Author Topic: How long can we wait while flattening the curve?  (Read 675128 times)

waltworks

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Re: How long can we wait while flattening the curve?
« Reply #2750 on: June 30, 2020, 09:39:21 AM »
I think part of it is that nursing homes have been more vigilant, older people have started to take it seriously and shelter in place as much as possible and the same with at risk people so you see healthier, younger people getting it at a higher rate and they are less likely to die.

In the first month or two at risk groups were not aware it was spreading or the impact it would have on them and now they are informed.

You also have more testing so the cases are going up where in the past they were just testing people that were sick enough to end up at the hospital.


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Yeah, that's my thought too. And if all we really need to do is be super careful about old/at risk people (nursing homes, primarily) then we should be putting a lot more resources there, and otherwise basically letting the disease run it's course.

-W

HBFIRE

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Re: How long can we wait while flattening the curve?
« Reply #2751 on: June 30, 2020, 09:45:40 AM »
Why aren't more people dying? We've had huge increases in case numbers for over a month now.

If another few weeks goes by and the death rate doesn't spike, we need a major rethink of our policy response, I'd say.

-W

More robust testing volume (quadruple what we were doing in mid april) catching a higher % of infections and the average age demographic of positives has lowered significantly.  Denominator higher w/lower average age = substantially lower death rate.  CFR is dropping extremely fast in the US.  We are also likely much better at treating it than we were a few months ago.
« Last Edit: June 30, 2020, 09:48:55 AM by HBFIRE »

MudPuppy

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Re: How long can we wait while flattening the curve?
« Reply #2752 on: June 30, 2020, 09:46:10 AM »
Why aren't more people dying? We've had huge increases in case numbers for over a month now.

If another few weeks goes by and the death rate doesn't spike, we need a major rethink of our policy response, I'd say.

-W

Lots of reasons! In many (most?) areas of the US hospitals and nursing home shave shit out the outside world. No visitors or even visiting care staff.  Other lockdown/precautionary measures are helping protect those who are most vulnerable to death, too. We’ve also had more time to see what does and doesn’t work as far as supportive care. I know time feels meaningless these days, but we’ve only known about this virus since December! The whole world has been flying by night trying to figure out which standard treatments are helpful and which aren’t.

Davnasty

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Re: How long can we wait while flattening the curve?
« Reply #2753 on: June 30, 2020, 09:51:14 AM »
Why aren't more people dying? We've had huge increases in case numbers for over a month now.

If another few weeks goes by and the death rate doesn't spike, we need a major rethink of our policy response, I'd say.

-W

The most important answer is because there is a significant lag between infection and death. I've seen figures from 2.5 to 5 weeks, I'll see if I can find links to data and add them to this post later.

Some other factors which may be affecting death rates:
- Younger (lower risk) populations are being infected at higher rates than the initial outbreak
- Treatment methods have improved
- Healthcare workers have more experience caring for Covid-19 patients
- Testing rates are up which increases the denominator in the CFR equation
- There may be additional lag time due to low risk populations being infected now and in turn increasing infection rates of high risk populations over the next few weeks as those low risk people spread the virus to high risk friends, relatives, and coworkers.
- Time lag between death and when deaths are counted in reported data (can be days to weeks)

A quick look at the confirmed cases vs deaths charts for the US it looks like the curve lagged by about 12-14 days which would indicate we should be seeing a similar increase right about now but that's before you account for the severe shortage of tests early on. The number of infections may have peaked well before data indicates.


ETA: haven't found data on time lag yet, but here's a decent article

https://news.bloomberglaw.com/coronavirus/virus-fatality-picture-is-obscured-by-ultimate-lagging-indicator

Quote
In Arizona, the time between diagnosis and death from Covid-19 now is about 14 or 15 days, up from four or five days early in the pandemic. Then the state health department must verify the death, so there can be a three-plus week lag between a new case and a fatality being reported, Gerald said.
« Last Edit: June 30, 2020, 09:58:13 AM by Davnasty »

the_fixer

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How long can we wait while flattening the curve?
« Reply #2754 on: June 30, 2020, 09:51:47 AM »
As a follow up I checked Colorado’s data, in March / April my age group had the highest case count, it has significantly shifted pretty much flipped from April.

In order

Age 20 - 29 is the highest amount of infections
30 - 39
40 - 49
50 - 59
60 - 69
80+ (guessing majority are under some type of care and not able to control their contact level)
70 - 79 (not working and taking it seriously)
10 - 19
0 - 9
 (my guess is there are plenty in the 0 - 19 but they are not symptomatic and do not get tested)


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« Last Edit: June 30, 2020, 10:03:14 AM by the_fixer »

waltworks

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Re: How long can we wait while flattening the curve?
« Reply #2755 on: June 30, 2020, 09:54:49 AM »
It's hard to make an argument for anything but keeping nursing homes bubbled/quarantined with the current numbers, IMO. 

I guess AZ will be the test case, really.

-W

GuitarStv

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Re: How long can we wait while flattening the curve?
« Reply #2756 on: June 30, 2020, 09:59:52 AM »
It's hard to make an argument for anything but keeping nursing homes bubbled/quarantined with the current numbers, IMO.

Agreed.



As long as death is the only concern with this disease.  Otherwise, what you're suggesting could be pretty bad for the economy long term.

waltworks

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Re: How long can we wait while flattening the curve?
« Reply #2757 on: June 30, 2020, 10:05:32 AM »
It's hard to make an argument for anything but keeping nursing homes bubbled/quarantined with the current numbers, IMO.

Agreed.



As long as death is the only concern with this disease.  Otherwise, what you're suggesting could be pretty bad for the economy long term.

If deaths are lower than we thought, all the other harmful long term effects are probably also lower (ie, the disease isn't as dangerous as we once thought). Obviously there's a lot we don't know.

The issue now, IMO, is that we're in danger of just using case numbers or outbreaks in the general/low risk population as our guideline for policy responses. It's starting to look (again, starting) like outbreaks in, say, a high school really don't matter, and we're doing much more harm than good when we do things like close schools.

-W

OtherJen

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Re: How long can we wait while flattening the curve?
« Reply #2758 on: June 30, 2020, 10:09:40 AM »
Why aren't more people dying? We've had huge increases in case numbers for over a month now.

If another few weeks goes by and the death rate doesn't spike, we need a major rethink of our policy response, I'd say.

-W

There are several possible reasons:

1) The rates of infection are rising among younger people, who are statistically less likely to die (although the significant risk of long-term medical sequelae should not be dismissed).
2) Cumulative global experience over the last 6 months has yielded more effective treatments, thus allowing infected patients a better chance at survival than they would have had back in March.
3) The virus has become less virulent (although without a loss of infectivity).

Although those are all positive, there's another possible reason that is less so:

4) We haven't yet seen a spike in deaths resulting from the spike in cases over the last couple of weeks. The person I knew who died of COVID-19 was in the hospital for weeks before he actually died. It isn't always a quick process.

Hopefully it's one of the first 3 and not the 4th reason. We'll have more information in a few weeks.

mm1970

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Re: How long can we wait while flattening the curve?
« Reply #2759 on: June 30, 2020, 12:04:28 PM »
Why aren't more people dying? We've had huge increases in case numbers for over a month now.

If another few weeks goes by and the death rate doesn't spike, we need a major rethink of our policy response, I'd say.

-W
I think part of it is that nursing homes have been more vigilant, older people have started to take it seriously and shelter in place as much as possible and the same with at risk people so you see healthier, younger people getting it at a higher rate and they are less likely to die.

In the first month or two at risk groups were not aware it was spreading or the impact it would have on them and now they are informed.

You also have more testing so the cases are going up where in the past they were just testing people that were sick enough to end up at the hospital.


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Also: learning

At the beginning of this whole thing there were a LOT of deaths, particularly in nursing homes.  These are our weakest people.  We just weren't vigilant and we didn't KNOW the risks to the degree we do now.  AND we didn't have enough PPE.

NOW, if you compare us to March, most places (nursing homes) are:
- social distancing
- wearing PPE, at least fabric masks, while at work
- regularly testing employees (hospitals, nursing homes, jails, etc) for COVID-19
- regularly monitoring people's temperatures as they go in to work
- providing more leave if you are sick
- contact tracing, and requiring quarantine if you were known to be exposed to someone with COVID-19
- regularly disinfecting surfaces at work
- not allowing visitors

Also, in general in the US
- restaurants and bars have been closed
- fewer people are traveling
- fewer people are working AT work

This means that in general (at least, where I live, and from reading the news), the spike in cases is overwhelmingly in younger groups.  30-49, 18-29, 0-17.  You would expect FAR fewer deaths in these groups compared to the older population.

That doesn't mean we are safe - all of these younger people can definitely pass it on to their older relatives and neighbors (and have).  We still need to be vigilant.

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #2760 on: June 30, 2020, 12:19:25 PM »
~80% of deaths have been in the 65 and older group. So I agree, as we prioritize protecting the older population, we should see lower deaths even with infections skyrocketing.

Still, it's worth putting into perspective, that we've had six to eight 9/11's worth of deaths among the 64 and under population. That already exceeds deaths at any age from H1N1, and that was with very aggressive mitigation.

It is the task of policy makers to weigh life vs. economic suffering. No arguments there. But make no mistake, this is a deadly and misery inducing disease. Let's not lose sight of that.

GuitarStv

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Re: How long can we wait while flattening the curve?
« Reply #2761 on: June 30, 2020, 12:31:41 PM »
It's hard to make an argument for anything but keeping nursing homes bubbled/quarantined with the current numbers, IMO.

Agreed.



As long as death is the only concern with this disease.  Otherwise, what you're suggesting could be pretty bad for the economy long term.

If deaths are lower than we thought, all the other harmful long term effects are probably also lower (ie, the disease isn't as dangerous as we once thought). Obviously there's a lot we don't know.

It's unclear if this is the case or not at this point.

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #2762 on: June 30, 2020, 12:43:02 PM »
Another thing is that as this has gone on longer and longer, we've kind of normalized the death count. I'm absolute guilty of this too. But between 110K and 150K more people than normal have died this year in the United States. That's a lot of people. And of course, taking 100K consumers out of the economy does a lot of damage to the economy.

waltworks

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Re: How long can we wait while flattening the curve?
« Reply #2763 on: June 30, 2020, 01:38:50 PM »
Yes, an 8-10% increase in the overall death rate is nothing to brush off.

If we don't see a spike in deaths/very serious illness soon, though, it's time to reevaluate a bunch of the policy responses (ie, closing schools and daycares and such).

-W


waltworks

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Re: How long can we wait while flattening the curve?
« Reply #2765 on: June 30, 2020, 03:00:17 PM »
"Dr. Boom said the encouraging part is fewer patients are being transferred to the intensive care unit at Houston Memorial"

So fewer *total* patients? Or fewer as a percentage of the patients coming in? Depending on the answer, that could be "scary" or it might not be, really.

-W

T-Money$

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Re: How long can we wait while flattening the curve?
« Reply #2766 on: June 30, 2020, 05:10:47 PM »
Georgia was one of the first states to reopen in late April.  It has been reopened for more than 2 months now.  During that time the death rate has not increased, most recently it is at it's "pre lockdown" level.

Even though Georgia's reopening was widely criticized by experts, politicians and numerical modelers almost all of their predictions and fears have been without merit.

https://www.theatlantic.com/health/archive/2020/04/why-georgia-reopening-coronavirus-pandemic/610882/

https://www.thedailybeast.com/ending-coronavirus-lockdowns-in-mississippi-georgia-and-florida-could-doom-thousands?ref=home

 

« Last Edit: June 30, 2020, 05:12:59 PM by T-Money$ »

obstinate

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Re: How long can we wait while flattening the curve?
« Reply #2767 on: June 30, 2020, 05:52:06 PM »
Georgia was one of the first states to reopen in late April.  It has been reopened for more than 2 months now.  During that time the death rate has not increased, most recently it is at it's "pre lockdown" level.

Even though Georgia's reopening was widely criticized by experts, politicians and numerical modelers almost all of their predictions and fears have been without merit.

https://www.theatlantic.com/health/archive/2020/04/why-georgia-reopening-coronavirus-pandemic/610882/

https://www.thedailybeast.com/ending-coronavirus-lockdowns-in-mississippi-georgia-and-florida-could-doom-thousands?ref=home
Yooo, I would sit on these boasts for about two weeks. https://rt.live/us/GA Don't worry, they'll still be just as spicy then as they are now -- which is to say totally bland.

maisymouser

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Re: How long can we wait while flattening the curve?
« Reply #2768 on: June 30, 2020, 06:31:04 PM »
So many of the recent responses are simply talking about deaths rather than long-term outcomes. I've read several accounts and have multiple friends who have told me that this disease goes on for weeks and the effects have lasted for months. These are people who are otherwise healthy. Shouldn't that count for something? We don't understand the full impact of having had severe coronavirus and "recovering" from it yet.

Until we do, people like me who are not concerned about the risk of dying but rather the impact on long term health effects are not going to take chances.

Of course, I also don't want to get fired and may end up having to be a little less conservative than I would like to be about this if I am required to go back to work in the fall during a continued first wave or second wave. TBD!

OtherJen

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Re: How long can we wait while flattening the curve?
« Reply #2769 on: June 30, 2020, 06:32:17 PM »
So many of the recent responses are simply talking about deaths rather than long-term outcomes. I've read several accounts and have multiple friends who have told me that this disease goes on for weeks and the effects have lasted for months. These are people who are otherwise healthy. Shouldn't that count for something? We don't understand the full impact of having had severe coronavirus and "recovering" from it yet.

Until we do, people like me who are not concerned about the risk of dying but rather the impact on long term health effects are not going to take chances.

Of course, I also don't want to get fired and may end up having to be a little less conservative than I would like to be about this if I am required to go back to work in the fall during a continued first wave or second wave. TBD!

Oh yeah, many of us have raised that point but it is regularly ignored by the “death is the only metric that counts, and only old people die so let’s get back to normal” crowd.

waltworks

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Re: How long can we wait while flattening the curve?
« Reply #2770 on: June 30, 2020, 06:54:21 PM »
Of course long term effects short of death count for something. We don't know a ton about that now, but we do know that a crapton of people have had the disease (something like 25 million in the US) and there's not a massive problem with young people unable to function after recovering out there.

There are tons of newsworthy (and hence probably rare) stories about younger people who are still short of breath a month or two later (which happens with other respiratory illnesses too, and tends to resolve itself). It's possible that everyone who contracts the disease will be damaged for life or something, but it's not looking all that likely at this point.

I guess the bottom line is: we know the disease is way less dangerous than we thought, overall, with some minor uncertainty about long term effects. Lots of places have suffered a TON of cases but not many deaths (or debilitating long term side effects) over the last 4-8 weeks.

How should we adjust our response (if we should at all) based on that information?

-W

Laserjet3051

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Re: How long can we wait while flattening the curve?
« Reply #2771 on: June 30, 2020, 07:15:40 PM »
Yes, an 8-10% increase in the overall death rate is nothing to brush off.

If we don't see a spike in deaths/very serious illness soon, though, it's time to reevaluate a bunch of the policy responses (ie, closing schools and daycares and such).

-W

I expect these policy responses will be reevaluated soon, as in...... after-Nov 6

Bloop Bloop

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Re: How long can we wait while flattening the curve?
« Reply #2772 on: June 30, 2020, 09:47:29 PM »
So many of the recent responses are simply talking about deaths rather than long-term outcomes. I've read several accounts and have multiple friends who have told me that this disease goes on for weeks and the effects have lasted for months. These are people who are otherwise healthy. Shouldn't that count for something? We don't understand the full impact of having had severe coronavirus and "recovering" from it yet.

Until we do, people like me who are not concerned about the risk of dying but rather the impact on long term health effects are not going to take chances.

Of course, I also don't want to get fired and may end up having to be a little less conservative than I would like to be about this if I am required to go back to work in the fall during a continued first wave or second wave. TBD!

Oh yeah, many of us have raised that point but it is regularly ignored by the “death is the only metric that counts, and only old people die so let’s get back to normal” crowd.

If you have any useful data on long-term sequelae in the general population or in a general subset of the population then feel free to share. Or even on hospitalisation/ICU rates (since it's not been long enough to really know long-term sequelae). We can presume anyone with long-term respiratory or other problems was sick enough to need hospitalisation. I'd like to know what is the relative hospitalisation rate for, say, <40 population versus >70.

OtherJen

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Re: How long can we wait while flattening the curve?
« Reply #2773 on: June 30, 2020, 10:03:21 PM »
So many of the recent responses are simply talking about deaths rather than long-term outcomes. I've read several accounts and have multiple friends who have told me that this disease goes on for weeks and the effects have lasted for months. These are people who are otherwise healthy. Shouldn't that count for something? We don't understand the full impact of having had severe coronavirus and "recovering" from it yet.

Until we do, people like me who are not concerned about the risk of dying but rather the impact on long term health effects are not going to take chances.

Of course, I also don't want to get fired and may end up having to be a little less conservative than I would like to be about this if I am required to go back to work in the fall during a continued first wave or second wave. TBD!

Oh yeah, many of us have raised that point but it is regularly ignored by the “death is the only metric that counts, and only old people die so let’s get back to normal” crowd.

If you have any useful data on long-term sequelae in the general population or in a general subset of the population then feel free to share. Or even on hospitalisation/ICU rates (since it's not been long enough to really know long-term sequelae). We can presume anyone with long-term respiratory or other problems was sick enough to need hospitalisation. I'd like to know what is the relative hospitalisation rate for, say, <40 population versus >70.

I've posted multiple links multiple times in this thread and others. Not my fault if no one bothers to read them or dismisses them because they're unpleasant. It isn't hard to 1) scroll through and find them or 2) do a very quick Google search on COVID-19 side effects. Maybe add the search terms "stroke," "blood clot," "kidney," or "pancreas."

Abe

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Re: How long can we wait while flattening the curve?
« Reply #2774 on: June 30, 2020, 10:58:31 PM »
Per the CDC: Among 287,320 (22%) cases with sufficient data on underlying health conditions, the most common were cardiovascular disease (32%), diabetes (30%), and chronic lung disease (18%). Overall, 184,673 (14%) patients were hospitalized, 29,837 (2%) were admitted to an intensive care unit (ICU), and 71,116 (5%) died. Hospitalizations were six times higher among patients with a reported underlying condition (45.4%) than those without reported underlying conditions (7.6%). Deaths were 12 times higher among patients with reported underlying conditions (19.5%) compared with those without reported underlying conditions (1.6%).

https://www.cdc.gov/mmwr/volumes/69/wr/mm6924e2.htm

Kyle Schuant

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Re: How long can we wait while flattening the curve?
« Reply #2775 on: June 30, 2020, 11:25:36 PM »
It stands to reason that something serious enough that it might kill you is also serious enough to have long-term effects if it doesn't kill you. With that in mind, the focus on deaths does not downplay the other effects. Just because you're looking at the tip doesn't mean you deny there's an iceberg underneath it.

Nonetheless, most of us would rather be alive with health complications than have those health complications kill us. In most countries, the death rate is falling as the medical world figures out better methods of treatment. The death rate also tends to be lower where the overall infections are lower - since the system isn't overwhelmed and can give them better care.

In Australia, though our infections have risen quite a bit, our deaths haven't. In large part this is because we've got better at keeping it away from the most vulnerable demographics. In this respect, the various restrictions mean a healthy younger person is acting as a wall between the virus and an unhealthy older person.

cerat0n1a

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Re: How long can we wait while flattening the curve?
« Reply #2776 on: July 01, 2020, 01:23:05 AM »
I see cases as a very important metric. This is a new disease. We had the opportunity to stop it entirely - to make it the horrible disease of 2020, much like some other Coronaviruses were the horrible disease of particular years, and haven’t become viral infections that we have to cope with as a herd in perpetuity. Unfortunately, the number of cases is becoming so large, and so global that it will be a human herd disease and will need a vaccine - much like AIDS was unknown 50 years ago and has become a human herd disease.

Unless you are in a high-risk cohort the risk of contracting AIDS is very, very close to zero, in fact it is so low that unless you are in a risk group a positive test is most likely a false positive. For Covid-19 it seems to be sufficient to be in the same room as someone infected or standing close to someone while they sneeze or cough.

Yes, hugely different chances of infection. It's still the second biggest infectious killer worldwide, after TB, though. Obviously Covid-19 is on track to push it into third place this year. More than 20% of the population of some countries has HIV. It took decades of medical research and public information campaigns to get the death rate as low as it now is (below 2 million per year) and possibly also the virus itself becoming less deadly.

Gremlin

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Re: How long can we wait while flattening the curve?
« Reply #2777 on: July 01, 2020, 02:29:29 AM »
So many of the recent responses are simply talking about deaths rather than long-term outcomes. I've read several accounts and have multiple friends who have told me that this disease goes on for weeks and the effects have lasted for months. These are people who are otherwise healthy. Shouldn't that count for something? We don't understand the full impact of having had severe coronavirus and "recovering" from it yet.

Until we do, people like me who are not concerned about the risk of dying but rather the impact on long term health effects are not going to take chances.

Of course, I also don't want to get fired and may end up having to be a little less conservative than I would like to be about this if I am required to go back to work in the fall during a continued first wave or second wave. TBD!

Oh yeah, many of us have raised that point but it is regularly ignored by the “death is the only metric that counts, and only old people die so let’s get back to normal” crowd.

If you have any useful data on long-term sequelae in the general population or in a general subset of the population then feel free to share. Or even on hospitalisation/ICU rates (since it's not been long enough to really know long-term sequelae). We can presume anyone with long-term respiratory or other problems was sick enough to need hospitalisation. I'd like to know what is the relative hospitalisation rate for, say, <40 population versus >70.

That's actually a very poor assumption to make.  It certainly wasn't the case for SARS and MERS, the two closest diseases to COVID - as a guide, between 15% and 20% of asymptomatic MERS cases ultimately presented with long-term lung damage and closer to 35% of overall cases.  And with SARS and MERS the long-term issues didn't necessarily present immediately, in many cases only years later.  So the proportion of long-term sequelae from these diseases wasn't known for several years.  In fact, we're only assuming that there are no further longer-term impacts that are yet to emerge from either SARS or MERS but we simply don't know that until the cohort who contracted those diseases dies out. 

Similarly, there are already cases presenting with long-term sequelae for COVID that had an asymptomatic episode.  There appears to be a higher prevalence in more severe cases, as with SARS and MERS.  But severity of initial disease is not necessarily showing to be that great an indicator of severity of sequelae.

At work, we are using those two illnesses as a benchmark against the very early emerging COVID experience.  This is leading us towards an estimate of 15% of infecteds with long-term sequelae, roughly in line with SARS and less than MERS.  The only thing I can guarantee about that estimate is that it's going to be wrong and it will probably be years before there is a firm estimate.  It could be as low as 5% or as high as 35%, it's simply too early to tell.  We're also working on the expectation that longer term impacts are distributed in line with the distribution of infection by age, not the distribution of death nor hospitalisation by age.  This also held true for SARS and MERS and early experience suggests that it is holding true for COVID.  But again, too early to definitively know.  I've seen one dataset that actually suggests there may be higher rates of long-term sequelae emerging in 20 to 40 year olds than would be expected, but my feeling is that it simply reflects the higher prevalence of undetected asymptomatics in this age group.

Paper Chaser

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Re: How long can we wait while flattening the curve?
« Reply #2778 on: July 01, 2020, 04:44:16 AM »
So many of the recent responses are simply talking about deaths rather than long-term outcomes. I've read several accounts and have multiple friends who have told me that this disease goes on for weeks and the effects have lasted for months. These are people who are otherwise healthy. Shouldn't that count for something? We don't understand the full impact of having had severe coronavirus and "recovering" from it yet.

Until we do, people like me who are not concerned about the risk of dying but rather the impact on long term health effects are not going to take chances.

Of course, I also don't want to get fired and may end up having to be a little less conservative than I would like to be about this if I am required to go back to work in the fall during a continued first wave or second wave. TBD!

Oh yeah, many of us have raised that point but it is regularly ignored by the “death is the only metric that counts, and only old people die so let’s get back to normal” crowd.

If you have any useful data on long-term sequelae in the general population or in a general subset of the population then feel free to share. Or even on hospitalisation/ICU rates (since it's not been long enough to really know long-term sequelae). We can presume anyone with long-term respiratory or other problems was sick enough to need hospitalisation. I'd like to know what is the relative hospitalisation rate for, say, <40 population versus >70.

I did find a Chinese study from late March with actual data regarding cardiovascular side effects:

https://jamanetwork.com/journals/jamacardiology/fullarticle/2763524?resultClick=1

With a sample size of 416 hospitalized COVID patients, they found just under 20% showed cardiovascular injury. Those with injury were older than the median age of the sample (74 year median age vs 64 year median for the sample as a whole) and more likely to have comorbidities (60% of those with cardio issues had hypertension).
What's unclear, is whether any of the patients were asymptomatic or had mild symptoms. I've seen some indication that in at least some locations/situations, anybody in China that tested positive for COVID was automatically hospitalized, (even if they showed no symptoms) but this study doesn't indicate if any of the sample were asymptomatic or not. If the sample only consists of those who were bad enough to need hospitalization, then the odds of having cardio issues from COVID seem pretty low. Especially for otherwise healthy people. Not zero of course, but it's not all that scary for most.

And a British study about neurological issues:

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30287-X/fulltext

A sample of 125 Brits (median age 71 years) that had been hospitalized showed 45% had a stroke, 7% had a hemorrhage. In the UK, I believe only those who needed to be hospitalized were put into hospitals, so the sample here probably doesn't include those with mild or no symptoms.

An American study from Mid-March -Mid-May of the link between COVID and Multisystem Inflammatory Syndrome in kids:

https://www.nejm.org/doi/full/10.1056/NEJMoa2021680

This study looked at all cases of MIS in kids (those under 21) in the US that met their definition (sample size of 186) and found that 70% tested positive for COVID or showed antibodies. 80% of the sample required ICU care, 20% required ventilation and 2% died. That comes off as scary, but considering there were likely hundreds of thousands of Americans under age 21 that had been exposed to this virus when the study was performed I'm not sure how concerned to actually be. If we assume 500k infections in this age range at the time of the study (possibly low), there's a 0.037% chance of developing severe MIS-C and a 0.0008% chance of death from it as a result of COVID exposure.
« Last Edit: July 01, 2020, 11:38:59 AM by Paper Chaser »

habanero

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Re: How long can we wait while flattening the curve?
« Reply #2779 on: July 01, 2020, 04:53:48 AM »
Probably the most accurate study done is in Ischgl in Austria, one of the European epicenters where a lot of foreigners got infected during ski holidays in Feb/Mar.

They have done antibody testing on the entire population (well, 90% of it) as the village only has about 1700 inhabitants.
42% of the sample had antibodies (this test apparently yield zero false positives, but might have false negatives).
Of these 42% confirmed having been infected, only 15% were actually confirmed cases, the remaining 85% were never tested for the infection.

The tally for the village is 2 dead, 9 ihospitalizations last I checked. It seems unknown if the two died from or with the virus (my guess: old/seriously sick people)

The antibody preveilance was clearly lower among the under-18s, "only" 27% of those had antibodies. They don't know why, theories are that they were less exposed to infected or that the immune system of children just reacts in a different way.

It's a small sample, but it's probably the most complete study of a population there is at mom.

Shane

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Re: How long can we wait while flattening the curve?
« Reply #2780 on: July 01, 2020, 06:54:29 AM »
Probably the most accurate study done is in Ischgl in Austria, one of the European epicenters where a lot of foreigners got infected during ski holidays in Feb/Mar.

They have done antibody testing on the entire population (well, 90% of it) as the village only has about 1700 inhabitants.
42% of the sample had antibodies (this test apparently yield zero false positives, but might have false negatives).
Of these 42% confirmed having been infected, only 15% were actually confirmed cases, the remaining 85% were never tested for the infection.

The tally for the village is 2 dead, 9 ihospitalizations last I checked. It seems unknown if the two died from or with the virus (my guess: old/seriously sick people)

The antibody preveilance was clearly lower among the under-18s, "only" 27% of those had antibodies. They don't know why, theories are that they were less exposed to infected or that the immune system of children just reacts in a different way.

It's a small sample, but it's probably the most complete study of a population there is at mom.

Over 42 percent in Austria’s Ischgl have coronavirus antibodies, study finds
"The Alpine ski resort was an early hot spot for the virus in Europe.

By LAURENZ GEHRKE 6/25/20, 3:35 PM CET Updated 6/25/20, 3:40 PM CET
More than 42 percent of residents in the Austrian ski resort of Ischgl carry coronavirus antibodies, the highest rate ever found, according to a study conducted by the University of Innsbruck."

habanero

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Re: How long can we wait while flattening the curve?
« Reply #2781 on: July 01, 2020, 07:08:20 AM »
Perhaps the most important takeaway from the Ischgl study is that it is unlikely that there are vast amounts of people who got the virus but didn't develop antibodies as almost half the population had antibodies in Ischgl.

ReadySetMillionaire

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Re: How long can we wait while flattening the curve?
« Reply #2782 on: July 01, 2020, 07:37:34 AM »
To me, there are two types of people following this.

First, there are the people who are paying attention to mainstream media outlets -- NYT, WaPo, CNN, MSNBC, etc. -- who are pushing this hype train the same way that the Russia, Kavenaugh, and impeachment stories were pushed. It's never ending breaking news, with the latest development always being worse than the last. These are the people citing the things you see on the news -- rare cases (e.g., of a young person dying), anecdotal side effects ("COVID feet"), and the constant moving of the goalposts (i.e., the media flavor of the week).

These people went from flatten the curve to hospital capacity to ventilators to asymptomatic spread to presymptomatic spread to we opened too soon and on and on and on and on. The concern never ends, and the context is never supplied. The bad news never stops, almost like it's on a treadmill that can't be turned off.

Second, there are people who are not paying as close of attention, but look at the macro statistics straight from the sources. They look at the antibody studies, the CDC data, their state data, the studies in Europe, etc. These people generally have accepted the pandemic for what it is and, based on what is actually happening, don't care anymore.

I concede that I fall into this second camp.

A specific example I can think of is COVID-feet. Remember that? No. Because it's not really a thing anymore.

Or what about the multi-immune system failure in kids? Again, not a thing -- it is so "extremely rare" (per University of Michigan) that it's been basically impossible to study on a macro scale.

At this point, you have to be willfully ignorant of the antibody data, of the CDC data, etc. to think our government response has been anything short of a complete overreach and a total disaster. We are on pace for a really bad flu season -- 1957 or 1968 for example -- yet we have triggered widespread panic and an economic collapse.

The harm being done to our kids (and their parents) won't be fully understood for decades. The failure of doing blanket lockdowns instead of concentrating resources on nursing homes -- which is what the data told is in MARCH -- is arguably the greatest public health failure of all time. The economic collapse from this -- the death of small businesses and rise of big box stores and Amazon/Google/whatever -- sickens me.

Most of all, the complete breakdown of separation of powers should terrify everyone. The public health statutes absolutely DO NOT permit what state governments did during COVID. Public health directors only have power to "isolate" and "quarantine," and these terms are very carefully defined, and they DO NOT mean shutting everything down. This was a disastrous government overrreach that set an extremely dangerous precedent.

Perhaps my greatest frustration in all of this is that there was never a debate. You were just presumed to be some right wing nutjob who lacked empathy if you opposed what was going on. This was not just a failure of democracy, but of science. And I cannot say it any better than these Nobel prize winning scientists, who all but weep at how much science failed us during COVID.

https://vimeo.com/433350887/33bbbe4090

So, "listen to the experts?" It's not just the folks getting popular on TV. It's the researchers at NYU, Stanford, Harvard, etc. who have been telling us for months that we screwed this up, and royally so. Perhaps we will start listening to them sooner rather than later.

Davnasty

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Re: How long can we wait while flattening the curve?
« Reply #2783 on: July 01, 2020, 08:15:20 AM »
To me, there are two types of people following this.

That's because it's easier and more comfortable to think of things in a binary way. Generally the two groups people see are the group of people who agree with them and the group of irrational extremists. It's just easier to view the people who disagree with you as "out there".

In reality there is wide array of opinions between your two groups that do not fit your descriptions. I see lots of them on this forum. Maybe you haven't actually been following Covid related threads?

Personally, I agree that we shouldn't be using our mental energy worrying about rare symptoms or specific individual tragedies. My SO could vouch for that as I think they're getting tired of me pointing it out every time those stories pop up. But frankly that's standard fare on the news regardless of liberal/conservative bias. That's what the media, especially televised media which I try to avoid, does.

At the same time, I wish we were taking the pandemic more seriously and behaving the way most other developed countries are. At the very least, we could all be wearing masks.

As for antibody data, I follow it with great interest. Somehow I haven't reached the conclusion that the US governments reaction was a complete overreach, but I do think it was and is a bit of disaster (probably for different reasons than yourself). So am I willfully ignorant? Or maybe I just have a different understanding of what that data means than you do?

If you could share your conclusions of what current data on antibodies tells us, maybe we could discuss.

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #2784 on: July 01, 2020, 08:20:12 AM »
Brings up Kavanaugh, completely absent of context. Lots of words. I'm smarter than you. Lots more words. Why does everyone think I'm a right wing nutjob?

Re: economic collapse, the United States prints its own currency and can borrow it at zero percent.

obstinate

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Re: How long can we wait while flattening the curve?
« Reply #2785 on: July 01, 2020, 08:20:37 AM »
At this point, you have to be willfully ignorant of the antibody data, of the CDC data, etc. to think our government response has been anything short of a complete overreach and a total disaster. We are on pace for a really bad flu season -- 1957 or 1968 for example -- yet we have triggered widespread panic and an economic collapse.
I guess all the public health people and doctors are willfully ignorant of the antibody data and CDC data. This is a surprising outcome! Are you sure you haven't just misinterpreted that data?

ReadySetMillionaire

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Re: How long can we wait while flattening the curve?
« Reply #2786 on: July 01, 2020, 08:27:46 AM »
To me, there are two types of people following this.

That's because it's easier and more comfortable to think of things in a binary way. Generally the two groups people see are the group of people who agree with them and the group of irrational extremists. It's just easier to view the people who disagree with you as "out there".

In reality there is wide array of opinions between your two groups that do not fit your descriptions. I see lots of them on this forum. Maybe you haven't actually been following Covid related threads?

Personally, I agree that we shouldn't be using our mental energy worrying about rare symptoms or specific individual tragedies. My SO could vouch for that as I think they're getting tired of me pointing it out every time those stories pop up. But frankly that's standard fare on the news regardless of liberal/conservative bias. That's what the media, especially televised media which I try to avoid, does.

At the same time, I wish we were taking the pandemic more seriously and behaving the way most other developed countries are. At the very least, we could all be wearing masks.

As for antibody data, I follow it with great interest. Somehow I haven't reached the conclusion that the US governments reaction was a complete overreach, but I do think it was and is a bit of disaster (probably for different reasons than yourself). So am I willfully ignorant? Or maybe I just have a different understanding of what that data means than you do?

If you could share your conclusions of what current data on antibodies tells us, maybe we could discuss.

A thoughtful response, which I appreciate. The "two types" is admittedly a false binary and an over-simplification, as there is with everything else these days. Pro-this or anti-that, etc.

It's just an observation of mine that we have generally, emphasis on generally, fallen into these two camps, for reasons that are more sociologically complex than this thread probably allows.

To be just a tad more specific, I guess what I'm saying is that, while the resulting opinions may vary on a spectrum, I can pretty quickly gauge where people get their news.

chemistk

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Re: How long can we wait while flattening the curve?
« Reply #2787 on: July 01, 2020, 08:29:08 AM »
To me, there are two types of people following this.


Personally, I agree that we shouldn't be using our mental energy worrying about rare symptoms or specific individual tragedies. My SO could vouch for that as I think they're getting tired of me pointing it out every time those stories pop up. But frankly that's standard fare on the news regardless of liberal/conservative bias. That's what the media, especially televised media which I try to avoid, does.

At the same time, I wish we were taking the pandemic more seriously and behaving the way most other developed countries are. At the very least, we could all be wearing masks.



I think the worst thing (that always happens) with the pandemic and the poor reaction to this whole thing is that the armchair epidemiologists start with the usual pedantry and obscure the very core thing that everyone should be discussing - wear masks, avoid crowds, wash hands, stay home while sick.

I am in no way denying that there are side effects to this - there are plenty and there are plenty reasons why people should take this seriously but we all rile ourselves up talking about the next worst thing that has been uncovered.

I've really felt that this is one of the biggest tests of the circles of concern and control theory on an individual level - on paper one can do for themselves what they can do (control) and be aware of what the rest of everyone is doing (concern) but a lot of people have been pulling too much into their circle of control ("you're a murderer if you don't wear masks") or pushing too much into the circle of concern (or worse, out of it altogether - "I'm low risk and the Wuhan flu is a scam so I don't care and won't wear a mask").

I've chosen to follow no news sources save for two local papers since this began and I can tell you, my anxiety and frustration really only mounts when others start talking about the pandemic. If I ignore it and wear my mask, I feel a lot better about the world.

ReadySetMillionaire

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Re: How long can we wait while flattening the curve?
« Reply #2788 on: July 01, 2020, 08:33:12 AM »
Brings up Kavanaugh, completely absent of context. Lots of words. I'm smarter than you. Lots more words. Why does everyone think I'm a right wing nutjob?

Re: economic collapse, the United States prints its own currency and can borrow it at zero percent.

My Kavenaugh comment is about the coverage, not necessarily the situation itself. If you don't think COVID is from the same playbook, that's on you.

And your comment regarding economic collapse wreaks of socioeconomic privilege. Glad this isn't affecting you. I live in a part of the country where the vast majority of the population don't know what the hell they're going to do when the stimulus expires this month, or how they will handle childcare if kids don't go back to school, etc.

obstinate

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Re: How long can we wait while flattening the curve?
« Reply #2789 on: July 01, 2020, 08:33:53 AM »
To be just a tad more specific, I guess what I'm saying is that, while the resulting opinions may vary on a spectrum, I can pretty quickly gauge where people get their news.
Where do you think DeSantis and Abbott are getting their news from? Have they suddenly switched to reading the New York Times in the past few days?

I live in a part of the country where the vast majority of the population don't know what the hell they're going to do when the stimulus expires this month, or how they will handle childcare if kids don't go back to school, etc.
Did the people in your part of the country happen to elect senators and a president who won't renew the stimulus? Whether or not they did, it's sad that they're going to be hurt by its lack. But it's, like, not an inherent problem? Like we could pass another stimulus bill, and there's only one of the two political parties that is currently opposed to that action.
« Last Edit: July 01, 2020, 08:35:54 AM by obstinate »

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #2790 on: July 01, 2020, 08:38:56 AM »
Brings up Kavanaugh, completely absent of context. Lots of words. I'm smarter than you. Lots more words. Why does everyone think I'm a right wing nutjob?

Re: economic collapse, the United States prints its own currency and can borrow it at zero percent.

My Kavenaugh comment is about the coverage, not necessarily the situation itself. If you don't think COVID is from the same playbook, that's on you.

media = bad is the most tired and lazy take of the past five years and I've lost all patience for it.

And your comment regarding economic collapse wreaks of socioeconomic privilege. Glad this isn't affecting you. I live in a part of the country where the vast majority of the population don't know what the hell they're going to do when the stimulus expires this month, or how they will handle childcare if kids don't go back to school, etc.

The United States prints its own currency and can borrow at zero percent. If you don't recognize that it's a false choice to say that we have to let the virus spread because of the economy, that's on you.

ReadySetMillionaire

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Re: How long can we wait while flattening the curve?
« Reply #2791 on: July 01, 2020, 08:41:47 AM »
To be just a tad more specific, I guess what I'm saying is that, while the resulting opinions may vary on a spectrum, I can pretty quickly gauge where people get their news.
Where do you think DeSantis and Abbott are getting their news from? Have they suddenly switched to reading the New York Times in the past few days?

I live in a part of the country where the vast majority of the population don't know what the hell they're going to do when the stimulus expires this month, or how they will handle childcare if kids don't go back to school, etc.
Did the people in your part of the country happen to elect senators and a president who won't renew the stimulus? Whether or not they did, it's sad that they're going to be hurt by its lack. But it's, like, not an inherent problem? Like we could pass another stimulus bill, and there's only one of the two political parties that is currently opposed to that action.

I live in Ohio. The county voted for Clinton; the Congressional district representative is a democrat; and our senators are one R and one D. So I don't know what you're getting at.

Regarding the former point, I don't think Abbott and DeSantis are making decisions based on any sort of science.


ReadySetMillionaire

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Re: How long can we wait while flattening the curve?
« Reply #2792 on: July 01, 2020, 08:43:47 AM »
Brings up Kavanaugh, completely absent of context. Lots of words. I'm smarter than you. Lots more words. Why does everyone think I'm a right wing nutjob?

Re: economic collapse, the United States prints its own currency and can borrow it at zero percent.

My Kavenaugh comment is about the coverage, not necessarily the situation itself. If you don't think COVID is from the same playbook, that's on you.

media = bad is the most tired and lazy take of the past five years and I've lost all patience for it.

And your comment regarding economic collapse wreaks of socioeconomic privilege. Glad this isn't affecting you. I live in a part of the country where the vast majority of the population don't know what the hell they're going to do when the stimulus expires this month, or how they will handle childcare if kids don't go back to school, etc.

The United States prints its own currency and can borrow at zero percent. If you don't recognize that it's a false choice to say that we have to let the virus spread because of the economy, that's on you.

Again, if you don't realize how big of a clusterfuck the first round of government "aid" was (both personally or as a business), then you are remarkably socioeconomically privileged. To give these buffoons a second bite at the apple would only compound the error.

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #2793 on: July 01, 2020, 08:45:14 AM »
So which serological study should we be paying attention to? The one out of Stanford from a few months ago that said everyone and their mom had COVID and thus it wasn't deadly at all? The ones out of New York that seem to agree with the notion that COVID is 10x deadlier than the flu? Or some other study that confirms your worldview?

Science is a conversation. Some scientists do research and form an opinion. Others do more research and present a different opinion. And over time, the facts evolve. And the media reports on those facts. It's messy and imperfect. But it's a process. Cheap second guessing and time traveling is not.

mathlete

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Re: How long can we wait while flattening the curve?
« Reply #2794 on: July 01, 2020, 08:46:44 AM »
Again, if you don't realize how big of a clusterfuck the first round of government "aid" was (both personally or as a business), then you are remarkably socioeconomically privileged. To give these buffoons a second bite at the apple would only compound the error.

Media bad. Government bad. Got it.

obstinate

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Re: How long can we wait while flattening the curve?
« Reply #2795 on: July 01, 2020, 08:52:36 AM »
Again, if you don't realize how big of a clusterfuck the first round of government "aid" was (both personally or as a business), then you are remarkably socioeconomically privileged. To give these buffoons a second bite at the apple would only compound the error.
Enlighten us. Seems like folks are pretty happy with the expanded unemployment benefits and it has prevented a lot of folks from descending into abject poverty. I am aware that people are less than pleased with the small business loan stuff, because it came with a lot of weird strings attached.

I am remarkably socioeconomically privileged, but, being as I'm in the top 0.5% of incomes, I did not need COVID to tell me that. It also doesn't impinge on my opinion about policy.

ReadySetMillionaire

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Re: How long can we wait while flattening the curve?
« Reply #2796 on: July 01, 2020, 08:55:27 AM »
So which serological study should we be paying attention to? The one out of Stanford from a few months ago that said everyone and their mom had COVID and thus it wasn't deadly at all? The ones out of New York that seem to agree with the notion that COVID is 10x deadlier than the flu? Or some other study that confirms your worldview?

Science is a conversation. Some scientists do research and form an opinion. Others do more research and present a different opinion. And over time, the facts evolve. And the media reports on those facts. It's messy and imperfect. But it's a process. Cheap second guessing and time traveling is not.

For this exact reason, I think John Ioannidis's pre-print study performing a macro-analysis of 23 different seroprevalence studies is a good barometer of where the science is at. I grant that it has not been peer-reviewed, but prior to being an "outsider" regarding COVID, my understanding is that Dr. Ioannidis was one of the most respected scientists in the world when it came to statistical analysis.

In examining these 23 different studies, he estimates that IFR is around .26%, and perhaps as high as .84%, and much, much, much lower for people under 70.

https://www.medrxiv.org/content/10.1101/2020.05.13.20101253v2

obstinate

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Re: How long can we wait while flattening the curve?
« Reply #2797 on: July 01, 2020, 09:01:51 AM »
This is the same guy whose lab published that widely panned study about the prevalence of infection in Santa Clara County in April.

waltworks

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Re: How long can we wait while flattening the curve?
« Reply #2798 on: July 01, 2020, 09:02:54 AM »
I think you can simultaneously think that with the limited information we had 4 months ago, it was ok to freak out, and also that with the information we have now, it's probably a waste of time to do much more than masks/no huge events/protect the elderly.

It's not clear to me why it's gov't overreach/right wing freakout time when at the time the disease seemed to be killing people like crazy. But likewise it seems dumb to double down on freaking out and mortgaging our future on the possibility that maybe some people will have lung problems down the road (ie, left wing freakout time). That's a big step down from worrying that it's going to kill many millions of people in the US, and it justifies an adjustment in policy.

-W

Kris

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Re: How long can we wait while flattening the curve?
« Reply #2799 on: July 01, 2020, 09:08:30 AM »
Brings up Kavanaugh, completely absent of context. Lots of words. I'm smarter than you. Lots more words. Why does everyone think I'm a right wing nutjob?



Right? I literally laughed out loud at that post.

 

Wow, a phone plan for fifteen bucks!