and they canít say how long that immunity would last. I live a streamlined minimalist lifestyle anyway, and donít have kids, so being on lockdown isnít the enormous inconvenience that it might be for others.

Given all this, I think we should begin to re-open our economy (UK) as soon as possible, but only once the daily cases and daily deaths have both reduced to about 20% of what they are now. That might take another 3 to 6 weeks. After that, I personally believe that we need to starting trying to re-open schools, or some shops. Figure out how we can test one or two variables at a time. I donít think we should have sport and concerts and festivals happening in June, July or August.

But what if 20% of the numbers we have now doesnít happen until August? I donít know. Itís tough.

=========

Regarding the US, they should be treated like a continent, not a country. What someone said earlier made me think.

The US lockdown is a bit like someone say that there are problems in Romania so people in Scotland must also stay indoors. That wouldn't work in Europe. Why should it be the case in the US?

I fear that the US is re-opening too soon in some areas, but in others, it sounds like they have been shut despite not really being affected.

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Re: How long can we wait while flattening the curve?
« Reply #887 on: April 21, 2020, 09:58:31 AM »

1.  Wait for a Vaccine.  How long is acceptable to wait? What if there is never an effective vaccine or it takes even longer than currently anticipated?
2.  Employ an antibody 'Passport'.  But what about those that don't have the antibody?  What % is OK to be forced to isolate?  Would they have to wait for a vaccine to get a 'passport'?
3.  Wait for a good treatment.  What defines good?  What % must the treatment be effective for? 
4.  Close borders.  Initiate harsh lockdowns again as needed when the eventual virus carrier slips though.  Does this work at a state level?
4.  Other? Wait for herd immunity which (according to this forum) takes anywhere from <1 year to generations. 
5.  Do we repeat stringent lockdowns on second, third, etc waves?  Do we think there will be no more waves?
.

To me one of the most obvious conditions is:
6. wait for the number of infected cases in a region to drop below a certain threshold. 

It's exponential growth.  If you have thousands of infected (not 'recovered') individuals per 100,000 moving freely, the likelihood of a full-blown outbreak within a few weeks approaches 100%. An uninfected individul will randomly encounter an infected person almost daily in that scenario, and many of those will be asymptomatic.  Conversely, if the number of infected is in the single digits then outbreaks can be contained and entirely prevented.

This of course only works if you have widespread testing with rapid results.  A region must be able to accurately predict how many infected people there are in the population. At least in my state testing remains reserved only for those with moderate to severe symptoms and people who have knowingly spent 10 minutes or longer in close contact with someone who has tested positive.

Once you've met those two conditions (knowing what % of your population are infected & having the tests to verify this) you can put into place things like travel restrictions (limiting people from areas with a high number of cases).

Right now we STILL don't have the testing capacity in the majority of the US.  So we are flying in the fog with no instraments to guide us. 

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Re: How long can we wait while flattening the curve?
« Reply #888 on: April 21, 2020, 10:19:44 AM »
Another study of antibody test results has been published. This time, USC rather than Stanford, but the results are similar

https://news.usc.edu/168987/antibody-testing-results-covid-19-infections-los-angeles-county/

They're estimating that the number of total infections is 28-55 times the number of confirmed cases. Compare that to other studies previously linked, and it's becoming pretty evident that the number of total infections is likely 30-60 times the current confirmed number of cases.

US currently has 43k deaths and 800k confirmed cases for reference. So the number of actual infections is probably 24-40 million

JGS1980

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Re: How long can we wait while flattening the curve?
« Reply #889 on: April 21, 2020, 10:38:03 AM »
Another study of antibody test results has been published. This time, USC rather than Stanford, but the results are similar

https://news.usc.edu/168987/antibody-testing-results-covid-19-infections-los-angeles-county/

They're estimating that the number of total infections is 28-55 times the number of confirmed cases. Compare that to other studies previously linked, and it's becoming pretty evident that the number of total infections is likely 30-60 times the current confirmed number of cases.

US currently has 43k deaths and 800k confirmed cases for reference. So the number of actual infections is probably 24-40 million

So what?

How does this change things?

So if best case scenario the actual antibody folks are 40 Million, and assuming that that immunity is sustained for at least a few months, that means that 290 Million citizens can still be exposed.

If we have 42,000 deaths (and not done yet) with 40 Million people infected, than if everyone is exposed, we will get the minimal amount of 350,000 deaths (if the medical system isn't overwhelmed).

Doesn't change a thing as far as I'm concerned.

fattest_foot

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Re: How long can we wait while flattening the curve?
« Reply #890 on: April 21, 2020, 10:43:14 AM »
Having more people with anti-bodies presents barriers to transmission. This is that whole "it takes generations to build herd immunity" argument (which is a completely different definition of herd immunity than I think is being used commonly).

Let's say you have a room of 5 people. If 1 is a carrier and 3 have anti-bodies, only 1 person can get infected. Extrapolate that out, and now you have fewer carriers to infect people. Essentially stopping the virus dead in its tracks. What the number is that presents a large enough barrier where we have "herd immunity," I don't know. But it's not 100% of people.

former player

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Re: How long can we wait while flattening the curve?
« Reply #891 on: April 21, 2020, 10:49:50 AM »
Having more people with anti-bodies presents barriers to transmission. This is that whole "it takes generations to build herd immunity" argument (which is a completely different definition of herd immunity than I think is being used commonly).

Let's say you have a room of 5 people. If 1 is a carrier and 3 have anti-bodies, only 1 person can get infected. Extrapolate that out, and now you have fewer carriers to infect people. Essentially stopping the virus dead in its tracks. What the number is that presents a large enough barrier where we have "herd immunity," I don't know. But it's not 100% of people.
Someone here linked to a study that suggested between 70% and 90%.

Abe

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Re: How long can we wait while flattening the curve?
« Reply #892 on: April 21, 2020, 11:00:48 AM »
Having more people with anti-bodies presents barriers to transmission. This is that whole "it takes generations to build herd immunity" argument (which is a completely different definition of herd immunity than I think is being used commonly).

Let's say you have a room of 5 people. If 1 is a carrier and 3 have anti-bodies, only 1 person can get infected. Extrapolate that out, and now you have fewer carriers to infect people. Essentially stopping the virus dead in its tracks. What the number is that presents a large enough barrier where we have "herd immunity," I don't know. But it's not 100% of people.

Based on estimates from other coronaviruses and other types of viruses with similar apparent transmission characteristics, the Harvard Public health paper and the Imperial College London estimated it to be 60-80%. It's a big unknown so it's true that 100% is not necessary. But that's also not what anyone here is arguing.

Regarding slee-stack's questions:

Quote from: Slee_stack on Today at 06:44:55 AM

1.  Wait for a Vaccine.  How long is acceptable to wait? What if there is never an effective vaccine or it takes even longer than currently anticipated? - Then see Goalposts 1 & 2 above
2.  Employ an antibody 'Passport'.  But what about those that don't have the antibody?  What % is OK to be forced to isolate?  Would they have to wait for a vaccine to get a 'passport'? - They don't necessarily have to isolate, but businesses and high-risk facilities (non-ER portions of the hospital, nursing facilities, crowded restaurants) can refuse service to them if they don't use reasonable precautions
3.  Wait for a good treatment.  What defines good?  What % must the treatment be effective for? - That's a question for society as a whole to answer. Ideally a non-vaccine treatment that is prophylactic would be the best. Second-best is a medication that reduces the # of ICU admissions. Those are reasonably good treatments and are being investigated. Hopefully trial results will be out in about a month.
4.  Close borders.  Initiate harsh lockdowns again as needed when the eventual virus carrier slips though.  Does this work at a state level? Probably not in the US, as it's unclear that states have the authority to close their borders (inter-state commerce is regulated by the federal government under most interpretations of the US Constitution. Other countries may have different rules.
4.  Other? Wait for herd immunity which (according to this forum) takes anywhere from <1 year to generations. Definitely doesn't take generations. Most estimates using models suggest anywhere from 1-2 years depending on how severe the initial waves of spread are. I've referenced one in my prior posts.
5.  Do we repeat stringent lockdowns on second, third, etc waves?  Do we think there will be no more waves? No, multiple waves are expected. Yes, we probably would need to do so in order to contain them. S Korea had a much smaller second wave about a month after the initial one, suggesting that good contact tracing can keep it to a reasonable level.


I'd turn the question on its head and ask everyone what number of dead (including potentially yourself) are acceptable casualties for reopening the economy? Absolute numbers or % of population figures would be appreciated. We agree it's not 0.0 or 0%, and probably the maximum estimated is 330m x 0.5% = 1.65 million. For reference, total deaths in the US per year are around 2.3 million from all causes. We could also go state-by-state. My state (CA) has 40m people. With a 0.1% fatality (similar to influenza), that's 40,000 people. With a 0.5% (estimated from S Korean and Germany figures) that's 200,000 people. I'd say losing an entire medium-sized city within a few months would be in a natural disaster scenario completely unacceptable. Just because we don't have damaged buildings and bodies rotting in the streets a la Katrina doesn't mean it isn't a disaster. To add extra skin in the game, I'll mention my wife is furloughed and my new job is delayed by several months as a result, so we're living on savings, my current paycheck that doesn't pay rent, and intermittent work for now.

My answer overall is the minimal number that need to die until we have good testing in place. That's looking like (reference prior posts) anywhere from 160,000 to 400,000 based on current mortality levels at various hotspots (NYC/NJ being the high end, CA/WA being the low end).

dandarc

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Re: How long can we wait while flattening the curve?
« Reply #893 on: April 21, 2020, 11:04:54 AM »
@Paper Chaser - the 2 studies released seem to have some flaws (as rushed research often does).

https://www.wired.com/story/new-covid-19-antibody-study-results-are-in-are-they-right/

I hope the results are as encouraging as those would seem, but there are problems with the studies in question. Which is why it is important not to jump to conclusions - peer review and replicating the results are very important parts of doing the science right.

And as @JGS1980 points out - the results as stated actually aren't that encouraging.

GardenerB

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Re: How long can we wait while flattening the curve?
« Reply #894 on: April 21, 2020, 11:12:33 AM »
Reply to:

"So what?

How does this change things?"

It changes things because this is another study showing the early IFR (infection fatality rate) in closer to 0.1% (if using the 43k deaths divided by 40 million infected).  Other tests/studies in Europe have also reached this same IFR estimation.  This is why some EU countries have started lifting restirctions gradually (ref. attached, Economist April 15, 2020).  Again some places higher infection rates (NYC) and higher IFR, some places lower.

As the Swedish epidemiologist said, final IFR estimates will be known in a year from now - come back in April 2021 and he estimates this will have been roughly twice the toll as a flu season.  Still reason for lockdowns and distancing, yes, to keep hospitals under capacity.  But then, eventually everyone will get this over time anyway over next few years, and a vaccine in 12 months (earliest) will help alleviate it (again all this just like the seasonal flu cycle).  But like flu, it won't just go away, it will keep returning seasonally, and mutate, and vaccines/immunity won't last more than a year.

GB





YttriumNitrate

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Re: How long can we wait while flattening the curve?
« Reply #895 on: April 21, 2020, 11:28:13 AM »
I'd turn the question on its head and ask everyone what number of dead (including potentially yourself) are acceptable casualties for reopening the economy? Absolute numbers or % of population figures would be appreciated. We agree it's not 0.0 or 0%, and probably the maximum estimated is 330m x 0.5% = 1.65 million.

My number for acceptable losses would be equal to half the annual number of cancer or heart disease deaths per year assuming that the COVID19 deaths are demographically distributed in roughly the same manner as heart disease / cancer. Of course, since people will still die during a lock down, this number needs to be the number in excess of those that would have died had a lock down been maintained.
 
For my state, current numbers for April 18-20 show about 15 deaths per day after a month of lock down. If we assume that number would stay constant for a full year of lock down (5,500), and then add half the number of cancer deaths (14,000/2) we get about 12,500 people, or 0.18% of the population.

mizzourah2006

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Re: How long can we wait while flattening the curve?
« Reply #896 on: April 21, 2020, 11:53:40 AM »
I'd turn the question on its head and ask everyone what number of dead (including potentially yourself) are acceptable casualties for reopening the economy? Absolute numbers or % of population figures would be appreciated. We agree it's not 0.0 or 0%, and probably the maximum estimated is 330m x 0.5% = 1.65 million.

My number for acceptable losses would be equal to half the annual number of cancer or heart disease deaths per year assuming that the COVID19 deaths are demographically distributed in roughly the same manner as heart disease / cancer. Of course, since people will still die during a lock down, this number needs to be the number in excess of those that would have died had a lock down been maintained.
 
For my state, current numbers for April 18-20 show about 15 deaths per day after a month of lock down. If we assume that number would stay constant for a full year of lock down (5,500), and then add half the number of cancer deaths (14,000/2) we get about 12,500 people, or 0.18% of the population.

So is the state by state thing? Between April 18-20th my state had 5 deaths total or ~ 1.66 deaths per day after a month of what could be considered lockdown.

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #897 on: April 21, 2020, 11:58:06 AM »
Something is driving excess mortality in 2020.


JGS1980

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Re: How long can we wait while flattening the curve?
« Reply #898 on: April 21, 2020, 12:18:46 PM »
Reply to:

"So what?

How does this change things?"

It changes things because this is another study showing the early IFR (infection fatality rate) in closer to 0.1% (if using the 43k deaths divided by 40 million infected).  Other tests/studies in Europe have also reached this same IFR estimation.  This is why some EU countries have started lifting restirctions gradually (ref. attached, Economist April 15, 2020).  Again some places higher infection rates (NYC) and higher IFR, some places lower.

Your Swedish epidemiologist is ignoring the actual dead people who apparently have actually died in our "real life" experience of the last month. I could care less about his predictions when reality is shouting something completely different. What that researcher is missing is the costs of overwhelming the medical system. Thus NYC's elevated fatality rates as compared to, say, California. Mathlete's last post conveys the "total death" point very elegantly from that nytimes article.
« Last Edit: April 21, 2020, 12:23:52 PM by JGS1980 »

JGS1980

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Re: How long can we wait while flattening the curve?
« Reply #899 on: April 21, 2020, 12:29:24 PM »
I'd turn the question on its head and ask everyone what number of dead (including potentially yourself) are acceptable casualties for reopening the economy? Absolute numbers or % of population figures would be appreciated. We agree it's not 0.0 or 0%, and probably the maximum estimated is 330m x 0.5% = 1.65 million.

My number for acceptable losses would be equal to half the annual number of cancer or heart disease deaths per year assuming that the COVID19 deaths are demographically distributed in roughly the same manner as heart disease / cancer. Of course, since people will still die during a lock down, this number needs to be the number in excess of those that would have died had a lock down been maintained.
 
For my state, current numbers for April 18-20 show about 15 deaths per day after a month of lock down. If we assume that number would stay constant for a full year of lock down (5,500), and then add half the number of cancer deaths (14,000/2) we get about 12,500 people, or 0.18% of the population.

The "acceptable deaths" argument has a particular fallacy. This pandemic is NOT like turning a faucet just a little warmer or a little colder as needed to achieve a goal of less than 200,000 deaths. This shit is EXPONENTIAL, which a lot of folks still don't understand. That means it can explode before you even realize you have a problem (like it just did last month). To extend the analogy, you can either get a trickle, or you'll get a firehose. Anything in between will be very difficult to control.