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Added a disclaimer on page 662. Many need to post better.
You take the best estimate for casualties at a certain date which is the excess death rate. This almost per definition excludes all the people that would have died anyway if there was no virus.
It is even more complicated! In places where the hospitals were overloaded, there were many excess deaths of people who were not infected by the virus.
For a good estimate of the mortality under normal conditions, I think a good place to start is the countries with good control and a high number of tests.
According to some early research (not peer reviewed yet) the dominant strain is a mutation that likely came out of Europe and spread quickly on the US east coast. Medical experts speculate that the strain we see on the West Coast is the one from China that is less infectious than the Europe mutation that is dominant on the East Coast of the US.
Scientists have identified a new strain of the coronavirus that has become dominant worldwide and appears to be more contagious than the versions that spread in the early days of the COVID-19 pandemic, according to a new study led by scientists at Los Alamos National Laboratory.
The new strain appeared in February in Europe, migrated quickly to the East Coast of the United States and has been the dominant strain across the world since mid-March, the scientists wrote.
In addition to spreading faster, it may make people vulnerable to a second infection after a first bout with the disease, the report warned.
The 33-page report was posted Thursday on BioRxiv, a website that researchers use to share their work before it is peer reviewed, an effort to speed up collaborations with scientists working on COVID-19 vaccines or treatments. That research has been largely based on the genetic sequence of earlier strains and might not be effective against the new one.
The mutation identified in the new report affects the now infamous spikes on the exterior of the coronavirus, which allow it to enter human respiratory cells. The report’s authors said they felt an “urgent need for an early warning” so that vaccines and drugs under development around the world will be effective against the mutated strain.
Wherever the new strain appeared, it quickly infected far more people than the earlier strains that came out of Wuhan, China, and within weeks it was the only strain that was prevalent in some nations, according to the report. The new strain’s dominance over its predecessors demonstrates that it is more infectious, according to the report, though exactly why is not yet known.
In the United States, doctors had begun to independently question whether new strains of the virus could account for the differences in how it has infected, sickened and killed people, said Alan Wu, a UC San Francisco professor who runs the clinical chemistry and toxicology laboratories at San Francisco General Hospital.
Medical experts have speculated in recent weeks that they were seeing at least two strains of the virus in the U.S., one prevalent on the East Coast and another on the West Coast, according to Wu.
The study above i have also seen,it is interesting and not very encouraging.
There was an interesting item on dutch tv with 2 experts on infectious diseases who are working towards an exit strategy for the lockdown. It was enlightning and sobering at the same time. It was not straight forward at all points but you could get a lot of information by reading between the lines. It more or less aplies to all western countries to some degree.
-They did not believe am effective vaccine would come anytime soon,suggesting it could be 10 years+ and maybe even be completely impossible. -They estimated current overall infection rate in the netherlands at around 4% (only up 1% from ~ 3 weeks ago due to all the restrictions) with the most infected regions aproaching 10%.
-The strategy is still reaching herd immunity in a controlled way without overloading the healthcare system,herd immunity estimated to be 60% of the people getting the virus (60% to me seems optimistic for an urban environment but i am not an expert and it could be a level at which it will be under control without completely eliminating the virus). With uncontrolled spread and no restrictions herd immunity could be reached in 100-150 days at a huge cost with the healthcare system beeing completely overrun.
-Another aproach was a pump break aproach,alternating restrictions on and off untill herd immunity is reached which would take somewhere up to 2 years. The closer you get to herd immunity,the longer the time will be between the periods with restrictions. During this aproach the healthcare system would come close to beeing overloaded several times and it would take about 10 cycles. If this aproach is anywhere realistic to implement i dont know,i am inclined to think no but it is possible in theory and it does seem more realistic to me then the following aproach.
-An approach in which they open up smaller regions (all with a similar population) 1 by 1 which was an approach they did seem in favor off. You open up one region first while keeping other regions closed. The healthcare system of the whole nation could then take care of the patients from that single one region untill herd immunity is reached in that region after which another region can be opened up. The advantage would be that it would have a high level of control (because with say 20 regions only 5% of the country would be exposed to uncontrolled infection at every point in time) and that some regions could open up soon,this would also take about 2 years. It does not seem realistic to me because of the huge difference in economic impact in various regions which will be hard to accept for the population. Some can open up in 1 month and some would have to wait for 2 years. It also doesnt adress the fact that people will flock to regions that are opened up already to go to restaurants and bars unless you would restrict movement between regions (which also seems unrealistic in the netherlands).
-Getting infections down to manageable levels followed by test, track, trace and isolate. This aproach would not reach herd immunity in a more or less reasonable time. It would stop at about 20% infections after which further growth would go very slow. The problem is mostly with the testing which would have to be very extensive and done very regulary to identify new cases in time. This aproach would be valid if there would be a vaccine within 2 years but since they think a vaccine wont come anytime soon this aproach would mean having to track and trace for a very long time,possibly 10 years or more. This aproach i think could be realistic in some nations but not for an open economy like the netherlands. It would have to come with strict border controls on all incoming people and electronic surveilance of the population to make track and trace possible for a very long period of time (asuming no vaccine) against which there seems to be a lot of resistance in the population and the economic impact will still be quiet large for the dutch economy.
The overall impression you get from this is that there is no easy solution and that the situation will be pretty horrible for 2 years to come,but i guess that we already knew. Reaching herd immunity will come with a considerable cost of life even without overloading the healthcare system and it will take 2 years to do it in a controlled way. One thing they didnt adress and that was a possible treatment (opposed to a vaccine). An effective treatment could lessen the time of hospital admissions and possibly also reduce them (with home medication). Increasing capacity of the healthcare system and reducing casualties. There are several treatments which do show promise and the more we learn about the disease,the better the treatments will be. This was not adressed so i have no clue if they think a treatment is also fundamentally impossible. They could also be wrong about a vaccine not beeing possible for the coming 2 years,they did seem reasonably sure of that but other experts are more optimistic. Another thing they didnt adress and which might also be a possible solution is a huge but temporary increase in healthcare capacity which could considerably lower the time to reach herd immunity (pretty much double capacity is halve the time to reach herd capacity) This does not seem very realistic either. you need supplies which are scarce and you need people which take time to train. It will come at a huge cost and the netherlands already more then doubled healthcare capacity which took tremendous effort. They would have to double capacity again or maybe even quadrupple it to be able to reach herd immunity in 6 months-1 year.
Personally i am inclined to prefer the track and trace method,hoping for better treatments and possibly a vaccine. Accepting the public surveilance and strict border controls and anticipating to keep that up for 5 years+ if needed. It is an aproach that heavily depends on other countries,at least those in europe, following the same aproach and i am not sure that is realistic either. The herd immunity aproach is an aproach which does not depend on other countries so much and the end result is best suited for very open economys like the netherlands,once you reached herd immunity you dont really care what other countries do though those other countries might still care for the situation in your country. Herd immunity also asumes long lasting immunity,at least 2 years+ else you have to start over again the moment you reach herd immunity. There is a lot of uncertainty about immunity lasting for 2 years which imo is another argument for the track and trace method.
Best hope is a vaccine and treatment so i hope more funding goes into that direction.
Sry for this long post,i am kinda done with the virus and want to stop thinking about it. Hence this last and extensive post about the situation.
edit:made a small adjustment to track and trace to be more accurate.
On May 06 2020 09:31 pmh wrote: The study above i have also seen,it is interesting and not very encouraging.
There was an interesting item on dutch tv with 2 experts on infectious diseases who are working towards an exit strategy for the lockdown. It was enlightning and sobering at the same time. It was not straight forward at all points but you could get a lot of information by reading between the lines. It more or less aplies to all western countries to some degree.
-They did not believe am effective vaccine would come anytime soon,suggesting it could be 10 years+ and maybe even be completely impossible. -They estimated current overall infection rate in the netherlands at around 4% (only up 1% from ~ 3 weeks ago due to all the restrictions) with the most infected regions aproaching 10%.
-The strategy is still reaching herd immunity in a controlled way without overloading the healthcare system,herd immunity estimated to be 60% of the people getting the virus (60% to me seems optimistic for an urban environment but i am not an expert and it could be a level at which it will be under control without completely eliminating the virus). With uncontrolled spread and no restrictions herd immunity could be reached in 100-150 days at a huge cost with the healthcare system beeing completely overrun.
-Another aproach was a pump break aproach,alternating restrictions on and off untill herd immunity is reached which would take somewhere up to 2 years. The closer you get to herd immunity,the longer the time will be between the periods with restrictions. During this aproach the healthcare system would come close to beeing overloaded several times and it would take about 10 cycles. If this aproach is anywhere realistic to implement i dont know,i am inclined to think no but it is possible in theory and it does seem more realistic to me the the following aproach.
-An approach in which they open up smaller regions (all with a similar population) 1 by 1 which was an approach they did seem in favor off. You open up one region first while keeping other regions closed. The healthcare system of the whole nation could then take care of the patients from that single one region untill herd immunity is reached in that region after which another region can be opened up. The advantage would be that it would have a high level of control and that some regions could open up soon,this would also take about 2 years. It does not seem realistic to me because of the huge difference in economic impact in various regions which will be hard to accept for the population. Some can open up in 1 month and some would have to wait for 2 years. It also doesnt adress the fact that people will flock to regions that are opened up already to go to restaurants and bars unless you would restrict movement between regions (which also seems unrealistic in the netherlands).
-Getting infections down to manageable levels followed by track and trace. This aproach would not reach herd immunity in a more or less reasonable time. It would stop at about 20% infections after which further growth would go very slow. This aproach would be valid if there would be a vaccine within 2 years but since they think a vaccine wont come anytime soon this aproach would mean having to track and trace for a very long time,possibly 10 years or more. This aproach i think could be realistic in some nations but not for an open economy like the netherlands. It would have to come with strict border controls on all incoming people and electronic surveilance of the population to make track and trace possible for a very long period of time (asuming no vaccine) against which there seems to be a lot of resistance in the population and the economic impact will still be quiet large for the dutch economy.
The overall impression you get from this is that there is no easy solution and that the situation will be pretty horrible for 2 years to come,but i guess that we already knew. Reaching herd immunity will come with a considerable cost of life even without overloading the healthcare system and it will take 2 years to do it in a controlled way. One thing they didnt adress and that was a possible treatment (opposed to a vaccine). An effective treatment could lessen the time of hospital admissions and possibly also reduce them (with home medication). Increasing capacity of the healthcare system and reducing casualties. There are several treatments which do show promise and the more we learn about the disease,the better the treatments will be. This was not adressed so i have no clue if they think a treatment is also fundamentally impossible. They could also be wrong about a vaccine not beeing possible for the coming 2 years,they did seem reasonably sure of that but other experts are more optimistic. Another thing they didnt adress and which might also be a possible solution is a huge but temporary increase in healthcare capacity which could considerably lower the time to reach herd immunity (pretty much double capacity is halve the time to reach herd capacity) This does not seem very realistic either. you need supplies which are scarce and you need people which take time to train. It will come at a huge cost and the netherlands already more then doubled healthcare capacity which took tremendous effort. They would have to double capacity again or maybe even quadrupple it to be able to reach herd immunity in 6 months-1 year.
Personally i am inclined to prefer the track and trace method,hoping for better treatments and possibly a vaccine. Accepting the public surveilance and strict border controls and anticipating to keep that up for 5 years+ if needed. It is an aproach that heavily depends on other countries,at least those in europe, following the same aproach and i am not sure that is realistic either. The herd immunity aproach is an aproach which does not depend on other countries so much and the end result is best suited for very open economys like the netherlands,once you reached herd immunity you dont really care what other countries do though those other countries might still care for the situation in your country. Herd immunity also asumes long lasting immunity,at least 2 years+ else you have to start over again the moment you reach herd immunity. There is a lot of uncertainty about immunity lasting for 2 years which imo is another argument for the track and trace method.
Best hope is a vaccine and treatment so i hope more funding goes into that direction.
Sry for this long post,i am kinda done with the virus and want to stop thinking about it. Hence this last and extensive post about the situation.
Looking at Netherlands. With a population of 17.28 million and assuming herd immunity is achieved with 70% of the population infected, at a constant rate of infection this would mean 16569 new infections per day. Meanwhile, confirmed infection up until now have peaked in the netherlands at +- 1350 mid april. These numbers seem incompatible.
The big question, of course, is the relationship between the true number of infected and the number of confirmed infected. From what I understood, the NY study claimed 10x more people were infected compared to confirmed tests. If the same was true for the Netherlands, this would mean the 1350 mid april confirmed number equal to 13500 real infections, which isn't far off of 16569. The question then becomes, is 10x the correct number? I have a feeling 10x is inflated by the lack of tests in NY, and the abundance of tests in the Netherlands would mean 10x is too high. If, hypothetically, the correct number is 5x, then the Netherlands would need an equivalent of 3313 new confirmed cases per day. Would this be even feasible for the healthcare system?
On May 05 2020 00:32 warding wrote: So a lot of serological studies are coming out - someone did the math and the mortality rate (IFR?) assumed from the average of those studies is 0.2%
Meanwhile, some studies suggest that measures that may not have a huge economic impact - wearing masks, homeoffice for more workers, banning masses and general awareness (washing hands, fewer handshakes and hugs) probably bring R close to 1. If R is at like 1.2, then herd immunity is achieved at 17% of the population being infected. Given the data from serological studies, places with visible outbreaks are likely past that.
I’m leaning in the same direction. Keep most of the impact ones you mention, lessen the more onerous ones. Hospitals around me are sending nurses and engineers home for lack of patients. There is abundant testing for those who need it.
Longer max lockdowns affecting entire states is just going to breed more massive civil disobedience.
I see a lot more people these days taking a position that is something like “the original lockdowns were justified, but now it’s time to start relaxing those protocols.” I think you’re maybe in this category, so maybe you can help me understand the position a little better. Here’s my understanding of the situation:
The original lockdowns were to reduce R, with the idea that a high R would create really high active case counts and high active case counts would cause high mortality (both due to the disease itself being fatal even under standard of care, and due to being unable to provide standard of care to so many people at once). So we want to reduce total cases (fewer total people get sick), but even more so we want to reduce active cases at one time (so we don’t overwhelm the system). The ultimate goal is to reduce fatalities.
The math:
Fatalities are a function of total cases and of the quality of treatment available. Active case growth is an exponential function, with R in the base and current cases in the exponent. R is determined by a lot of variables, including innate properties of the virus, contact behavior of the population, and immune percentage of the population.
So let’s list the relevant variables, and compare where they are now to where they were in March:
Active cases: much higher now Quality of treatment available: essentially the same (remdesivir may provide moderately better time to recovery, but apparently not statistically significant improvement in mortality) Innate properties of the virus: essentially the same Contact behavior of the population: much better (but only due to lockdown/social distancing protocols) Immune percentage of the population: somewhat higher, but probably not anywhere close to herd immunity
So if the lockdowns were justified in March, what’s changed? The exponential growth we shut down to avoid in March is just as scary now, isn’t it? If you look at a chart of daily new cases and take a rolling sum of the last 14 days, there’s a lot more people able to spread this thing now than there were in March. The only thing that might help some now compared to then is immune percentage, but iirc serology studies of NYC suggest only ~20-25% are immune, and the rest of the country is presumably much lower.
TL;DR: I know everybody’s tired of being locked down, but what empirical reason is there to think opening the doors is more justified now than it was in March?
On May 05 2020 00:32 warding wrote: So a lot of serological studies are coming out - someone did the math and the mortality rate (IFR?) assumed from the average of those studies is 0.2%
Meanwhile, some studies suggest that measures that may not have a huge economic impact - wearing masks, homeoffice for more workers, banning masses and general awareness (washing hands, fewer handshakes and hugs) probably bring R close to 1. If R is at like 1.2, then herd immunity is achieved at 17% of the population being infected. Given the data from serological studies, places with visible outbreaks are likely past that.
I’m leaning in the same direction. Keep most of the impact ones you mention, lessen the more onerous ones. Hospitals around me are sending nurses and engineers home for lack of patients. There is abundant testing for those who need it.
Longer max lockdowns affecting entire states is just going to breed more massive civil disobedience.
I see a lot more people these days taking a position that is something like “the original lockdowns were justified, but now it’s time to start relaxing those protocols.” I think you’re maybe in this category, so maybe you can help me understand the position a little better. Here’s my understanding of the situation:
The original lockdowns were to reduce R, with the idea that a high R would create really high active case counts and high active case counts would cause high mortality (both due to the disease itself being fatal even under standard of care, and due to being unable to provide standard of care to so many people at once). So we want to reduce total cases (fewer total people get sick), but even more so we want to reduce active cases at one time (so we don’t overwhelm the system). The ultimate goal is to reduce fatalities.
The math:
Fatalities are a function of total cases and of the quality of treatment available. Active case growth is an exponential function, with R in the base and current cases in the exponent. R is determined by a lot of variables, including innate properties of the virus, contact behavior of the population, and immune percentage of the population.
So let’s list the relevant variables, and compare where they are now to where they were in March:
Active cases: much higher now Quality of treatment available: essentially the same (remdesivir may provide moderately better time to recovery, but apparently not statistically significant improvement in mortality) Innate properties of the virus: essentially the same Contact behavior of the population: much better (but only due to lockdown/social distancing protocols) Immune percentage of the population: somewhat higher, but probably not anywhere close to herd immunity
So if the lockdowns were justified in March, what’s changed? The exponential growth we shut down to avoid in March is just as scary now, isn’t it? If you look at a chart of daily new cases and take a rolling sum of the last 14 days, there’s a lot more people able to spread this thing now than there were in March. The only thing that might help some now compared to then is immune percentage, but iirc serology studies of NYC suggest only ~20-25% are immune, and the rest of the country is presumably much lower.
TL;DR: I know everybody’s tired of being locked down, but what empirical reason is there to think opening the doors is more justified now than it was in March?
The weather's getting warmer and people are getting restless, that's the only change. Governments are gonna let people have a few months of "normalcy" before shutting things down again (when the numbers go up and it starts getting colder). Western countries don't have the discipline to go through with a proper quarantine so this is the best we'll get, sadly.
On May 05 2020 00:32 warding wrote: So a lot of serological studies are coming out - someone did the math and the mortality rate (IFR?) assumed from the average of those studies is 0.2%
Meanwhile, some studies suggest that measures that may not have a huge economic impact - wearing masks, homeoffice for more workers, banning masses and general awareness (washing hands, fewer handshakes and hugs) probably bring R close to 1. If R is at like 1.2, then herd immunity is achieved at 17% of the population being infected. Given the data from serological studies, places with visible outbreaks are likely past that.
I’m leaning in the same direction. Keep most of the impact ones you mention, lessen the more onerous ones. Hospitals around me are sending nurses and engineers home for lack of patients. There is abundant testing for those who need it.
Longer max lockdowns affecting entire states is just going to breed more massive civil disobedience.
I see a lot more people these days taking a position that is something like “the original lockdowns were justified, but now it’s time to start relaxing those protocols.” I think you’re maybe in this category, so maybe you can help me understand the position a little better. Here’s my understanding of the situation:
The original lockdowns were to reduce R, with the idea that a high R would create really high active case counts and high active case counts would cause high mortality (both due to the disease itself being fatal even under standard of care, and due to being unable to provide standard of care to so many people at once). So we want to reduce total cases (fewer total people get sick), but even more so we want to reduce active cases at one time (so we don’t overwhelm the system). The ultimate goal is to reduce fatalities.
The math:
Fatalities are a function of total cases and of the quality of treatment available. Active case growth is an exponential function, with R in the base and current cases in the exponent. R is determined by a lot of variables, including innate properties of the virus, contact behavior of the population, and immune percentage of the population.
So let’s list the relevant variables, and compare where they are now to where they were in March:
Active cases: much higher now Quality of treatment available: essentially the same (remdesivir may provide moderately better time to recovery, but apparently not statistically significant improvement in mortality) Innate properties of the virus: essentially the same Contact behavior of the population: much better (but only due to lockdown/social distancing protocols) Immune percentage of the population: somewhat higher, but probably not anywhere close to herd immunity
So if the lockdowns were justified in March, what’s changed? The exponential growth we shut down to avoid in March is just as scary now, isn’t it? If you look at a chart of daily new cases and take a rolling sum of the last 14 days, there’s a lot more people able to spread this thing now than there were in March. The only thing that might help some now compared to then is immune percentage, but iirc serology studies of NYC suggest only ~20-25% are immune, and the rest of the country is presumably much lower.
TL;DR: I know everybody’s tired of being locked down, but what empirical reason is there to think opening the doors is more justified now than it was in March?
The weather's getting warmer and people are getting restless, that's the only change. Governments are gonna let people have a few months of "normalcy" before shutting things down again (when the numbers go up and it starts getting colder). Western countries don't have the discipline to go through with a proper quarantine so this is the best we'll get, sadly.
I suppose I should say “weather effects + higher percent immune” would be the reasons to hope things would be better now than they were in March. But do we even have good reason to think there’s much weather effect on R? Last I looked into it the evidence was mixed, but admittedly that was a few months ago. There may be more recent research on the subject.
On May 05 2020 00:32 warding wrote: So a lot of serological studies are coming out - someone did the math and the mortality rate (IFR?) assumed from the average of those studies is 0.2%
Meanwhile, some studies suggest that measures that may not have a huge economic impact - wearing masks, homeoffice for more workers, banning masses and general awareness (washing hands, fewer handshakes and hugs) probably bring R close to 1. If R is at like 1.2, then herd immunity is achieved at 17% of the population being infected. Given the data from serological studies, places with visible outbreaks are likely past that.
I’m leaning in the same direction. Keep most of the impact ones you mention, lessen the more onerous ones. Hospitals around me are sending nurses and engineers home for lack of patients. There is abundant testing for those who need it.
Longer max lockdowns affecting entire states is just going to breed more massive civil disobedience.
I see a lot more people these days taking a position that is something like “the original lockdowns were justified, but now it’s time to start relaxing those protocols.” I think you’re maybe in this category, so maybe you can help me understand the position a little better. Here’s my understanding of the situation:
The original lockdowns were to reduce R, with the idea that a high R would create really high active case counts and high active case counts would cause high mortality (both due to the disease itself being fatal even under standard of care, and due to being unable to provide standard of care to so many people at once). So we want to reduce total cases (fewer total people get sick), but even more so we want to reduce active cases at one time (so we don’t overwhelm the system). The ultimate goal is to reduce fatalities.
The math:
Fatalities are a function of total cases and of the quality of treatment available. Active case growth is an exponential function, with R in the base and current cases in the exponent. R is determined by a lot of variables, including innate properties of the virus, contact behavior of the population, and immune percentage of the population.
So let’s list the relevant variables, and compare where they are now to where they were in March:
Active cases: much higher now Quality of treatment available: essentially the same (remdesivir may provide moderately better time to recovery, but apparently not statistically significant improvement in mortality) Innate properties of the virus: essentially the same Contact behavior of the population: much better (but only due to lockdown/social distancing protocols) Immune percentage of the population: somewhat higher, but probably not anywhere close to herd immunity
So if the lockdowns were justified in March, what’s changed? The exponential growth we shut down to avoid in March is just as scary now, isn’t it? If you look at a chart of daily new cases and take a rolling sum of the last 14 days, there’s a lot more people able to spread this thing now than there were in March. The only thing that might help some now compared to then is immune percentage, but iirc serology studies of NYC suggest only ~20-25% are immune, and the rest of the country is presumably much lower.
TL;DR: I know everybody’s tired of being locked down, but what empirical reason is there to think opening the doors is more justified now than it was in March?
Just the latter part of what you said: so as not to overwhelm hospital capacity with a high burden of cases that required specialty equipment like ventilators. Secondly to that, to increase unrelated disease mortality by insufficient ICU beds and staff.
And then the hardest hit area in the country, New York City, plagued by inaction at the opening steps (sanitization of subway cars, warnings against crowds of people, etc etc etc) gets it bad. And ... emergency hospital beds at the Javit center sit mostly unused and closes having seen very little usage. The USNS Comfort sails away. An urgent demand for 40,000 ventilators is made, and denied, and it turns out NY had plenty to give away in stockpile.
Then, as I've been posting and I hope you read, most states are over their peak and have been in the linear increase model for several weeks now. No exponential growth. Widespread obedience, few (highly publicized) cases of disobedience. Moreover, it's apparent that continued social distancing, hand washing, and mask-wearing will stop the curve from returning to exponential growth as back in the initial weeks of infection.
The ultimate goal is to flatten the curve to allow treatment. This does not mean the tail to the curve no longer exists. It doesn't mean this thing suddenly contradicts lessons from Florida (beaches open did not cause bumps in confirmed cases), or the staggering hospital underutilization, which frankly is astounding.
And to what's changed from March, it's in excess of 100,000 tests per day compared to ... well, America did not do well approving and mass producing tests at the beginning. This capacity is able to confirm any sudden uptick in metro or state growth in a very short time, which is unlikely (in my area) given widespread social distancing, mask use, and hand washing.
Feel free to respond to prior posts of mine that I did not repeat here.
On May 05 2020 00:32 warding wrote: So a lot of serological studies are coming out - someone did the math and the mortality rate (IFR?) assumed from the average of those studies is 0.2%
Meanwhile, some studies suggest that measures that may not have a huge economic impact - wearing masks, homeoffice for more workers, banning masses and general awareness (washing hands, fewer handshakes and hugs) probably bring R close to 1. If R is at like 1.2, then herd immunity is achieved at 17% of the population being infected. Given the data from serological studies, places with visible outbreaks are likely past that.
I’m leaning in the same direction. Keep most of the impact ones you mention, lessen the more onerous ones. Hospitals around me are sending nurses and engineers home for lack of patients. There is abundant testing for those who need it.
Longer max lockdowns affecting entire states is just going to breed more massive civil disobedience.
I see a lot more people these days taking a position that is something like “the original lockdowns were justified, but now it’s time to start relaxing those protocols.” I think you’re maybe in this category, so maybe you can help me understand the position a little better. Here’s my understanding of the situation:
The original lockdowns were to reduce R, with the idea that a high R would create really high active case counts and high active case counts would cause high mortality (both due to the disease itself being fatal even under standard of care, and due to being unable to provide standard of care to so many people at once). So we want to reduce total cases (fewer total people get sick), but even more so we want to reduce active cases at one time (so we don’t overwhelm the system). The ultimate goal is to reduce fatalities.
The math:
Fatalities are a function of total cases and of the quality of treatment available. Active case growth is an exponential function, with R in the base and current cases in the exponent. R is determined by a lot of variables, including innate properties of the virus, contact behavior of the population, and immune percentage of the population.
So let’s list the relevant variables, and compare where they are now to where they were in March:
Active cases: much higher now Quality of treatment available: essentially the same (remdesivir may provide moderately better time to recovery, but apparently not statistically significant improvement in mortality) Innate properties of the virus: essentially the same Contact behavior of the population: much better (but only due to lockdown/social distancing protocols) Immune percentage of the population: somewhat higher, but probably not anywhere close to herd immunity
So if the lockdowns were justified in March, what’s changed? The exponential growth we shut down to avoid in March is just as scary now, isn’t it? If you look at a chart of daily new cases and take a rolling sum of the last 14 days, there’s a lot more people able to spread this thing now than there were in March. The only thing that might help some now compared to then is immune percentage, but iirc serology studies of NYC suggest only ~20-25% are immune, and the rest of the country is presumably much lower.
TL;DR: I know everybody’s tired of being locked down, but what empirical reason is there to think opening the doors is more justified now than it was in March?
Sweden has an R level of 0,85 according to the governments latest calculations about a week ago. I would wait a week or two more because there are many different studies that will be presented by then and the data will be more certain but it certainly seems that mostly voluntary action is enough with a few key restrictions thrown into the mix.
Also about death rates. It's really only about if the virus gets into care homes for elderly and keeping other elderly people safe. Everyone knows our death numbers are much, much higher than our neighbors. However in the southern region of Sweden we have lower deaths per million than Denmark and this is a densely populated region! This is only because they managed to keep it away from the elderly care homes (lots of statistics on this) both from good early preventive work, better circumstances (more permanent staff from the start, less and better trained temp workers) and a bit of luck. The difference is absolutely huge. If all of the country had the same rate we would probably have less than half the deaths right now.
On May 05 2020 00:32 warding wrote: So a lot of serological studies are coming out - someone did the math and the mortality rate (IFR?) assumed from the average of those studies is 0.2%
Meanwhile, some studies suggest that measures that may not have a huge economic impact - wearing masks, homeoffice for more workers, banning masses and general awareness (washing hands, fewer handshakes and hugs) probably bring R close to 1. If R is at like 1.2, then herd immunity is achieved at 17% of the population being infected. Given the data from serological studies, places with visible outbreaks are likely past that.
I’m leaning in the same direction. Keep most of the impact ones you mention, lessen the more onerous ones. Hospitals around me are sending nurses and engineers home for lack of patients. There is abundant testing for those who need it.
Longer max lockdowns affecting entire states is just going to breed more massive civil disobedience.
I see a lot more people these days taking a position that is something like “the original lockdowns were justified, but now it’s time to start relaxing those protocols.” I think you’re maybe in this category, so maybe you can help me understand the position a little better. Here’s my understanding of the situation:
The original lockdowns were to reduce R, with the idea that a high R would create really high active case counts and high active case counts would cause high mortality (both due to the disease itself being fatal even under standard of care, and due to being unable to provide standard of care to so many people at once). So we want to reduce total cases (fewer total people get sick), but even more so we want to reduce active cases at one time (so we don’t overwhelm the system). The ultimate goal is to reduce fatalities.
The math:
Fatalities are a function of total cases and of the quality of treatment available. Active case growth is an exponential function, with R in the base and current cases in the exponent. R is determined by a lot of variables, including innate properties of the virus, contact behavior of the population, and immune percentage of the population.
So let’s list the relevant variables, and compare where they are now to where they were in March:
Active cases: much higher now Quality of treatment available: essentially the same (remdesivir may provide moderately better time to recovery, but apparently not statistically significant improvement in mortality) Innate properties of the virus: essentially the same Contact behavior of the population: much better (but only due to lockdown/social distancing protocols) Immune percentage of the population: somewhat higher, but probably not anywhere close to herd immunity
So if the lockdowns were justified in March, what’s changed? The exponential growth we shut down to avoid in March is just as scary now, isn’t it? If you look at a chart of daily new cases and take a rolling sum of the last 14 days, there’s a lot more people able to spread this thing now than there were in March. The only thing that might help some now compared to then is immune percentage, but iirc serology studies of NYC suggest only ~20-25% are immune, and the rest of the country is presumably much lower.
TL;DR: I know everybody’s tired of being locked down, but what empirical reason is there to think opening the doors is more justified now than it was in March?
Just the latter part of what you said: so as not to overwhelm hospital capacity with a high burden of cases that required specialty equipment like ventilators. Secondly to that, to increase unrelated disease mortality by insufficient ICU beds and staff.
And then the hardest hit area in the country, New York City, plagued by inaction at the opening steps (sanitization of subway cars, warnings against crowds of people, etc etc etc) gets it bad. And ... emergency hospital beds at the Javit center sit mostly unused and closes having seen very little usage. The USNS Comfort sails away. An urgent demand for 40,000 ventilators is made, and denied, and it turns out NY had plenty to give away in stockpile.
Then, as I've been posting and I hope you read, most states are over their peak and have been in the linear increase model for several weeks now. No exponential growth. Widespread obedience, few (highly publicized) cases of disobedience. Moreover, it's apparent that continued social distancing, hand washing, and mask-wearing will stop the curve from returning to exponential growth as back in the initial weeks of infection.
Other people are better practiced at looking at the latest charts than me, but at a glance it doesn’t look like almost anybody is over their peak? More to the point, though, the “peak” is an equilibrium point determined by the variables I was talking about. If *with* social distancing we’re able to get an effective R of 1.25, then we’d hit peak active cases at ~20% immune. Shortly before that you’re growing ~linearly, shortly after that you’re shrinking ~linearly. Eventually you’ll get back to the same number of active cases as you had pre-lockdown.
But if you flip the social distancing back off (and bring that effective R back up) while you’re still at “peak” you start climbing again. The math is extremely straightforward on this point. So if you jump back up to an R of 2.5 or something (that puts the equilibrium point at ~60% immune), you’re on more or less the same exponential curve you were on in March, but now you’ve got tens of thousands of cases growing exponentially instead of a few hundred.
The ultimate goal is to flatten the curve to allow treatment. This does not mean the tail to the curve no longer exists. It doesn't mean this thing suddenly contradicts lessons from Florida (beaches open did not cause bumps in confirmed cases), or the staggering hospital underutilization, which frankly is astounding.
I think you’re overestimating how much we can tease out a signal from stuff like Florida’s spring break stuff and determine what effect it had on the whole state’s numbers, but I also don’t care. Open the beaches if you want. People have been going to beaches down here in San Diego recently to see the red tide and it doesn’t seem like that huge a risk to me as long as people are keeping their distance and it doesn’t get too crowded at any one time. It could start to be an issue later in summer when they normally get really packed, but I think there are bigger problems to worry about.
“Hospital underutilization” (at least in the US) seems to be a result of the fact that the healthcare industry by far makes most of its money from treatment that was completely haltable. We’re in the middle of the worst pandemic in a century, and healthcare is leading the recession. What that says about the merits of structuring our healthcare system (and its profit motives) as we have is a discussion for another thread; but suffice to say when you hear about “furloughed nurses” it’s because hospitals are cash-strapped because treating a pandemic nowhere near as profitable as things like elective surgery.
There’s another interesting point here though: are we trying for “suppression” or “mitigation”? That is, do we want to reduce total cases, or just ease our path to herd immunity? You seem to be in the latter camp, although I’ll point out that if that’s the plan, the total mortality is gonna be more or less IFR * herd immunity percentage * total population. I’ll give you a conservative 0.5% IFR and 40% herd immunity; that’s still 600,000 Americans dead by my math.
And to what's changed from March, it's in excess of 100,000 tests per day compared to ... well, America did not do well approving and mass producing tests at the beginning. This capacity is able to confirm any sudden uptick in metro or state growth in a very short time, which is unlikely (in my area) given widespread social distancing, mask use, and hand washing.
So we’re reopening because we’ve got higher testing capacity? It’s not *that* high (especially considering some of the reliability issues) but even if it was, we’ve got very little in the way of infrastructure for chasing down the positives and quarantining them, let alone chasing down their previous 7-14 days of contacts. In fact I’m not sure we’ve got any?
I guess you’re figuring with more tests we’re better equipped to make course corrections (e.g. turn distancing measures back on if cases spike), but I see two problems: 1) time lag means you’ll be “course-correcting” to one-two week old data, and 2) the data we have right now is more dire than when we locked down.
Feel free to respond to prior posts of mine that I did not repeat here.
I think I’ve read this entire thread, but things tend to blur together recently. If there’s something specific you’d like me to respond to, mind linking it? Feel free to PM me if you’d rather not make a new post just to link your old ones.
On May 06 2020 09:31 pmh wrote: The study above i have also seen,it is interesting and not very encouraging.
There was an interesting item on dutch tv with 2 experts on infectious diseases who are working towards an exit strategy for the lockdown. It was enlightning and sobering at the same time. It was not straight forward at all points but you could get a lot of information by reading between the lines. It more or less aplies to all western countries to some degree.
-They did not believe am effective vaccine would come anytime soon,suggesting it could be 10 years+ and maybe even be completely impossible. -They estimated current overall infection rate in the netherlands at around 4% (only up 1% from ~ 3 weeks ago due to all the restrictions) with the most infected regions aproaching 10%.
-The strategy is still reaching herd immunity in a controlled way without overloading the healthcare system,herd immunity estimated to be 60% of the people getting the virus (60% to me seems optimistic for an urban environment but i am not an expert and it could be a level at which it will be under control without completely eliminating the virus). With uncontrolled spread and no restrictions herd immunity could be reached in 100-150 days at a huge cost with the healthcare system beeing completely overrun.
-Another aproach was a pump break aproach,alternating restrictions on and off untill herd immunity is reached which would take somewhere up to 2 years. The closer you get to herd immunity,the longer the time will be between the periods with restrictions. During this aproach the healthcare system would come close to beeing overloaded several times and it would take about 10 cycles. If this aproach is anywhere realistic to implement i dont know,i am inclined to think no but it is possible in theory and it does seem more realistic to me the the following aproach.
-An approach in which they open up smaller regions (all with a similar population) 1 by 1 which was an approach they did seem in favor off. You open up one region first while keeping other regions closed. The healthcare system of the whole nation could then take care of the patients from that single one region untill herd immunity is reached in that region after which another region can be opened up. The advantage would be that it would have a high level of control and that some regions could open up soon,this would also take about 2 years. It does not seem realistic to me because of the huge difference in economic impact in various regions which will be hard to accept for the population. Some can open up in 1 month and some would have to wait for 2 years. It also doesnt adress the fact that people will flock to regions that are opened up already to go to restaurants and bars unless you would restrict movement between regions (which also seems unrealistic in the netherlands).
-Getting infections down to manageable levels followed by track and trace. This aproach would not reach herd immunity in a more or less reasonable time. It would stop at about 20% infections after which further growth would go very slow. This aproach would be valid if there would be a vaccine within 2 years but since they think a vaccine wont come anytime soon this aproach would mean having to track and trace for a very long time,possibly 10 years or more. This aproach i think could be realistic in some nations but not for an open economy like the netherlands. It would have to come with strict border controls on all incoming people and electronic surveilance of the population to make track and trace possible for a very long period of time (asuming no vaccine) against which there seems to be a lot of resistance in the population and the economic impact will still be quiet large for the dutch economy.
The overall impression you get from this is that there is no easy solution and that the situation will be pretty horrible for 2 years to come,but i guess that we already knew. Reaching herd immunity will come with a considerable cost of life even without overloading the healthcare system and it will take 2 years to do it in a controlled way. One thing they didnt adress and that was a possible treatment (opposed to a vaccine). An effective treatment could lessen the time of hospital admissions and possibly also reduce them (with home medication). Increasing capacity of the healthcare system and reducing casualties. There are several treatments which do show promise and the more we learn about the disease,the better the treatments will be. This was not adressed so i have no clue if they think a treatment is also fundamentally impossible. They could also be wrong about a vaccine not beeing possible for the coming 2 years,they did seem reasonably sure of that but other experts are more optimistic. Another thing they didnt adress and which might also be a possible solution is a huge but temporary increase in healthcare capacity which could considerably lower the time to reach herd immunity (pretty much double capacity is halve the time to reach herd capacity) This does not seem very realistic either. you need supplies which are scarce and you need people which take time to train. It will come at a huge cost and the netherlands already more then doubled healthcare capacity which took tremendous effort. They would have to double capacity again or maybe even quadrupple it to be able to reach herd immunity in 6 months-1 year.
Personally i am inclined to prefer the track and trace method,hoping for better treatments and possibly a vaccine. Accepting the public surveilance and strict border controls and anticipating to keep that up for 5 years+ if needed. It is an aproach that heavily depends on other countries,at least those in europe, following the same aproach and i am not sure that is realistic either. The herd immunity aproach is an aproach which does not depend on other countries so much and the end result is best suited for very open economys like the netherlands,once you reached herd immunity you dont really care what other countries do though those other countries might still care for the situation in your country. Herd immunity also asumes long lasting immunity,at least 2 years+ else you have to start over again the moment you reach herd immunity. There is a lot of uncertainty about immunity lasting for 2 years which imo is another argument for the track and trace method.
Best hope is a vaccine and treatment so i hope more funding goes into that direction.
Sry for this long post,i am kinda done with the virus and want to stop thinking about it. Hence this last and extensive post about the situation.
Looking at Netherlands. With a population of 17.28 million and assuming herd immunity is achieved with 70% of the population infected, at a constant rate of infection this would mean 16569 new infections per day. Meanwhile, confirmed infection up until now have peaked in the netherlands at +- 1350 mid april. These numbers seem incompatible.
The big question, of course, is the relationship between the true number of infected and the number of confirmed infected. From what I understood, the NY study claimed 10x more people were infected compared to confirmed tests. If the same was true for the Netherlands, this would mean the 1350 mid april confirmed number equal to 13500 real infections, which isn't far off of 16569. The question then becomes, is 10x the correct number? I have a feeling 10x is inflated by the lack of tests in NY, and the abundance of tests in the Netherlands would mean 10x is too high. If, hypothetically, the correct number is 5x, then the Netherlands would need an equivalent of 3313 new confirmed cases per day. Would this be even feasible for the healthcare system?
The netherlands does not test all that much and i think 10 times for the netherlands might even be to low instead of to high. I like your aproach though and unfortunatly i did not think of this myself,the math has to add up with every model and this calculation (needed nr of infections/day) is a very important calculation to see if the model can be correct in the first place. I am not sure about max confirmed infections every day and i dont want to look it up either anymore but i think 1350 is about the correct nr and 10 fold or more is a reasonable estimate. There is another thing that is overlooked as you say and that is that it has to be continious to reach herd immunity in 2 years. And it wont be continious at all,for example with the pump break aproach it would only reach this average amount of daily effections maybe halve the time,specially at the start (1-2 months spread followed by 1-2 months semi lockdown). Taking this into account would suggest reaching herd immunity would actually take 4 years instead of the projected 2 based on a continuous17k infections a day.
It could be though that the max nr of infections was far higher then 10 times 1350 early on in the epidemic,when we barely did any tests at all and about which we dont have all that much info other then a retro analyzis based on IFR and nr of casualties. The netherlands was pretty late with imposing the lockdown and there where several super spreader events before lockdown when we barely did any tests. The estimated infection rate based on blood samples suggests 3% infections ~ 3 weeks ago,a little over halveway into the lockdown and about 2-3 months since the start of the outbreak . (a rough estimate with this whould give at least 40 months for reaching herd immunity as we are almost done with the first cycle) Asuming most of those infections where from before the lockdown and taking (arguably) 1 month of uncontrolled spreading before the lockdown then you have about 400k infections in 1 month which would put it at 13k a day in an uncontrolled situation (and starting from virtually zero,which wont be the case with the following cycles). At first sight 2 years indeed seems impossible with a pump break aproach but maybe i did overlook a few things (specially the starting with zero infections for the first cycle compared to starting with a considerable amount of infections for every next cycle could be a factor,though this in the end would also has an effect on how long uncontrolled spread can be allowed for before overloading capacity and probably will not lower the time that is needed to reach herd immunity).
It all is kinda complicated and many of the asumptions needed to make these models are probably quiet off.I probably also did overlook a few important things which could mean 2 years is a reasonable estimate after all. (this response is pretty much on the fly without properly thinking about it). 4 years to reach herd immunity would be a big problem and more or less invalid the whole aproach,2 years already is a long time and 2 years does look very optimistic based on all these numbers. 4 years would also mean immunity has to last at least for 4 years else we would never get there. And to make it more or less bearable it would have to last at least twice as long as 4 years,else we will benefit from the immunity for a time that is shorter then it took us to get there and then we might have to go through another cycle shortly after.
Best hope is still a vaccine/treatment. (or the virus losing strenght,which does not apear to be the case right now but still could happen in the future) I can not judge how realistic that is at all and even experts seem to have widely different opinions on this. Then there also still is the completely uncontrolled spread,it does have several advantages if you compare to the models above, but it also has a huge disadvantage which makes it unrealistic and definitely very undesireable.
Another adaption to the strategy of herd immunity might be to completely isolate and shield of the more vulnerable part of the population. This would be pretty bad for that part of the population and also quiet complicated as some of them need continious care. Maybe it could allow for a slightly faster spreading in the rest of the population which would lower the time to reach herd immunity in that part of the population (but at the same time wont lead to any sorts of immunity in the vulnerable population which means that nursing homes will remain extremely vulnerable to infection for a very long time ). I guess this is more or less beeing tried already and the most vulnerable part of the population with age 80+ does not put a lot of burden on medical capacity (many of them voluntarily opt out for ic treatment) so the overal gains on healthcare capacity from this adaptation might be relativly small. (though it could considerably lower the casualties in that part of the population which is a huge benefit in itself,at the cost of the rather large sacrifice of having to be virtually completely isolated). To get a decent effect from this adaptation on the burden this puts on the healthcare system you would have to shield people starting from age 60 and maybe even lower (people who are now making use of medical capacity) and many of those people are still part of the workforce. This aproach is beeing considered to some extend,for example bars and restaurants are contemplating the idea of opening up with an age restriction,it could be a reasonable adaptation (specially for the people not effected by the age restriction) which has not gotten much attention yet. It would require proper isolation extending beyond the bars and restaurants themselves for a rather large group of people so this adaptation probably also has its limits.
On May 05 2020 00:32 warding wrote: So a lot of serological studies are coming out - someone did the math and the mortality rate (IFR?) assumed from the average of those studies is 0.2%
Meanwhile, some studies suggest that measures that may not have a huge economic impact - wearing masks, homeoffice for more workers, banning masses and general awareness (washing hands, fewer handshakes and hugs) probably bring R close to 1. If R is at like 1.2, then herd immunity is achieved at 17% of the population being infected. Given the data from serological studies, places with visible outbreaks are likely past that.
I’m leaning in the same direction. Keep most of the impact ones you mention, lessen the more onerous ones. Hospitals around me are sending nurses and engineers home for lack of patients. There is abundant testing for those who need it.
Longer max lockdowns affecting entire states is just going to breed more massive civil disobedience.
I see a lot more people these days taking a position that is something like “the original lockdowns were justified, but now it’s time to start relaxing those protocols.” I think you’re maybe in this category, so maybe you can help me understand the position a little better. Here’s my understanding of the situation:
The original lockdowns were to reduce R, with the idea that a high R would create really high active case counts and high active case counts would cause high mortality (both due to the disease itself being fatal even under standard of care, and due to being unable to provide standard of care to so many people at once). So we want to reduce total cases (fewer total people get sick), but even more so we want to reduce active cases at one time (so we don’t overwhelm the system). The ultimate goal is to reduce fatalities.
The math:
Fatalities are a function of total cases and of the quality of treatment available. Active case growth is an exponential function, with R in the base and current cases in the exponent. R is determined by a lot of variables, including innate properties of the virus, contact behavior of the population, and immune percentage of the population.
So let’s list the relevant variables, and compare where they are now to where they were in March:
Active cases: much higher now Quality of treatment available: essentially the same (remdesivir may provide moderately better time to recovery, but apparently not statistically significant improvement in mortality) Innate properties of the virus: essentially the same Contact behavior of the population: much better (but only due to lockdown/social distancing protocols) Immune percentage of the population: somewhat higher, but probably not anywhere close to herd immunity
So if the lockdowns were justified in March, what’s changed? The exponential growth we shut down to avoid in March is just as scary now, isn’t it? If you look at a chart of daily new cases and take a rolling sum of the last 14 days, there’s a lot more people able to spread this thing now than there were in March. The only thing that might help some now compared to then is immune percentage, but iirc serology studies of NYC suggest only ~20-25% are immune, and the rest of the country is presumably much lower.
TL;DR: I know everybody’s tired of being locked down, but what empirical reason is there to think opening the doors is more justified now than it was in March?
Just the latter part of what you said: so as not to overwhelm hospital capacity with a high burden of cases that required specialty equipment like ventilators. Secondly to that, to increase unrelated disease mortality by insufficient ICU beds and staff.
And then the hardest hit area in the country, New York City, plagued by inaction at the opening steps (sanitization of subway cars, warnings against crowds of people, etc etc etc) gets it bad. And ... emergency hospital beds at the Javit center sit mostly unused and closes having seen very little usage. The USNS Comfort sails away. An urgent demand for 40,000 ventilators is made, and denied, and it turns out NY had plenty to give away in stockpile.
Then, as I've been posting and I hope you read, most states are over their peak and have been in the linear increase model for several weeks now. No exponential growth. Widespread obedience, few (highly publicized) cases of disobedience. Moreover, it's apparent that continued social distancing, hand washing, and mask-wearing will stop the curve from returning to exponential growth as back in the initial weeks of infection.
Other people are better practiced at looking at the latest charts than me, but at a glance it doesn’t look like almost anybody is over their peak? More to the point, though, the “peak” is an equilibrium point determined by the variables I was talking about. If *with* social distancing we’re able to get an effective R of 1.25, then we’d hit peak active cases at ~20% immune. Shortly before that you’re growing ~linearly, shortly after that you’re shrinking ~linearly. Eventually you’ll get back to the same number of active cases as you had pre-lockdown.
If you'll look at the charts I've already linked... They don't involve as much estimation as you're linking back at me. In other words, the visualizations can be made clearer.
But if you flip the social distancing back off (and bring that effective R back up) while you’re still at “peak” you start climbing again. The math is extremely straightforward on this point. So if you jump back up to an R of 2.5 or something (that puts the equilibrium point at ~60% immune), you’re on more or less the same exponential curve you were on in March, but now you’ve got tens of thousands of cases growing exponentially instead of a few hundred.
I'm really challenged to anticipate why you're wanting to flip social distancing back off. When I've said four times thus far that staged opening still involved social distancing, then I think you're trying to respond to someone that's encouraging a drop in this procedure. A position I'm taking in favor of easing of lock downs does not imply a reversal of social distancing
The ultimate goal is to flatten the curve to allow treatment. This does not mean the tail to the curve no longer exists. It doesn't mean this thing suddenly contradicts lessons from Florida (beaches open did not cause bumps in confirmed cases), or the staggering hospital underutilization, which frankly is astounding.
I think you’re overestimating how much we can tease out a signal from stuff like Florida’s spring break stuff and determine what effect it had on the whole state’s numbers, but I also don’t care. Open the beaches if you want. People have been going to beaches down here in San Diego recently to see the red tide and it doesn’t seem like that huge a risk to me as long as people are keeping their distance and it doesn’t get too crowded at any one time. It could start to be an issue later in summer when they normally get really packed, but I think there are bigger problems to worry about.
I'm very glad to find agreement on this aspect, as hard as it is to find mutual areas of agreement.
“Hospital underutilization” (at least in the US) seems to be a result of the fact that the healthcare industry by far makes most of its money from treatment that was completely haltable. We’re in the middle of the worst pandemic in a century, and healthcare is leading the recession. What that says about the merits of structuring our healthcare system (and its profit motives) as we have is a discussion for another thread; but suffice to say when you hear about “furloughed nurses” it’s because hospitals are cash-strapped because treating a pandemic nowhere near as profitable as things like elective surgery.
There’s another interesting point here though: are we trying for “suppression” or “mitigation”? That is, do we want to reduce total cases, or just ease our path to herd immunity? You seem to be in the latter camp, although I’ll point out that if that’s the plan, the total mortality is gonna be more or less IFR * herd immunity percentage * total population. I’ll give you a conservative 0.5% IFR and 40% herd immunity; that’s still 600,000 Americans dead by my math.
You're making a political point on how the healthcare industry ought to make its money. I've already been warned once in this thread on making political points and counterpoints, so I must ignore this aspect. I hope you'll understand. From the original post "This thread is a place for you to share the ways the coronavirus is affecting your life." That's a statement about how the current system is affecting you, not how a restructure of the current "healthcare system" might intersect with profitability.
As I've said once, I put it to you that the goal is to flatten the curve. Suppression vs mitigation is not useful in this context; it is a false duality. I must direct you towards lessening a peak or potential overwhelm of hospital capacity, rather than talk in such broad terms as you are introducing.
And to what's changed from March, it's in excess of 100,000 tests per day compared to ... well, America did not do well approving and mass producing tests at the beginning. This capacity is able to confirm any sudden uptick in metro or state growth in a very short time, which is unlikely (in my area) given widespread social distancing, mask use, and hand washing.
So we’re reopening because we’ve got higher testing capacity? It’s not *that* high (especially considering some of the reliability issues) but even if it was, we’ve got very little in the way of infrastructure for chasing down the positives and quarantining them, let alone chasing down their previous 7-14 days of contacts. In fact I’m not sure we’ve got any?
I guess you’re figuring with more tests we’re better equipped to make course corrections (e.g. turn distancing measures back on if cases spike), but I see two problems: 1) time lag means you’ll be “course-correcting” to one-two week old data, and 2) the data we have right now is more dire than when we locked down.
Higher testing capacity gives reliable information if the current relaxation of lockdowns are too-much too-soon. These are reported pretty rapidly. I actually get text updates for my city and state the day of or the day after. Any major departure from the actual current trend (most states are already past their peak) will be noted soon after they actually occur.
Feel free to respond to prior posts of mine that I did not repeat here.
I think I’ve read this entire thread, but things tend to blur together recently. If there’s something specific you’d like me to respond to, mind linking it? Feel free to PM me if you’d rather not make a new post just to link your old ones.
I posted the trends in current case growth and testing growth. If you dispute any of the conclusions I'm reaching from the data, in terms of the linearity of national case growth and the capacity of testing, I would direct you to the data I've cited in my last 5 posts in this thread.
ChristianS I think one of the key questions is where R is going to be. In most models I've seen of Europe, once the lockdown was imposed, R was already nearing or trending to 1 or below 1. Masks, no mass events, contact tracing, mass testing in nursing homes and protection of the elderly, home office for those who can, are policies that have a relatively low economic cost and can bring R way down. So even if you open up commerce, beaches, schools, R wouldn't go back up to 2.5, it would stay way lower until we reach an effective treatment or vaccine.
Then we also know that the population is heterogenous. A lot of the infections happen in hospitals and public transport. If those most likely to get infected get infected in the first wave. The required % for herd immunity goes way down.
Also note that once 15-20% of the population of some urban centers is already infected (like NYC, probably northern italy, madrid, spain, possibly london?), the growth rate of the virus is also going to be way slower, making tracing strategies more effective.
mahrgell you're right on the extrapolation of the Gangelt study.
Acrofales I pretty much agree with your general assessment of the situation. I understand the cautious deescalation in Europe atm given all the uncertainty. Even though I'm 70%-30% inclined to believe primary schools should open and we should allow people to go to the beach already, I understand that the scenario where my assumptions are wrong mean everything goes to shit quickly.
farvacola I'm curious about IFR and the results of the serology studies because they give us (hopefully) accurate information on the actual lethality rate, which informs policy. I think IHME and imperial college models are using IFRs of 0.8 to 1%, whereas others are suggesting it could be around 0.1%. That's a massive difference and somewhere the bureacrats making cost-benefit analyses of how to handle policy are inputing that into their models with great implications. Meanwhile company owners are trying to understand whether they should fire most employees because the lockdown is going to come back on the second and third waves or whether they should hold steady because we're going to find a decent equilibrium between containment policy and keeping the economy afloat.
Interresting interview with the controversial chief epidemologist in Sweden, Dr. Anders Tegnell.
As for "flatten the curve" they seemed to have found a sweet spot, as the hospitals were never overwhelmed. The death rate is much higher than in neighbouring countries as they were unable to properly shield the elderly homes.
@Danglars: regarding graphics, you’re right, this NYT visualizer is what I would have linked had I found it yesterday. By my count they’ve got 22 states and one territory with worsening cases, 13 states and one territory with flat cases, and 15 states and 1 territory with lessening cases. But in terms of where they are relative to their peak, eyeballing it I’d say LA, WV, VT, AK, NY, MI, AR, SD, ID, HI, and MT look meaningfully “past their peak,” and only HI and MT look like they’re back to baseline. We could quibble over a few of those - I skipped some that looked noisy enough I wasn’t sure if they were really past their peak or not.
But consider how few of those curves seem to crest and then fall rapidly in anything approximating a Gaussian manner. There’s probably a lot of factors introducing noise here (inconsistencies in testing or reporting, for instance), but for whatever reason in a lot of places this thing seems to rise quickly, peak, and then slowly fall off ~linearly.
I don’t know what to do with vague prescriptions like “lessen the more onerous restrictions while keeping the more effective ones.” As far as I can tell there’s one restriction that is by far the most onerous, and by far the most effective: where possible workers are not supposed to go to their place of employment, and customers are not supposed to go there either. Are we going back to work or not? The only restriction that might compete on onerousness and effectiveness: are we sending kids back to school or not?
Because I don’t care that much about beaches or the Home Depot Gardening Center. If they’re gonna make a meaningful difference in how soon we can go back to work I’d say keep them closed, and I certainly don’t think opening them is going to make much difference in the economic and human costs of lockdown. But if that’s all the “liberate [my state]” protesters wanted I’d say let them work on their tan or buy fertilizer if it will shut them up.
But it’s not. Obviously I can’t say what you specifically want, but people making noise about ending lockdowns seem to want to “open up” the economy, presumably meaning businesses reopen, and workers and customers start showing up again. Sure, we’ll still be doing more voluntary distancing than we were in February, but you can’t really help contact with coworkers all that much.
I look at those NYT charts and think if we had any more stops to pull I’d wanna pull them. A slow linear decline from now to, say, August is sickening. And if we relax work and school restrictions the most likely result would be the curve climbing to find its new equilibrium.
@warding: One question. I googled the confirmed NYC coronavirus death count and total NYC population yesterday and divided them, and got a little over 0.002. That’s almost certainly a massive underestimate of IFR, and it’s still higher than the 0.1% you’re quoting. How can anyone be saying 0.1% right now given that?
For NYC there are actually state-led serology studies saying around 20% which means an IFR of 0.8% to 1.1% which is indeed quite high. The argument that a general IFR may be way lower is that different populations are going to have different IFRs based on age, how much each age group is affected, pollution, general health and so on. NYC got it pretty bad, places like Lombardy or Madrid also, but there are going to be places where IFR is lower. Looking at confirmed cases and CFR rates, NY does indeed look like an outlier in the US alone with a CFR of 7.6% vs a national average of 5.8% while having seemingly way more widespread testing than everyone else.
So if the lockdowns were justified in March, what’s changed? The exponential growth we shut down to avoid in March is just as scary now, isn’t it? If you look at a chart of daily new cases and take a rolling sum of the last 14 days, there’s a lot more people able to spread this thing now than there were in March. The only thing that might help some now compared to then is immune percentage, but iirc serology studies of NYC suggest only ~20-25% are immune, and the rest of the country is presumably much lower.
A very important number is how many each infected person brings the virus to. This is the main argument for opening up, as well as the number of intensive care patients. If both are under control and the number of deaths and new infections are falling rapidly, you can't justify a lockdown. It is too expensive, and has major negative health impacts on its own.
As Dr. Tegnell mentioned in the video, even if herd immunity is not achieved, every extra % of the population being immune will slow down the spread and thus be easier and easier to control.
The big issue for this virus is really the homes for the elderly. The curious thing is that if you ask them, they would often prefer the risk of getting the virus over not having visitors from their family. Many of them actually fear isolation more than death! I am not saying they should be given that choice, but it is a moral dilemma.
So if the lockdowns were justified in March, what’s changed? The exponential growth we shut down to avoid in March is just as scary now, isn’t it? If you look at a chart of daily new cases and take a rolling sum of the last 14 days, there’s a lot more people able to spread this thing now than there were in March. The only thing that might help some now compared to then is immune percentage, but iirc serology studies of NYC suggest only ~20-25% are immune, and the rest of the country is presumably much lower.
A very important number is how many each infected person brings the virus to. This is the main argument for opening up, as well as the number of intensive care patients. If both are under control and the number of deaths and new infections are falling rapidly, you can't justify a lockdown. It is too expensive, and has major negative health impacts on its own.
As Dr. Tegnell mentioned in the video, even if herd immunity is not achieved, every extra % of the population being immune will slow down the spread and thus be easier and easier to control.
The big issue for this virus is really the homes for the elderly. The curious thing is that if you ask them, they would often prefer the risk of getting the virus over not having visitors from their family. Many of them actually fear isolation more than death! I am not saying they should be given that choice, but it is a moral dilemma.
Don't forget readiness of the health system and scaling up of ICUs etc.
On May 06 2020 23:55 ChristianS wrote: @Danglars: regarding graphics, you’re right, this NYT visualizer is what I would have linked had I found it yesterday. By my count they’ve got 22 states and one territory with worsening cases, 13 states and one territory with flat cases, and 15 states and 1 territory with lessening cases. But in terms of where they are relative to their peak, eyeballing it I’d say LA, WV, VT, AK, NY, MI, AR, SD, ID, HI, and MT look meaningfully “past their peak,” and only HI and MT look like they’re back to baseline. We could quibble over a few of those - I skipped some that looked noisy enough I wasn’t sure if they were really past their peak or not.
But consider how few of those curves seem to crest and then fall rapidly in anything approximating a Gaussian manner. There’s probably a lot of factors introducing noise here (inconsistencies in testing or reporting, for instance), but for whatever reason in a lot of places this thing seems to rise quickly, peak, and then slowly fall off ~linearly.
I don’t know what to do with vague prescriptions like “lessen the more onerous restrictions while keeping the more effective ones.” As far as I can tell there’s one restriction that is by far the most onerous, and by far the most effective: where possible workers are not supposed to go to their place of employment, and customers are not supposed to go there either. Are we going back to work or not? The only restriction that might compete on onerousness and effectiveness: are we sending kids back to school or not?
Of the states that are increasing, the majority are in the linear growth range. Basically, the curve of total confirmed cases (neglecting recoveries) has a daily new case rate that is static. Just like in my local example, you'll see new cases of like ~100 125 150 100 100 75 100, putting them as round numbers. That isn't the kind of growth rates that overwhelm hospitals. Flat increase is manageable increase.
Where you might disagree with me is the affect of letting people go back to shopping, and trusting businesses to implement sensible compliance strategies on sanitization, distancing, and max customers in the store at once. Masks, distancing, small groups, sequestered aged/extra susceptible, frequent hand washing are exactly the low-impact measures that will keep these growth rates linear. I know people that think widespread disobedience or simply letting people go back to work will suddenly start NYC late-march style explosion. I think we're more conscious and responsible having seen the deaths and NYC and Italy.
Schools, gyms, churches, and stadiums should be the final ones to open. In as much as this is a regional disease, when you look at metros vs the rest, it will have to be a local decision. For schools specifically, the year is almost totally over, so I'm not stressing about whether the final month of normal education happens in a classroom or not. And I'm not going to dig into state data to see which districts are particularly impacted.
Because I don’t care that much about beaches or the Home Depot Gardening Center. If they’re gonna make a meaningful difference in how soon we can go back to work I’d say keep them closed, and I certainly don’t think opening them is going to make much difference in the economic and human costs of lockdown. But if that’s all the “liberate [my state]” protesters wanted I’d say let them work on their tan or buy fertilizer if it will shut them up.
But it’s not. Obviously I can’t say what you specifically want, but people making noise about ending lockdowns seem to want to “open up” the economy, presumably meaning businesses reopen, and workers and customers start showing up again. Sure, we’ll still be doing more voluntary distancing than we were in February, but you can’t really help contact with coworkers all that much.
I look at those NYT charts and think if we had any more stops to pull I’d wanna pull them. A slow linear decline from now to, say, August is sickening. And if we relax work and school restrictions the most likely result would be the curve climbing to find its new equilibrium.
The protests around here were mostly around the idiodic decision to shut down beaches, essentially punishing the portion of the population documented to be doing the best at sensible compliance. I understand people who couldn't care less. And the questions of how much the protests are based on ineffective and downright nonsensical, for example, closing of aisles within an open store is more of a political question anyways.
If businesses want to stay closed because of close contact between customers or coworkers, then fine. Also, masks are annoying and avoiding people in narrow hallways is annoying, but I think people are actually willing if it means a return to normal, with like seven asterisks after normal. The data from states that never closed their beaches, or opened up earlier than I thought was wise, is quite encouraging. No real concave-upward case growth. No hospital %occupancy or temporary hospital %occupancy worrying numbers. These will be confirmed probably sometime next week, given the asymptomatic phase. [End Christian section] Testing >500k
Source:CDC
National Trend of New Cases by Day - Just to reinforce the static new cases per day as national trend, because it obviously has to follow from the vast majority of states showing the same thing. See March for what it looks like when cases are growing exponentially.
EPT![[image loading]](https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/05012020/images/commercial-lab.png)
