Author Topic: How long can we wait while flattening the curve?  (Read 253731 times)

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #950 on: April 22, 2020, 10:38:15 AM »
News in scare quotes. Attributing a phantom unavailability of case data to political reasons...

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Re: How long can we wait while flattening the curve?
« Reply #952 on: April 22, 2020, 12:23:49 PM »
It appears that some posters here just want an echo chamber.  We're already seeing the dismissing and passive aggressive personal attacks.  That's sad.

I've been on the fence since the start.

I do like Paper Chaser's recent posts which start making one think about the additional second or third order effects of this lockdown.

It adds even more complication to the already complicated direct effects.

I am curious how pro-conservative folks think we should proceed, and what do we do in a few Plan B's so to speak.

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?

It seems like the only real option is to wait for a vaccine and/or good treatment. 

There is another option:  Exercise social distancing until the peak has passed.  That way you don't overwhelm the medical system as we saw in Italy and other countries.  Then slowly open up the country in concert with an aggressive testing and contact tracing regimen.  When a positive case is detected, you can isolate just those people and their contacts, instead of keeping the whole country closed.   This will require at least triple if not 20 times our current testing capacity, and several hundred thousand workers. 

Hiring 200,000 thousand contact tracers is a big order, but we hire at least that many for the Census.   Can be done, plus it would a badly needed temporary jobs program.  Same with testing.  Need a lot of equipment and people, but South Korea did it.  Therefore it is possible. 

Unfortunately, our federal government is lead by incompetent buffoons.  We're buying ventilators from General Motors which will be delivered long after they were needed.  We should have ordered testing equipment.  Our president has stated several times there will be no federal testing program, leaving it up to the states.  But the states don't have budgets to ramp up programs like this.  So there won't be a big testing program.

Here's the problem as it relates to this thread:  It doesn't matter what the government orders people to do at this point.  Huge swaths of the economy are shut down and they are going to stay shut down until people feel safe to venture out.  Because our leaders don't want to do the thing that will make people feel safe, our economy will stay in the crapper for a long time. 








   

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bacchi

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Re: How long can we wait while flattening the curve?
« Reply #955 on: April 22, 2020, 01:40:51 PM »
https://www.nytimes.com/2020/04/22/world/africa/coronavirus-hunger-crisis.html

-W

But they don't matter.  Only narcissistic hypochondriacs matter.

The whole world is in on it except for you and a few freedom fighters. Keep fighting the good fight!

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #956 on: April 22, 2020, 01:58:51 PM »
I can hear egillespie grinding his ax from several states away.

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Re: How long can we wait while flattening the curve?
« Reply #957 on: April 22, 2020, 02:07:13 PM »
A more charitable reading is that people care more about their own health and those of their family and friends than others far removed   Its a well studied human tendency.

I am equally concerned at the economic costs should we open too early. In past epidemics the conservative approach has yielded less economic pain overall

Bloop Bloop

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Re: How long can we wait while flattening the curve?
« Reply #958 on: April 22, 2020, 07:14:51 PM »
My state of five million people has recorded only 3 new cases in the last 48 hours yet wants 3 more weeks of near-complete lockdown - does that make sense to anyone?

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Re: How long can we wait while flattening the curve?
« Reply #959 on: April 22, 2020, 07:18:18 PM »
My state of five million people has recorded only 3 new cases in the last 48 hours yet wants 3 more weeks of near-complete lockdown - does that make sense to anyone?

Two days can be noise - it hasn’t been uncommon for numbers to jump by a factor of 4 day-to-day.  If it were a few cases over an entire week I think it would be time to discuss opening up more businesses.


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Re: How long can we wait while flattening the curve?
« Reply #960 on: April 22, 2020, 09:47:12 PM »
My state of five million people has recorded only 3 new cases in the last 48 hours yet wants 3 more weeks of near-complete lockdown - does that make sense to anyone?

I think it does. Look what happened in a Singapore. It looked completely under control and now it’s not under control.

A couple more weeks will really suppress the virus to the lowest practical level and give the country the best chance to keep it in check.

If things continue to trend the right way the 3 weeks might become 2 weeks. Shortening the lockdown due to too much good news is better than having to keep adding extra weeks, which would really piss everyone off,

Already the CMO is saying borders will be shut for 4 months only, as opposed to  wing shut until 2021 as was being said a week or 2 ago. Schools are reopening etc.

Just be patient. Stay at home. Soon you will be back stuck in peak hour traffic reflecting whimsically back on those few weeks where you were able to have long slow breakfasts,  take short naps at lunch time and extended coffee breaks throughout the day.

People always want what they can’t have. Be thankful for what you do have.

Bloop Bloop

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Re: How long can we wait while flattening the curve?
« Reply #961 on: April 22, 2020, 10:04:33 PM »
Yeah, I saw that backflip too on borders. Till today it was borders closed till the end of the year - now we are talking about a 4 month timespan.

I am not hugely affected by the lockdown - I am happy to work from home, and I have been visiting my parents in defiance of the lockdown anyway (so sue me - given that I'm in isolation otherwise, it's no different to any other family unit of parents and children). I am mostly worried about the day-to-day economic burden it's having on people who have lost their jobs and businesses.

But as you say, if the government keeps backflipping on timeframes, then there is no problem. I just wish they wouldn't treat us like idiots by constantly giving us the "worst case scenario" and then retreating on it. Daniel Andrews in particular sounds like a parent scolding his children.

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Re: How long can we wait while flattening the curve?
« Reply #962 on: April 22, 2020, 10:06:57 PM »
I'm not sure that Singapore is directly comparable here.  The spike in cases in Singapore is largely due to the cramped and unsanitary living conditions of underpaid migrant workers, and not among the general population as a result of an overall relaxation in restrictions.

Australia has had <50 new cases per day for over a week, and our testing has been - and continues to be - extensive.  The total number of active cases continues to trend lower.

Unless we are going to try and completely eradicate the virus, or wait for a viable vaccine, at some point we need to slowly re-open critical activities (like schools to get my kids out of the house!) and see what happens (with appropriate testing and controls in place).

The key question - which I believe Bloop is asking - is why not start that process now?  What value is there in waiting an extra 2-3 weeks, and at what cost? 

Kyle Schuant

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Re: How long can we wait while flattening the curve?
« Reply #963 on: April 22, 2020, 10:13:07 PM »

My state of five million people has recorded only 3 new cases in the last 48 hours yet wants 3 more weeks of near-complete lockdown - does that make sense to anyone?

I was unaware that any expiry date had been given in Victoria, let alone 3 weeks. Can you link us?


Two days can be noise - it hasn’t been uncommon for numbers to jump by a factor of 4 day-to-day.  If it were a few cases over an entire week I think it would be time to discuss opening up more businesses.

It's more than that. Our peak was Mar 28th when we had 111 new cases, then 84, 52, 96, 68 and steadily down since then. In the week preceding and including today, we've had 36 cases, before that 73, before that 192, before that 516.

When you subtract those who've died (~1% here, as we finally have extensive testing and also have had not more than a few percent of ICU taken up by covid patients so they could all get the best possible care), and those who've recovered, the peak was the turn of Mar/Apr with 622/1 active cases, we're now down to 70 active cases. Today we have 17 people in a main ward of a hospital and 10 in ICU, which means 43 people have the infection and are confined at home or in quarantine - at least 10 of them are in quarantine, as all recent arrivals were placed there. So there are about 33 active infections out in the wild, so to speak.

The Commonwealth's Chief Medical Officer advises that at least 84 and not more than 92% of actual infections have been detected, which means there are not more than 6 asymptomatic carriers out there floating around. A "second wave" from community transmission is not really plausible.



I think it does. Look what happened in a Singapore. It looked completely under control and now it’s not under control.

Singapore's "second wave" has come from foreign workers confined in dormitories without proper sanitation or medical care. It's worse even than a cruise ship as a way to ensure as many people as possible get sick.

In Australia we don't have foreign worker dormitories, and all recent arrivals have been put in hotel rooms as quarantine, with access to excellent sanitation and medical care. They are under police guard, and one covid-positive fellow who managed to sneak out has been sentenced to five years in prison. It's very unlikely to spread out of those quarantine hotels.

Since someone will mention it, China's "second wave" has come from Chinese arriving back home. This is one of the reasons Australia is quarantining recent arrivals, rather than just letting them wander in as they please - we learned something from the Ruby Princess mess.

Certainly, closed borders and quarantine will have to remain in place in Australia for some time. Given that, a "second wave" from overseas arrivals is not really plausible at this time.

Australia as a whole has it under control, though NSW is still having some trouble. It would be stupid to allow large football games and religious services now, but I think we could safely allow a few friends to have a barbeque and that sort of thing.

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Re: How long can we wait while flattening the curve?
« Reply #964 on: April 22, 2020, 10:22:38 PM »
Kyle - no hard expiry date, but a date of 11 May given as the time when Victoria will start considering easing social (but probably not most business) restrictions:

https://www.skynews.com.au/details/_6150906452001

All these timeframes are a work in progress but I think the problem for our state is that Andrews, having committed to a very tough stance on the virus, will lose political points if he relents any time before 11 May - even if we continue to see 0, 1 or 2 new cases daily.

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Re: How long can we wait while flattening the curve?
« Reply #965 on: April 22, 2020, 10:34:36 PM »
Kyle - no hard expiry date, but a date of 11 May given as the time when Victoria will start considering easing social (but probably not most business) restrictions:

https://www.skynews.com.au/details/_6150906452001

All these timeframes are a work in progress but I think the problem for our state is that Andrews, having committed to a very tough stance on the virus, will lose political points if he relents any time before 11 May - even if we continue to see 0, 1 or 2 new cases daily.
This mentality basically explains why so many politicians waited until it was too late to do anything. They rightly didn't trust their citizens to take the long view* and wrongly put their own political wellbeing above the wellbeing of the people.

*That is, if you have one or two cases a day, and then revert to an ordinary stance where each person infects three or four more people, how many cases a day are you going to have in eight weeks?

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Re: How long can we wait while flattening the curve?
« Reply #966 on: April 22, 2020, 10:38:20 PM »
That's black or white thinking. I haven't said we should go straight from stage 3 to stage 0 restrictions, but rather that we start loosening them a small amount at a time with regular reviews based on the case numbers. Victoria has such a good testing regime that any uptick would be easily detected.

Don't believe me? Have a look at the previous wave of coronavirus cases in Australia. With lesser testing (because we weren't ready for it) and lesser preparedness, and also lighter restrictions, we still managed to go from peak acceleration to deceleration within about 10 days. We bent the curve very quickly. Our total death toll is only 74 (out of 25 million) which is minuscule in the scheme of things.

You can't compare our situation with that in the US or Italy where the parameters are completely different.

Nor was there anything like an average infection number of 3-4 people per infected person. The context is completely different.

Gremlin

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Re: How long can we wait while flattening the curve?
« Reply #967 on: April 22, 2020, 10:51:29 PM »
My state of five million people has recorded only 3 new cases in the last 48 hours yet wants 3 more weeks of near-complete lockdown - does that make sense to anyone?

I think it does. Look what happened in a Singapore. It looked completely under control and now it’s not under control.

A couple more weeks will really suppress the virus to the lowest practical level and give the country the best chance to keep it in check.

If things continue to trend the right way the 3 weeks might become 2 weeks. Shortening the lockdown due to too much good news is better than having to keep adding extra weeks, which would really piss everyone off,

Already the CMO is saying borders will be shut for 4 months only, as opposed to  wing shut until 2021 as was being said a week or 2 ago. Schools are reopening etc.

Just be patient. Stay at home. Soon you will be back stuck in peak hour traffic reflecting whimsically back on those few weeks where you were able to have long slow breakfasts,  take short naps at lunch time and extended coffee breaks throughout the day.

People always want what they can’t have. Be thankful for what you do have.

For those outside Australia, the Federal and State Governments (at both ends of the political spectrum) collectively announced a week ago that the conditions for winding back restrictions would be:

  • Australia has in place sufficient capabilities to undertake widespread testing
  • Australia has in place sufficient capabilities to undertake widespread case tracking
  • Australia has a suitable isolation policies in place, including the ability to isolate localised communities to contain future outbreaks

All of these measures seem, to me, to be eminently sensible.  Note that these conditions do not talk about incremental daily case numbers.  Fundamentally that's because these three steps will set up a process that Australia will be adhering to for months, if not years. 

At the time they announced that it would take four weeks to put these measures in place.  We are now one and a bit weeks into that four week period.  State and Federal leaders, at both ends of the political spectrum, have once again reiterated this timeframe in the past couple of days and they have described the consequences of getting this wrong being harder and longer periods of lockdown in the future.

I have a friend in one of the Health Depts who explained it to me like this.  As a nation, we currently are meeting capacity for testing given we have a (relatively) locked down population and relatively low community transmission.  As the restrictions lift, the interactions between people increase.  The incidence of "flu-like symptoms" will also increase, particularly as we come into winter.  We need more capacity to test in the future than we have now if we want our ability to test to remain comprehensive. 

Similarly, we have a contact tracing regime that works given the number of cases we have.  If we lift restrictions we will have more COVID-19 cases.  With more interactions, we not only have more cases than now, but each have more contacts making contact tracing harder.  Even though this makes contact tracing harder, it is also far more important as it avoids significant clusters emerging which would be the catalyst for a wider lockdown.  As a result, the contact tracing needs to be beefed up, either manually or via technology.  And finally, we need clearer and consistent isolation rules, not just at an individual level but at a community level too.  Whilst we are gearing up the first two we might as well get the third one right.


Gremlin

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Re: How long can we wait while flattening the curve?
« Reply #968 on: April 22, 2020, 10:54:30 PM »
That's black or white thinking. I haven't said we should go straight from stage 3 to stage 0 restrictions, but rather that we start loosening them a small amount at a time with regular reviews based on the case numbers. Victoria has such a good testing regime that any uptick would be easily detected.

Don't believe me? Have a look at the previous wave of coronavirus cases in Australia. With lesser testing (because we weren't ready for it) and lesser preparedness, and also lighter restrictions, we still managed to go from peak acceleration to deceleration within about 10 days. We bent the curve very quickly. Our total death toll is only 74 (out of 25 million) which is minuscule in the scheme of things.

You can't compare our situation with that in the US or Italy where the parameters are completely different.

Nor was there anything like an average infection number of 3-4 people per infected person. The context is completely different.

I have a very good friend who works in the Health Dept that asserts that's only the case given that the restrictions are reducing person-to-person contact.  Capacity to test is being expanded, but one of the clear drivers of the current timetable is that if restrictions are reduced the capacity to test at the moment would be potentially compromised.  Seems sensible to get this right to me.

Kyle Schuant

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Re: How long can we wait while flattening the curve?
« Reply #969 on: April 22, 2020, 10:59:40 PM »

Kyle - no hard expiry date, but a date of 11 May given as the time when Victoria will start considering easing social (but probably not most business) restrictions

That's simply because that's when the current state of emergency ends. If no further decisions are taken, ALL restrictions end at midnight on May 11th. That won't happen, they'll extend it another 28 days to June 8th, and at least twice more after that. But in order to make it palatable, they may have to ease up some restrictions on the 11th.

I think Andrews would like to keep Stage 3 going for another 28 days after that, whether he does or not depends on how much public and media opposition there is by then - parliament won't oppose him, they'll rubber-stamp after token amendments that get rejected like Albo did federally. Absent any more large arrivals from overseas we'll have had a week or so with no new cases then by May 11th.

Going on how much Andrews has been going, I think that May 11th may just see the schools thing go from a default "no" to a default "yes, if you can't keep them at home." I don't see him opening restaurants and other things. Eating a kebab alone on a park bench will remain a serious offence. The police had started losing their enthusiasm for fining people for harmless acts, judging by the deputy commissioner's statements and the numbers of fine issued, but since the police unfortunately lost 4 of their members in a freeway smash last night, they'll get angry and be keen to crack down on everyone, too.

In other countries a large part of the pressure to reopen has come from people who have no income now. Like I said, if I were locked up at home going hungry I might be waving a rifle around in front of parliament house, too. But the Commonwealth government is tossing billions of dollars at people, with doubled dole and the JobKeeper payment lasting till September, so this takes the pressure off Andrews, he can keep the lockdown going on for months yet without anyone going hungry, even if they're going crazy.

Today he's passing the emergency legislation, notably allowing the state govt to change how the justice system works merely by decreeing it so. I think he'll continue to use this crisis to try to force through unrelated changes and spending in line with his personal politics, and so long as the Commonwealth govt keeps propping the state up he can do so.


For those outside Australia, the Federal and State Governments (at both ends of the political spectrum) collectively announced a week ago that the conditions for winding back restrictions would be:
  • Australia has in place sufficient capabilities to undertake widespread testing
  • Australia has in place sufficient capabilities to undertake widespread case tracking
  • Australia has a suitable isolation policies in place, including the ability to isolate localised communities to contain future outbreaks
Those conditions exist today.
« Last Edit: April 22, 2020, 11:03:24 PM by Kyle Schuant »

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Re: How long can we wait while flattening the curve?
« Reply #970 on: April 23, 2020, 02:25:26 AM »
Poundwise posted this link on the "Coronavirus is the end of Trump" thread today.  It suggests that the virus may be directly causing heart damage in some patients -

https://www.scientificamerican.com/article/heart-damage-in-covid-19-patients-puzzles-doctors/

In the rising death statistics for the UK only part of the rise has been attributed to covid-19: if the virus causes heart damage and death in patients who do not have severe lung disease symptoms then that could account for it.  Anecdotally there have also been reports from paramedics in New York of having high levels of resuscitation attempts in their shifts.   So I am inclined to think that the evidence will stack up for this coronavirus being a viral heart disease to add to the ones we already have.  If so, patients who have appeared to recover might still be left with heart disease which could become disabling over time and the implications for letting the virus go through a population, even with a reduction in the curve to enable health services to cope with the demand, could be severe.




Kyle Schuant

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Re: How long can we wait while flattening the curve?
« Reply #971 on: April 23, 2020, 03:38:29 AM »
Note: it is quite possible for the virus to be a very serious problem and at the same time for governments to be using it to arrogate more power to themselves, and abuse it.

https://www.theage.com.au/politics/victoria/victorian-government-blocks-opposition-calls-for-scrutiny-of-pandemic-response-20200423-p54mo6.html

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Re: How long can we wait while flattening the curve?
« Reply #972 on: April 23, 2020, 04:32:13 AM »
In Sweden, herd immunity could be reached in a few weeks time.

https://www.cnbc.com/2020/04/22/no-lockdown-in-sweden-but-stockholm-could-see-herd-immunity-in-weeks.html

https://www.nature.com/articles/d41586-020-01098-x

God bless the Nordic nations.    Their ability to act with pragmatism is enviable.  I'm aware Denmark, Norway and Finland initially behaved differently -- but regardless of the initial response their governments are so much more functional and flexible. 
« Last Edit: April 23, 2020, 04:47:52 AM by egillespie »

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Re: How long can we wait while flattening the curve?
« Reply #973 on: April 23, 2020, 06:14:39 AM »
In Covid19 Deaths/Population/Country, Sweden went from bottom of the heap to top 10 in the last month. We will see what happens in the following month.

Oh, and their Economy got shellacked anyway.

What exactly have they gained by this experiment?

Perhaps they will take less of an economic hit than some other countries, but we don't know that yet. Their government also recently approved a bailout.

UK tried this early as well with Boris Johnson, they are now top 5 for Covid19 Deaths/Population/Country

USA just cracked the top 10, and rising fast.

Top 10 (only including countries >1 million people) with [deaths/million]
1. Belgium [540]
2. Spain [464]
3. Italy [415]
4. France [327]
5. UK [267]
6. Netherlands [540]
7. Sweden [237]
8. Switzerland [192]
9. Ireland [156]
10. USA [144]

https://www.worldometers.info/coronavirus/#countries

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Re: How long can we wait while flattening the curve?
« Reply #974 on: April 23, 2020, 06:38:19 AM »
https://www.nytimes.com/2020/04/23/health/coronavirus-measles-vaccines.html

Who cares about children and preventable diseases anyway.  Hey, we can save a 93-year-old with dementia in a nursing home!

So how long can we wait?  Apparently, we are willing to wait long after the curve has been flattened and we are willing to collapse society. 
« Last Edit: April 23, 2020, 06:40:16 AM by egillespie »

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Re: How long can we wait while flattening the curve?
« Reply #975 on: April 23, 2020, 06:54:19 AM »
https://www.nytimes.com/2020/04/23/health/coronavirus-measles-vaccines.html

Who cares about children and preventable diseases anyway.  Hey, we can save a 93-year-old with dementia in a nursing home!

So how long can we wait?  Apparently, we are willing to wait long after the curve has been flattened and we are willing to collapse society.

You bring up a really interesting point here. Has anyone seen a study done of Cost/Year of life saved? As these disease is especially deadly to the especially old I am curious to see how many years we are saving (as opposed to lives)

Warning **made up numbers**
If 4 people are out of work for a year to save the life of a 95 year old for 2 years, that hardly seams worth it. Now if 4 people are out of work for a year to save the life of a 35 year old I feel that is a completely different story. So lets just say that 1 year of unemployment costs society $250k. So with my made up numbers

1 million/2 years or 500k a year of life

and

1 million/40 years  or 25k per year of life.







T-Money$

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Re: How long can we wait while flattening the curve?
« Reply #976 on: April 23, 2020, 06:57:24 AM »
If the following is true it's possible social distancing has no positive effect as the disease was already so widespread in March.

https://www.nytimes.com/2020/04/23/us/coronavirus-early-outbreaks-cities.html?action=click&module=Spotlight&pgtype=Homepage

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Re: How long can we wait while flattening the curve?
« Reply #977 on: April 23, 2020, 07:01:16 AM »
https://www.nytimes.com/2020/04/23/health/coronavirus-measles-vaccines.html

Who cares about children and preventable diseases anyway.  Hey, we can save a 93-year-old with dementia in a nursing home!

So how long can we wait?  Apparently, we are willing to wait long after the curve has been flattened and we are willing to collapse society.

You bring up a really interesting point here. Has anyone seen a study done of Cost/Year of life saved? As these disease is especially deadly to the especially old I am curious to see how many years we are saving (as opposed to lives)

Warning **made up numbers**
If 4 people are out of work for a year to save the life of a 95 year old for 2 years, that hardly seams worth it. Now if 4 people are out of work for a year to save the life of a 35 year old I feel that is a completely different story. So lets just say that 1 year of unemployment costs society $250k. So with my made up numbers

1 million/2 years or 500k a year of life

and

1 million/40 years  or 25k per year of life.

If you look at the amount of debt amassed, the job loss and all the problems from other medical problems not being diagnosed and treated, I think it is easy to come up with a cost of tens of millions of dollars per life saved.

Half of those dead were in nursing homes.  In New York City, 73% of those dead were senior citizens, 97% of all deaths had previous conditions (mostly preventable).

I could not imagine a more ineffective and destructive response from the government and medical community. 

https://www.msn.com/en-us/news/us/in-new-yorks-largest-hospital-system-88-percent-of-coronavirus-patients-on-ventilators-didnt-make-it/ar-BB133Act

Ventilators are about as effective as treatment for pancreatic cancer (which is one of the least treatable cancers).

This is an excellent example of the "Circle of Control" From MMM.  And what happens when there is a hysterical reaction to something that falls within the "Circle of Concern".
« Last Edit: April 23, 2020, 07:03:39 AM by egillespie »

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Re: How long can we wait while flattening the curve?
« Reply #978 on: April 23, 2020, 07:52:24 AM »
If the following is true it's possible social distancing has no positive effect as the disease was already so widespread in March.

I do not understand how you arrived at that conclusion.  It seems we were slow to act when our own medical experts were certain it would come here.  Had we acted sooner with there lock-down measures we could be in a much better place now.  As it is, my biggest concern is that 'opening up' the economy will cause far greater economic distress and bankruptcies than keeping restrictions in place until transmission is reduced further.  We've seen that play out in other outbreaks.

LightTripper

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Re: How long can we wait while flattening the curve?
« Reply #979 on: April 23, 2020, 08:03:28 AM »
https://www.nytimes.com/2020/04/23/health/coronavirus-measles-vaccines.html

Who cares about children and preventable diseases anyway.  Hey, we can save a 93-year-old with dementia in a nursing home!

So how long can we wait?  Apparently, we are willing to wait long after the curve has been flattened and we are willing to collapse society.

You bring up a really interesting point here. Has anyone seen a study done of Cost/Year of life saved? As these disease is especially deadly to the especially old I am curious to see how many years we are saving (as opposed to lives)

Warning **made up numbers**
If 4 people are out of work for a year to save the life of a 95 year old for 2 years, that hardly seams worth it. Now if 4 people are out of work for a year to save the life of a 35 year old I feel that is a completely different story. So lets just say that 1 year of unemployment costs society $250k. So with my made up numbers

1 million/2 years or 500k a year of life

and

1 million/40 years  or 25k per year of life.

This is why we have "QALYs": https://en.wikipedia.org/wiki/Quality-adjusted_life_year
Though you will see across multiple studies that in practice, though e.g. the NHS in the UK tries to be consistent in how much it will pay for a QALY, there are inconsistencies (e.g. the amount spent on achieving a QALY through road safety in the UK does not match the amount spent on health, and the NHS will pay more for a QALY for a rare disease than a common one - as otherwise the costs of treating these things would never be covered, and I guess as a society we don't like to say "this is too niche, it's not efficient to treat it").  Still, it gives a framework for thinking about some of the costs.  Though for my money anxiety/fear caused by yourself and your loved ones being exposed to risk is a significant cost, and having a "good death" when the time comes has significant value ... nothing is ever simple.

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Re: How long can we wait while flattening the curve?
« Reply #980 on: April 23, 2020, 08:06:43 AM »
In Covid19 Deaths/Population/Country, Sweden went from bottom of the heap to top 10 in the last month. We will see what happens in the following month.

Oh, and their Economy got shellacked anyway.

What exactly have they gained by this experiment?

Perhaps they will take less of an economic hit than some other countries, but we don't know that yet. Their government also recently approved a bailout.

UK tried this early as well with Boris Johnson, they are now top 5 for Covid19 Deaths/Population/Country

USA just cracked the top 10, and rising fast.

Top 10 (only including countries >1 million people) with [deaths/million]
1. Belgium [540]
2. Spain [464]
3. Italy [415]
4. France [327]
5. UK [267]
6. Netherlands [540]
7. Sweden [237]
8. Switzerland [192]
9. Ireland [156]
10. USA [144]

https://www.worldometers.info/coronavirus/#countries

Doesn't it stand to reason that Sweden is just way further ahead in their curve than everyone else?

Which goes back to my point that we can't eradicate the virus by staying in our homes. Eventually a single patient turns into thousands. Which is why "flatten the curve" was about preventing hospitals from being overburdened for additional deaths. Eventually the US will have to face the music and people will become infected. It's inevitable.

It seems like normally logical people are overcome by fear in this instance. These things seems fairly obvious to me.

Oh, and please spare me the "we were also waiting for treatment" that someone replies with every time I mention flattening the curve. We're not waiting 2 years of lockdown for a new treatment to be studied and approved.

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Re: How long can we wait while flattening the curve?
« Reply #981 on: April 23, 2020, 08:11:00 AM »
The New York Time articles on immunization is a good one. The point of journalism like that is to highlight ongoing issues and advocate for those affected. So maybe someone in a county health department reads the article, looks at their own numbers, and decides the county needs a mobile vaccination solution. Or maybe their numbers look just fine but it was a good checkup.

Aggressively skeptical people read articles like that though and immediately run with, "We're killing babies to save grandma!!!"

The UN put out a report last week that expressed concern for the global poor in a shutdown era. The point was not to advocate opening back up full steam. It was to alert banks, wealthier governments, and philanthropists to step in and help out.
« Last Edit: April 23, 2020, 08:12:42 AM by mathlete »

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Re: How long can we wait while flattening the curve?
« Reply #982 on: April 23, 2020, 08:13:35 AM »
If the following is true it's possible social distancing has no positive effect as the disease was already so widespread in March.

I do not understand how you arrived at that conclusion.  It seems we were slow to act when our own medical experts were certain it would come here.  Had we acted sooner with there lock-down measures we could be in a much better place now.  As it is, my biggest concern is that 'opening up' the economy will cause far greater economic distress and bankruptcies than keeping restrictions in place until transmission is reduced further.  We've seen that play out in other outbreaks.
Not picking on you, but this is the most recent post and exactly what I'm talking about.

This idea that we didn't "act soon enough." Sure, maybe "acting sooner" gave us more tests. But how does locking down sooner do anything positive? Was your goal to have hospitals even MORE empty than they are now?

When we go from a single person in China in November/December to millions in March, what good is locking down doing? Flatten the curve, once again, is about additional deaths that can't be treated because the hospitals are at capacity. When they're not at capacity, we're wasting time and resources. We need people catching the virus and either getting immunity because their symptoms are mild, or they're getting treatment at a hospital. Having no one catch it is counter productive.

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Re: How long can we wait while flattening the curve?
« Reply #983 on: April 23, 2020, 08:19:07 AM »
The way exponentiality works, is that if we can figure out a way to reliably keep transmission under 1, i.e., each newly infected person infects fewer than one other person, then the aggregate number of cases goes down. And we do indeed save lives without a vaccine. Not just overburdened hospital lives. Other benefits include possibly getting us through seasonality.

Does keeping transmission under 1 mean that we have to persist in our current state? Or can we do it by limiting large gatherings, keeping people who can WFH working from home, temperature scanning everyone who shows up to their essential job, everyone wearing PPE, etc.

That's what really smart people are working on right now.

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Re: How long can we wait while flattening the curve?
« Reply #984 on: April 23, 2020, 08:25:48 AM »
Not picking on you, but this is the most recent post and exactly what I'm talking about.

This idea that we didn't "act soon enough." Sure, maybe "acting sooner" gave us more tests. But how does locking down sooner do anything positive? Was your goal to have hospitals even MORE empty than they are now?

When we go from a single person in China in November/December to millions in March, what good is locking down doing? Flatten the curve, once again, is about additional deaths that can't be treated because the hospitals are at capacity. When they're not at capacity, we're wasting time and resources. We need people catching the virus and either getting immunity because their symptoms are mild, or they're getting treatment at a hospital. Having no one catch it is counter productive.

This is exactly why I say that it's a binary decision people are making on this earlier (either full quarantine or yolo). People use the "flatten the curve" language but really, what practically is being suggested societally is to zero the curve or just ignore it entirely.

The decision that needs to be discussed is:

  • Can covid be eliminated completely without anything close to herd immunity? aka through suppression/full quarantine?

Zeroing the curve seems like inevitable yoyoing on this for a long time (years seems likely) if the models about transmissibility are remotely close to true and it's not completely eradicated worldwide. Or we're going to basically be in a state of lockdown indefinitely.




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Re: How long can we wait while flattening the curve?
« Reply #985 on: April 23, 2020, 08:26:04 AM »
In Covid19 Deaths/Population/Country, Sweden went from bottom of the heap to top 10 in the last month. We will see what happens in the following month.

Oh, and their Economy got shellacked anyway.

What exactly have they gained by this experiment?

Perhaps they will take less of an economic hit than some other countries, but we don't know that yet. Their government also recently approved a bailout.

UK tried this early as well with Boris Johnson, they are now top 5 for Covid19 Deaths/Population/Country

USA just cracked the top 10, and rising fast.

Top 10 (only including countries >1 million people) with [deaths/million]
1. Belgium [540]
2. Spain [464]
3. Italy [415]
4. France [327]
5. UK [267]
6. Netherlands [540]
7. Sweden [237]
8. Switzerland [192]
9. Ireland [156]
10. USA [144]

https://www.worldometers.info/coronavirus/#countries

Doesn't it stand to reason that Sweden is just way further ahead in their curve than everyone else?

Which goes back to my point that we can't eradicate the virus by staying in our homes. Eventually a single patient turns into thousands. Which is why "flatten the curve" was about preventing hospitals from being overburdened for additional deaths. Eventually the US will have to face the music and people will become infected. It's inevitable.

It seems like normally logical people are overcome by fear in this instance. These things seems fairly obvious to me.

Oh, and please spare me the "we were also waiting for treatment" that someone replies with every time I mention flattening the curve. We're not waiting 2 years of lockdown for a new treatment to be studied and approved.

Well - I would say:
a) avoiding those "additional" deaths (non-covid deaths and avoidable covid deaths) also has a value that should be taken into account (for those who die, their families and wider society who doesn't have to live so much in fear) - locking down now also buys time to build surge capacity so that the level of infection that results in "additional" deaths is higher; and

b) on "treatment" this isn't a zero/one thing.  Yes, it may take 1.5-2 years to come up with a really effective vaccine or drug treatment (maybe longer), and it isn't realistic to maintain current levels of social distancing until then.  However, we are learning more about how to monitor and treat this thing all the time (e.g. early monitoring of oxygen levels, use of CPAP vs ventilator, existing drugs that may have some usefulness).

I do agree there are serious questions on how and when to lift the lockdown.  But it seems clear to me it should be done through small incremental steps, designed to release the parts of the economy undergoing the most damage at the least benefit to controlling the rate of spread.  That process too will be a learning experience, and although the UK has done lots of things wrong, I feel fortunate to live in a country that is not running that experiment first, so we will get a chance to learn a little from those who go before us.  I'm not sure why a country like the US, that was running behind the rest of the world (even behind the UK), would volunteer to run to the front of the queue to be the guinea pigs here?

But in the end the economics is uncertain, and this is a philosophical, social and political question too, so each country or region will have to choose their own path.

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Re: How long can we wait while flattening the curve?
« Reply #986 on: April 23, 2020, 08:26:41 AM »
Do we really believe that if the world governments kept the MMM forums as counsel, that we could end the lockdowns right now? Because if they only listened to us, they'd realize that no lives are savable and we're just lighting GDP growth on fire for no reason?

If that is the case, I strongly encourage you to reach out and try to make that happen. Share your research and conclusions. These are uncertain times and we're dealing with something that not a lot of people know about. You may get further than you think. That's been my experience. I have a STEM degree and I work with models. That alone has been enough for me to get into conversations with people who are doing things that really matter right now. Decision makers are desperate for competing analysis. If you think you've got that, I say go for it.

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Re: How long can we wait while flattening the curve?
« Reply #987 on: April 23, 2020, 08:32:44 AM »
If the following is true it's possible social distancing has no positive effect as the disease was already so widespread in March.

I do not understand how you arrived at that conclusion.  It seems we were slow to act when our own medical experts were certain it would come here.  Had we acted sooner with there lock-down measures we could be in a much better place now.  As it is, my biggest concern is that 'opening up' the economy will cause far greater economic distress and bankruptcies than keeping restrictions in place until transmission is reduced further.  We've seen that play out in other outbreaks.
Not picking on you, but this is the most recent post and exactly what I'm talking about.

This idea that we didn't "act soon enough." Sure, maybe "acting sooner" gave us more tests. But how does locking down sooner do anything positive? Was your goal to have hospitals even MORE empty than they are now?

When we go from a single person in China in November/December to millions in March, what good is locking down doing? Flatten the curve, once again, is about additional deaths that can't be treated because the hospitals are at capacity. When they're not at capacity, we're wasting time and resources. We need people catching the virus and either getting immunity because their symptoms are mild, or they're getting treatment at a hospital. Having no one catch it is counter productive.

You don’t seem to understand my posts, not acknowledge that there are benefits to self isolation beyond preventing the overwhelming of hospitals that you continually mention as the “only reason” why we have instituted these measures.

It is NOT just about preventing “additional deaths” in the manner you keep describing. It is ALSO about drastically reducing transmission rates (as mathlete described) AND ultimately about reducing the economic fallout. I realize this is a hard concept to grasp here but reopening front facing businesses when transmission is widespread may push us much deeper into recession than we currently are. Such is the dreaded “W” recession curve. That seems to me to be the most likely outcome to lifting stay at home orders when there are still thousands of infected spreaders in a region.

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Re: How long can we wait while flattening the curve?
« Reply #988 on: April 23, 2020, 08:33:08 AM »
Do we really believe that if the world governments kept the MMM forums as counsel, that we could end the lockdowns right now? Because if they only listened to us, they'd realize that no lives are savable and we're just lighting GDP growth on fire for no reason?

If that is the case, I strongly encourage you to reach out and try to make that happen. Share your research and conclusions. These are uncertain times and we're dealing with something that not a lot of people know about. You may get further than you think. That's been my experience. I have a STEM degree and I work with models. That alone has been enough for me to get into conversations with people who are doing things that really matter right now. Decision makers are desperate for competing analysis. If you think you've got that, I say go for it.

You are a lot more optimistic than I am regarding the capability of politicians to take in information on topics they know nothing about and act rationally/reasonably.

Pretty much every topic I am well versed in is a colossal trainwreck when politicians discuss it.

I do agree there are serious questions on how and when to lift the lockdown.  But it seems clear to me it should be done through small incremental steps, designed to release the parts of the economy undergoing the most damage at the least benefit to controlling the rate of spread.  That process too will be a learning experience, and although the UK has done lots of things wrong, I feel fortunate to live in a country that is not running that experiment first, so we will get a chance to learn a little from those who go before us.  I'm not sure why a country like the US, that was running behind the rest of the world (even behind the UK), would volunteer to run to the front of the queue to be the guinea pigs here?

But in the end the economics is uncertain, and this is a philosophical, social and political question too, so each country or region will have to choose their own path.

Keep in mind the population of the United States alone is 50% of all of Europe and has a massive geographic area comparatively.

Each state in the USA has very different circumstances and you realistically can't say "the US" should respond as a single entity as far as how it should react to covid anymore than you can say all countries in Europe should be doing the exact same thing at all stages in this entire process.

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Re: How long can we wait while flattening the curve?
« Reply #989 on: April 23, 2020, 08:38:03 AM »
At what virus contagion are quarantines and lock downs no longer effective?  Is there an estimate with this virus?

I'm wondering if 30%, 50%, 60% of the population has already been exposed at what point would a reasonable person think containment is no longer an option?  Are there any models that deal with this question?

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Re: How long can we wait while flattening the curve?
« Reply #990 on: April 23, 2020, 08:38:40 AM »
You are a lot more optimistic than I am regarding the capability of politicians to take in information on topics they know nothing about and act rationally/reasonably.

Pretty much every topic I am well versed in is a colossal trainwreck when politicians discuss it.

I don't know. Scientists and science conscious people sounded the alarm on this, and world governments acted accordingly. Some faster or slower than others.

If economists, and economically conscious people can point to the damage being done, and also point to conclusions that show that the medical science is evolving in such a way that the lockdown wasn't or is no longer worth it, it seems like politicians would listen. I live in a country with a pretty right wing government. It seems like they'd be really eager to hear arguments that say we can lift restrictions.
« Last Edit: April 23, 2020, 08:42:16 AM by mathlete »

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Re: How long can we wait while flattening the curve?
« Reply #991 on: April 23, 2020, 08:39:30 AM »
At what virus contagion are quarantines and lock downs no longer effective?  Is there an estimate with this virus?

I'm wondering if 30%, 50%, 60% of the population has already been exposed at what point would a reasonable person think containment is no longer an option?  Are there any models that deal with this question?

The NIH is doing an antibody study right now to figure out if this is the case.

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Re: How long can we wait while flattening the curve?
« Reply #992 on: April 23, 2020, 09:34:47 AM »

Keep in mind the population of the United States alone is 50% of all of Europe and has a massive geographic area comparatively.

Each state in the USA has very different circumstances and you realistically can't say "the US" should respond as a single entity as far as how it should react to covid anymore than you can say all countries in Europe should be doing the exact same thing at all stages in this entire process.

That is a very fair point: although I assume it gets difficult unless states control their own borders?  At some point you'd expect internal travel to spread the risks from one State to another, and create possible clashes of preferred policies.  But I guess this is something your system must be used to dealing with in many ways, given you share a currency.

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Re: How long can we wait while flattening the curve?
« Reply #993 on: April 23, 2020, 09:58:01 AM »
In Covid19 Deaths/Population/Country, Sweden went from bottom of the heap to top 10 in the last month. We will see what happens in the following month.

Oh, and their Economy got shellacked anyway.

What exactly have they gained by this experiment?

Perhaps they will take less of an economic hit than some other countries, but we don't know that yet. Their government also recently approved a bailout.

UK tried this early as well with Boris Johnson, they are now top 5 for Covid19 Deaths/Population/Country

USA just cracked the top 10, and rising fast.

Top 10 (only including countries >1 million people) with [deaths/million]
1. Belgium [540]
2. Spain [464]
3. Italy [415]
4. France [327]
5. UK [267]
6. Netherlands [540]
7. Sweden [237]
8. Switzerland [192]
9. Ireland [156]
10. USA [144]

https://www.worldometers.info/coronavirus/#countries

What have Sweden gained?

Their economy is currently more functional than pretty anybody else’s. Their borders are open. They have had 2,021 deaths at the time of me writing this. The whole “deaths per million” is funny. India could suffer 500,000 deaths today and still only be ranked in 4th place by that metric tomorrow.

As @fattest_foot said, Sweden are way ahead of the curve.

They’ve still built field hospitals and increased PPE and medical equipment and prepared for the worst. They’ve not done nothing. They just not locked down. The Swedish government didn’t mandate anything. They simply advised people and gave them some guidance. Nothing more.

They don’t have to agonise over the order in which they should lift lockdown measures and to what degree and for how long. They kept bars, pubs, shops and restaurants open. Schools for those aged 16 and under stayed open. Even their largest cinema chain has kept movie theatres open but capped auditorium capacity at 50 people per showing. There is very little for them to do now. They just keep going as they are. They had 185 deaths yesterday, but only 84 today.

In the opinion of the people behind their strategy, they traded more deaths at this early stage, for fewer deaths further on, and that countries who locked down are simply doing the reverse, because they will be hit by multiple waves of the virus over the next year or so.

Sweden aren’t going to experience a second, third or fourth wave because they’re already in a post-lockdown state and have been since the start. Whatever waves they might experience, will all happen right now if they’re going to. If herd immunity is something that can be achieved in less than a decade and helps, Sweden will be the first country to experience it. They’re already talking about Stockholm possibly having herd immunity by mid-May or June.
 
As I said earlier in this thread, or perhaps on another thread, they’re able to do this because their national attitude/collective temperament and respect for the government is very high and their population is quite small (10 million) and much of it is scattered over a large area. My native UK kind of tried this approach but thankfully we gave up and locked down because our collective temperament is not conducive to doing what the Swedes are doing. We have too many idiots over here. It would have been pure chaos. Sweden however have the ability to pull this off because they’re a different kind of people and a different kind of society. The only thing they wish they’d done sooner is ban people from visiting care homes.

That said, all countries have been hit hard in care homes, which brings me to a another point. I think Swedish death figures may include hospital deaths AND care home deaths. The UK doesn’t do this at the moment. We might be omitting about 10,000 deaths from our count because we don’t want to know how many people have died in care homes. The numbers increased greatly in the weeks leading up to Friday April 10th, I can’t begin to imagine how much worse they will be by the time they are reported properly in the next week or so.

Also, I read that every time the Swedish government discovers that someone who had the virus has died, that person is registered as a COVID-19 death if it happened within 30 days of the diagnosis – even if the cause of death was cancer or a heart attack. It means that Sweden reports the number of people who die with COVID-19, not of COVID-19.

I don’t know how true that is, but if it is true then it puts Sweden even further ahead of the game, and that if everyone else registered deaths in the same way and counted their care home deaths, Sweden would probably drop down the rankings.

Either way, as things stand right now, Sweden are in a better position than pretty much every country in the world, economical, socially and in terms of total number of deaths because everyone else, even the likes of Germany and South Korea will experience an increase in deaths when they re-open schools, workplaces, bars and cinemas etc.

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Re: How long can we wait while flattening the curve?
« Reply #994 on: April 23, 2020, 09:59:21 AM »
ptf

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Re: How long can we wait while flattening the curve?
« Reply #995 on: April 23, 2020, 10:32:25 AM »
In Covid19 Deaths/Population/Country, Sweden went from bottom of the heap to top 10 in the last month. We will see what happens in the following month.

Oh, and their Economy got shellacked anyway.

What exactly have they gained by this experiment?

Perhaps they will take less of an economic hit than some other countries, but we don't know that yet. Their government also recently approved a bailout.

UK tried this early as well with Boris Johnson, they are now top 5 for Covid19 Deaths/Population/Country

USA just cracked the top 10, and rising fast.

Top 10 (only including countries >1 million people) with [deaths/million]
1. Belgium [540]
2. Spain [464]
3. Italy [415]
4. France [327]
5. UK [267]
6. Netherlands [540]
7. Sweden [237]
8. Switzerland [192]
9. Ireland [156]
10. USA [144]

https://www.worldometers.info/coronavirus/#countries

Their economy is currently more functional.

As @fattest_foot said, Sweden are way ahead of the curve.

Hi Spud, you make some decent points. Foremost of which is that their economy is more functional.

The metric of death per million is what it is, how else should we measure the impact of Covid between countries of different size? Impact on GDP [% loss of GDP per quarter or year] should certainly be a consideration but can only be measured in hindsight.

I disagree with your argument about Sweden being late in the Covid19 whole population infection process. Beginning at the 25th death, Sweden is only about 30 days along. Compare to USA which is 45 days along, and Italy is at around 60 days.

https://www.nytimes.com/interactive/2020/03/21/upshot/coronavirus-deaths-by-country.html

I sincerely hope you are entirely right and that Sweden will be a model for other countries down the line. Unfortunately we will not really know this for another 30 days. Of course, if the toll gets too high, Sweden will adjust accordingly and lock things down tighter. We will see.

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Re: How long can we wait while flattening the curve?
« Reply #996 on: April 23, 2020, 10:47:42 AM »
https://www.cnbc.com/2020/04/23/new-york-antibody-study-estimates-13point9percent-of-residents-have-had-the-coronavirus-cuomo-says.html

Antibody study estimates 21% of New York City residents have been infected, or about 1.76 million people in the City limits alone.  With a virus R0 of 5.7 it seems unlikely that stopping the spread could be effective, unless we decide to drop a nuke on NYC.

Makes an iFR of about 0.56%.

« Last Edit: April 23, 2020, 10:50:28 AM by egillespie »

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Re: How long can we wait while flattening the curve?
« Reply #997 on: April 23, 2020, 10:56:19 AM »
https://www.cnbc.com/2020/04/23/new-york-antibody-study-estimates-13point9percent-of-residents-have-had-the-coronavirus-cuomo-says.html

Antibody study estimates 21% of New York City residents have been infected, or about 1.76 million people in the City limits alone.  With a virus R0 of 5.7 it seems unlikely that stopping the spread could be effective, unless we decide to drop a nuke on NYC.

Makes an iFR of about 0.56%.

Wow that's bad, but also makes the decision making easier. I guess the silver lining if in those numbers is it is not nearly as deadly as first predicted?

Oh ok, IFR is infected fatality rate? 1/2 a percent is not great, but  likely an acceptable risk to society.

 




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Re: How long can we wait while flattening the curve?
« Reply #998 on: April 23, 2020, 10:57:33 AM »
I also think Sweden is very interesting.  They have kind of volunteered themselves as guinea pigs to see if this kind of more laissez faire approach can work (though as you say Spud, it does depend on all kinds of features of your demographics and society that will be hard to read across elsewhere: e.g. I heard somewhere that 50% of Sweden's population is in single person households, which increases the costs to mental health of the type of lockdown we've had - but may also mean their "natural" R0 is lower).

If I lived in Sweden I would still feel bloody nervous, and I do not believe they can claim this is necessarily a successful strategy against Corona yet.  But yes, Sweden is a very interesting model of roughly what a "post-lockdown" world might look like in many countries, if we get lucky and it turns out that doing it the Swedish way gives you an R of around or below 1 (or that adjusts to below 1 if death rates rise), so you don't get exponential growth.  It will also be interesting to see what impact this kind of "guided distancing" has on their GDP, relative to the more restrictive mandated distancing measures other countries have imposed.

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Re: How long can we wait while flattening the curve?
« Reply #999 on: April 23, 2020, 11:03:08 AM »
https://www.cnbc.com/2020/04/23/new-york-antibody-study-estimates-13point9percent-of-residents-have-had-the-coronavirus-cuomo-says.html

Antibody study estimates 21% of New York City residents have been infected, or about 1.76 million people in the City limits alone.  With a virus R0 of 5.7 it seems unlikely that stopping the spread could be effective, unless we decide to drop a nuke on NYC.

Makes an iFR of about 0.56%.

Wow that's bad, but also makes the decision making easier. I guess the silver lining if in those numbers is it is not nearly as deadly as first predicted?

Oh ok, IFR is infected fatality rate? 1/2 a percent is not great, but  likely an acceptable risk to society.

It's not great, 0.56% iFR, but it is higher than the University of Oxford estimate of 0.10-0.36%.  I'm fascinated what models show when this newer data is used. 

For example, can social distancing have a positive effect with a 21% infection rate and a R0 of 5.7?  Doesn't seem so, but as more and more accurate data are used the models should be less erratic.