1) we want to eradicate the virus from our population => total cases matter and should be 0 sometime soon, I think that was and is China’s goal
2) we don’t try to eradicate the virus, but we want to keep the stress on the health system manageable => total cases don’t matter that much, bed capacity is the relevant indicator. This seems to be the goal of the “flatten the curve” thinking
3) we don’t care that much, let the virus spread like wildfire so we will have herd immunity asap => I am not sure, but from outside it seems like Brazil is trying to do this
I think the reason you and I are confused is because it’s seems to be unclear if we are trying to achieve 1) or 2). It’s not communicated. Maybe it’s unclear to policy makers, too.
The USA definitely does not. I'm starting to wonder if "not knowing what we want" will be the root cause for the end of American hegemony.
We entered 2 wars without clarity on what it would mean to win. This was the #1 post-mortem on Iraq and Afghanistan from basically every general involved over 15 years: they never had mission clarity.
On the back of that tough lesson, we immediately entered a trade war with zero clarity on what it would mean to win.
And before we could learn the lesson a third time we're now up against a pandemic and apparently can't decide what it means for us to win.
I'm starting to wonder if "not knowing what you want" is even worse than wanting something dumb.
https://en.wikipedia.org/wiki/Sovereign_democracy
https://en.wikipedia.org/wiki/Vladislav_Surkov
https://www.economist.com/europe/2013/05/11/an-ideologues-ex...
The long-term goal of the trade war with China is... QoL that costs low six figure salaries plus a pension and union protection for every high school grad in the midwest willing to work in a factory, even as the rest of the world surpasses us in labor productivty. In other words, a literal pipe dream.
We always have some pipe dream. We just never have an actual sober-minded mission with realistic expectations.
Maybe America needs a war on the drug of American exceptionalism. idk. I know war is always the answer, though. :-\
If we weren't drunk on exceptionalism, we would be containing the virus and we would have a Manhattan project-level investment in vaccine research. We don't. Calling a spade a spade literally sounds like trolling these days.
This has never been the goal of the United states
US Presidents typically have a lot of problems with democracies/democratic movements in Iran, Venezuela, Haiti, Egypt etc but very much liked the dictatorships in Saudi Arabia, Egypt, Chile, Brazil, El Salvador.
I judge governments and people by their actions and not their words.
Maybe not the best way to phrase that these days.
Until the 20th century phrase had exclusively the meaning I always thought it had, and that meaning dates back to the 1500s (spade = gardening tool).
In the 1920s some people started using "spade" to mean "person with dark-toned skin" (because spades are black in a deck of cards, so spade the gardnening tool => spade the suit in a deck of cards => poc). I've never heard "spade" used like that before, and the article suggests that use of "spade" remains fairly esoteric, but it's apparently in wide enough use that dictionaries have picked up on this meaning.
The article doesn't ever establish that the phrase itself is used as a double entendre. In a quick saerch, I can't find any in-the-wild uses of "Call a spade a spade" that evoke the double meaning.
TBH I think the article's advice is sound but also extremely jaded ("Rather than taking the chance of unintentionally offending someone or of being misunderstood, it is best to relinquish the old innocuous proverbial expression all together"). I'll stop using the phrase, but doing so feels like assuming the worst of my interlocutors' intelligence and intent.
Does that really sound like a conspiracy theory now we know that the regime deliberately and knowingly lied about Weapons of Mass Destruction?
If you think that possible then perhaps the "long-term goal" wasn't really what the liars were lying at the time? There are those who believer endless war was the precise goal. There hasn't been a lot of anti-corruption impetus in washington since that distraction was launched - save for Trump pretending he was anti-corruption at the last minute before the lasrt election. That last minute inspiration might have won it for him too.
Anyway if you have an unclear goal you can just move the goalposts and declare success, which is the kind of the point, right? And why the goals are unclear because otherwise America might lose and you'd be the loser president.
Out of interest how do Americans feel about the Vietnam war? Did America lose that war?
Pretty sure of all of most of that for both, though not the same parts for Iraq and Afghanistan. The political imperative for Afghanistan after 9/11 is pretty unmistakable. The long-term neocon objective with Iraq also was unmistakable. There's also pretty solid indication that factions I. The Administration wanted to use 9/11 as a pretext to execute the latter but were delayed by the political imperative for the former.
> Does that really sound like a conspiracy theory now we know that the regime deliberately and knowingly lied about Weapons of Mass Destruction?
Yes, the ascriptions of the motives cited to both Afghanistan and Iraq still sounds like a conspiracy theory. And I’m not sure what you mean by “now that we know”; that the claims were being advanced were false and that the administration had the information which showed them to be false was widely reported in the major media at the time the claims were made.
> If you think that possible then perhaps the "long-term goal" wasn't really what the liars were lying at the time?
No, but in the case of Iraq, it's what the leading figures of the neocon movement were telling the truth about the desires for right up to the moment the whole gang became the defense and foreign policy apparatus (and hyper-empowered VP) of the Bush 43 administration.
> There are those who believer endless war was the precise goal.
“There are those who believe” is not an argument that makes your position sound less like a conspiracy theory.
> There hasn't been a lot of anti-corruption impetus in washington since that distraction was launched
There wasn't a lot in the two decades before that, either. So unless the distraction was as effective backwards in time as forwards, I don't think it was really a significant factor.
> Out of interest how do Americans feel about the Vietnam war? Did America lose that war?
Most recognize that we lost the war; there are those who cling to loudly propounding the fact that we militarily defeated the VC before the NVA took over the main fighting as if that somehow negates losing the war.
Without that, then we shouldn't be too worried about getting the disease as long as we keep transmission rates low enough so hospitals don't get overwhelmed. But if some people end up with long-term respiratory issues after contracting the disease, now there's a reason to keep people from getting it, period, regardless of hospital capacity.
But it would be nice to hear these goals actually articulated by public health officials. I'm not sure if my above paragraph is actually what any public health officials are thinking or are worried about (I'm just guessing), but it would be nice to know, because I agree with you that there seems to be a lack of "goal clarity" at this point.
That is, we want to minimize infections, just not at all costs (to society/economy/...). And similarly, we want to minimize impact on society/economy/..., just not at all cost (to health).
Keep in mind that every infection bears a risk for long time health impact or short term (death), no matter if a hospital bed is available or not.
Finding this compromise is a matter of opinion and therefore a political question. It's not as easy and black-and-white to formulate as it would be to say whether we do 1 or 2.
Eradication in the US seems unreasonable, and just keeping hospitals less than overflowing not enough.
Keeping it under control but not eradicated means averaging exactly 1 over time, which seems like a much harder balancing act.
Focusing on the rate as the metric of attention seems very much like the right thing to be at the center of public policy.
Just put the control rods - I mean open restaurants - on a control loop driven by number of number of hospitalizations.
Helps if you have prompt and delayed transmission modes, so you can regulate at the slower speed.
I'm not saying it's not achievable. Just that you need to evaluate if it is achievable before you focus on it and it certainly doesn't seem like its "obvious" that it is to me.
Not surprising after COVID burned through their population (quarantine or not) the case numbers have subsided. If anything NYC demonstrates that quarantine was entirely ineffective, and that the biggest mistake was not focusing on protecting the people actually at risk.
The most interesting takeaway from COVID is that “both sides” were right. It is much more deadly than an average flu (for the elderly) and also much less deadly than the average flu (for those under 50).
Are you serious? How do you even come up with misinformation like this and not even bother to back anything up with any sources? How do you seriously look at the case charts and pretend like going from 10k cases/day to 500 cases/day was an inevitable outcome resulting from burning through nursing homes? It would be funny if it weren't completely insulting to their herculean efforts in containing everything when so much of the rest of the country is going in the opposite direction. https://www.nytimes.com/interactive/2020/us/new-york-coronav...
1) NY has the highest cases per capita and death rate per capita in the country. [1] [2] This is what I mean by burned through their population. Serology estimates about 20% of NYC population was infected. [3]
2) NY’s policy blunder in shipping COVID positive patients into nursing homes is well documented. [4]
#2 did not lead to #1, nor did I claim it did.
Their “herculean efforts” to contain COVID notwithstanding, NY is in the process of phased reopening, just like pretty much everyone else.
[1] - https://www.statista.com/statistics/1109004/coronavirus-covi...
[2] - https://www.statista.com/statistics/1109004/coronavirus-covi...
[3] - https://www.governor.ny.gov/news/amid-ongoing-covid-19-pande...
[4] - https://abcnews.go.com/Health/wireStory/ap-count-4300-virus-...
Most places just aren't being transparent. Wearing a mask has turned into a political or moral statement without being driven by a goal. Leaders aren't really selling any goals, though CDC / various health departments probably have goals, the technical details are not being communicated. Instead all you see is vague information and seemingly arbitrary action from leaders and virtue signaling from the population.
In Trump-led America, I think the goal is pretty obviously positive political outcomes for Trump. CDC and others might have goals but I haven't seen them.
Part of the problem is people are generally so stupid about failure that any goal setting sets you up to be a target for people angry about not meeting your goal or not setting an aggressive enough goal so being vague is seen as the best strategy, even though I think it leads to the sort of "fake news" vs "moral crusade" problem.
Eradication seems possible when there's a small number of cases, and effective border control (being an island nation helps a lot). In the US it's going to be difficult to eradicate, because people can move about the country easily and the case load is high.
I haven't looked at other states, but Washington state has fairly clear metrics for opening restrictions at a county level. We'll see how well that works, I guess. Other states will be doing their own thing, as well as other countries, and maybe we can figure out which methods are more or less effective and either switch or know for next time.
They probably expected to see light at the end of the tunnel last month, like other countries. Now, maybe next year?
We are not being treated by robots and the longer the pandemic lasts the more healthcare professionals suffering (physically and mentally) we will see, the more churn we will get and less care capacity we will have...
I think rather than it being "unclear" to policy makers, it's rather that there's a short-term economic imperative to go for 3), or if not, then 2), while 1) upfronts economic cost. This means that while the general desire might be to go for 1) from an ethical/expert/academic-advice perspective, policy makers are doing their best to hedge (while not wanting to appear as if they are).
What other country do you think of that doesn't have clarity?
I agree, and with the recent outbreak, I don't think it's possible, at least not for China. New Zealand has a shot at it.
If vaccines will also be available in ‘waves’ as they are produced, then that must mean testing is some kind of a prerequisite to know who to give the vaccine to that needs it most - and who also may already be immune from exposure?
It seems like the total cases —> 0 option is virtually unattainable in the near term (probably into 2021). Maybe with more cases being reported, we are aiming for 2) but actually going through 3).
I think the other, possibly just as important, reason to lower the infection count is that medical professionals are yet unsure of the long-term, chronic health impacts of this disease and that there appear to be some preliminary signs of significant respiratory and pulmonary issues that can effect many age groups - perhaps even in those not necessarily requiring hospitalization.
It would appear that medical science has a few additional treatments in their toolbox now (as compared to, say, March or April) that lower the severity of the disease and helps prevent death in some populations, but still, many concerning unknowns remain.
At least that is what I have seen here and there from several medical professionals that I have seen on Twitter over the past few weeks...
If you aren't sufficiently worried, John Campbell has a video about the clinical presentation: https://www.youtube.com/watch?v=U7BbXEOB1gk
edit: thanks!
https://www.ft.com/content/6bd88b7d-3386-4543-b2e9-0d5c6fac8...
We shut down cancer screening and gyms for 3 months in Ontario; that’s almost certainly going to kill more people than COVID did.
If there are ~1 million gym patrons in Ontario, then the gym lockdown (which is still ongoing) only needs to decrease a gym patron's lifespan by 10 days on average to be worse than COVID.
Also, I claimed cancer screenings + gyms combined. Hundreds of people get diagnosed with malignant tumors every day in Ontario and those tumors are now 3 months more advanced than they should be (and will be for a long time after the lockdown until the queues for medical care clear up).
At an avg lifespan of 78 years, 100 kids is ~68 million hours. 30 minutes saved a day / 261 days / year for 75,000 people is ~9.7 million hours a year, so after 7 years, it basically free. Except we would never do that because we don't measure human value in hours because the people in power would be free to make some really terrible optimizations.
You are right though, you did include cancers and I ignored it so we can call it a tie.
Edit: and it's not just the gym obviously, we've removed any incidental exercise one might get from work or leisure activities that were locked down too
Those are absolutely moving deaths forward by a couple months at best.
I'd be willing to put money on a fair amount of the rest of the deaths also being people who are pretty ill. Not all, of course.
Maybe not even most of the rest.
But enough to not be a rounding error.
The fact that the numbers don't seem that dramatic yet doesn't mean that measures to slow the progress of the virus aren't important.
The US didn't devolve into mass graves and people dying waiting for hospital care yet, it doesn't mean that the fearmongering is misplaced and the more you doubt it the more you will be part of the problem.
No, we are not setting death records day after day. Deaths worldwide have held steady since mid May; deaths in the US have been trending downwards since May.
The CFR for coronaplague is ~ 1 %, comparable to the Spanish Flu in Germany. The impact was catastrophic, the High Command had to decide between sending young men to the front or keeping them at work in coal and steel. In those days there was little automation, the infection would spread like wildfire through the workforce at any large employer. The only reason we aren't seeing the same now is that people adhere to some form of social distancing - work from home, no going out to bars, no gym, no church, kids are not in school, but as soon as guard is dropped infection rates jump up again. We are seeing this as well. Israel had new cases down to 1 per 100000 people until they opened up the schools and cases increased by two orders of magnitude.
[1] - https://www.latimes.com/california/story/2020-03-20/newsom-c...
[2] - https://www.sanjoseinside.com/news/san-jose-braces-for-2000-...
You've made a classic converse error.
But that's not the only driver. And when you increase testing and the percentage of positives you find goes up from 5% to 20% (as it's happening in some states) instead of going down you really have a problem.
> The people getting infected now, the out-and-abouters, are much, much lower risk of complications.
But the people that will now be infected by them (relatives, coworkers, customers) will be closer to the general population and have higher risk.
I think more significantly they're driven by total cases. Are you suggesting we test less?
Also you seem to have a very black and white view of outcomes. It's not clear cut between alive or dead. There's many things that we still don't know about this virus and the harm it causes. https://www.bbc.com/future/article/20200622-the-long-term-ef...
Of course this is a case where no long term effects are something we are only sure of after currently young people die of old age.
Or do you work with the concept "long term = next quarter"?
Young people are generally on the front lines now. Both voluntarily through outings, bars, etc, and front-line jobs, so they are a leading indicator that "things are getting worse."
And while that doesn't guarantee that most "at risk" people will get sick and require hospitalization, it's a safe assumption that the probability of that occurring is increasing.
It's the same reason you get a mole checked out. Might be nothing now, but it could be something much worse in the near future.
That depends which numbers you follow. "Cases" is different than "clinical cases". A clinical case will show some sort of symptom. While asymptomatic spread is almost certainly a thing, symptomatic patients spread much more readily than asymptomatic. So rather than look only a total cases, look for data on clinical cases because those are the ones that are most likely to spread to others. That will normally be patients under treatment rather than the larger number of people who have tested positive, show no real symptoms, and are sitting at home waiting for another test.
Daily case numbers in Illinois, at least, have no correlation with the increase in testing. I'm certain all we've found with the extra tests is people who never had it.
The logic behind this is that people are going to the hospital whether or not they have been tested, they are not going to stay away because they haven't been. I don't have easy access to numbers of hospitalized patients, so I watch the number of deaths. Right now they have been flattening out or decreasing, as you pointed out. When that changes I'll get worried more. In either case, I am playing it safe by social distancing and wearing my mask and reducing the amount of time I'm in the office.
White people under 50, to be specific. As many as 50% of new hospitalizations in Texas are under 50.
The problem will be if they infect higher risk groups, potentially in catastrophic numbers, and the deaths surge along with cases.
Also, deaths remaining somewhat flat is concerning considering the low risk population getting infected.
The number of reported or confirmed cases is correlated with testing.
That's a significantly different statement, and also tautological and essentially vacuous.
Average time to death after confirmation of disease is around 13 days, so the death rate today has essentially nothing to do with the number of cases confirmed today. The death rate today has a lot to do with the number of cases confirmed a few weeks ago.
One of the reasons the US is doing so incredibly poorly is the incredible sloppiness of the analyses in so much of the media. I don't know if it's willful -- an attempt to pretend that nature will bend to political delusion -- or if it's simple innumeracy.
To an extent, by the time the hospital numbers are going up sharply, it's too late, and the hospitals will inevitably be overwhelmed, so it's not a good guide of policy. New case count is the only vaguely timely indicator we have.
If you need to pick a metric on which to reinstitute lockdowns, hospitalization isn't really very useful; it's better than nothing but if you use it you're probably going to overshoot.
The only reason the hospitals aren't overwhelmed is that we kept the total case count low enough. Now that the case count is going up, we're seeing the same problems.
Yes, we don't seem to have quite the same equipment shortages as we had in March. That's good. That was part of the reasoning behind the lockdowns.
Yes, we seem to be doing better at keeping people dying, that's good ... but it's going to take up more hospital resources for longer periods, that's going to exacerbate shortages.
The problem is that in a lot of places, the information about hospital use isn't available, isn't timely, or isn't reliable.
Hospital owners and their lobbying groups have blocked some states and county health departments from reporting such information, claiming it's "proprietary information."
One of the Las Vegas newspapers had a series of articles about it. The hospital lobbying group actually somehow "prohibited" the state from releasing the information, as if hospitals have some kind of authority over the government.
This was my understanding as well, and it is what is shown in Wikipedia:
https://en.wikipedia.org/wiki/Flatten_the_curve
The bigger thing that I have chatted about with several other is that the area under the curve is the same, i.e. the same amount of inidividuals will still get sick.
You flatten the curve to buy time for medical advancements, which will reduce the total area under the curve. It can be any or all of:
1) flattening the curve enough to make contact tracing viable, which can eradicate breakouts before they take hold
2) finding a decent anti-viral treatment so that number of deaths or "permanent damage" cases decrease, even if # of cases does not
3) developing a vaccine
This thing about "area under the curve remaining the same" is only true for calculus, it has no bearing on real life because we are making medical advances.
If we had taken decisive action in January or February, we would have had enough resources for contact tracing, and really limit the spread. Instead we'll see at least 200K deaths from this before it is over.
Looking at the new case counts for the USA vs. the EU makes me sad and angry.
When 2 Mother's Day gatherings account for 50% of the cases in Santa Cruz county, what can you do short of saying "You're a moron."
It probably also doesn't help that a lot of Arizonans travel to California at this time of year to escape the heat.
Look for example at Norway and Sweden. Norway took drastic measures early and were able to stop the spread to such a degree that schools opened up again after Easter and everything is almost back to normal now. Sweden did not take very drastic measures early and have had massive spread and 20 times more fatalities than Norway and now they have in many regards stricter social distancing rules than than Norway.
After a certain point it seems like you have to either shut down society for a long period of time (Italy) or just let it run its course through society somewhat controlled.
Austria and Italy, share a border, have ski lodges in the same Alps. Austria got off easy even though they had a one of the first outbreaks, Italy got hammered for two months. Yet Italy locked down harder during all this time.
I don't know in what way is Norway different from Sweden, Norway looks and feels a lot more rural and sparse. Sweden more cosmopolitan.
You could also compare Sweden to Denmark which is more similar than Norway. Denmark took drastic measures quite early and were able to get it under control.
Further to that I agree it's too early to say what is the best strategy long term. All epidemiologists in Scandinavia basically agreed with the Swedish approach in the beginning of the outbreak, but politicians in Norway and Denmark thought otherwise. I guess epidemiologists didn't think it was an option to basically lock down a modern country for several months and maintain social distancing rules for months on end. If this works until the end I assume the books on the subject will be rewritten ...
* Forcibly testing people regularly
* Forcibly quarantining people who test positive
* Mandating contact tracing regardless of personal preference
* Imposing travel restrictions on hot spots with actual blockades
* Restricting any gatherings that aren't essential, with "essential" actually meaning essential (grocery stores, pharmacies, hospitals, etc) rather than politically necessary.
* Mandating correct wearing of masks
* Closing borders or requiring quarantine upon entry
In effect, we need to do what China did. We absolutely lack the political will to do that in the US for a variety of reasons, and so we will not be able to approach containment until we get a vaccine.
most people do not want that at all
I most certainly not want to be forcibly tested or mandated to "correctly" wear the mask and you can fuck off you do
Aside from medical advancements, if the health care personnel is not overworked, overstressed, overtired, patients have a better chance to survive.
Flattening the curve means lives saved.
Not to mention hospitals usually shutting down elective procedures once the amount of infected patients in their care crosses a certain threshold.
Do you have a specific source that can explain it?
Basically, the number of infections peaks at the point where - due to some combination of immunity and measures like social distancing - each person infects at most one other person on average. However, there are still a whole bunch of infected and susceptible people spreading the disease, meaning that quite a lot more people then become infected than is actually necessary to end the outbreak. If you assume no attempt to flatten the curve, then a lot more people become infected than the herd immunity threshold, and that's what the NYT and co have focused on. However, one consequence is that flattening the curve without fully surpressing the outbreak reduces overall infections and deaths - the peak is lower and happens after fewer total infections, making it possible to build a whole bunch of herd immunity without all the extra infections and deaths from massively overshooting it.
With the assumption that every vaccinated person counts towards herd immunity and isn't likely to die, you can plug in your own numbers to the equation above. Even with really conservative estimates, it's easy* to get into the millions when you consider the entire planet.
*Barring some highly effective treatments that may or may not surface.
You need the lower IFR, not the CFR, here.
At this time we don't know how effective any of the vaccine candidates will be.
kids and young adults have less than 1/100,000 chance of dying of COVID. The vaccine needs to be better than that. There is an ethical issue at hand of vaccinating people that are not at risk to save those that are at risk.
For reference after administering 3.1 billion vaccines the US paid damages in about 3,000 cases thus across all vaccines the rate of serious side effects is about 1 in a hundred thousand (considering about 10 vaccines per individual).
There is no vaccine that we currently mandate for the sole reason of protecting someone else.
The fundamental requirement of the Hippocratic Oath is "First, do no harm". If you are vaccinating someone, you better cause less damage to that person than the disease itself would do.
I have a kid, I am not an anti-vaxxer by any stretch of imagination: the whole family gets flu shots every single year.
But will I rush to get my kid vaccinated with a new thing rushed to market during a exaggerated hysteria, a vaccine not properly vetted for long term effects ... uhh most certainly not. I am going to wait a couple of years to see how others will fare.
(FYI I work in life sciences and I like to believe that I understand the inner workings of a living cell better than overwhelming majority of the population)
And as far as COVID vaccinations go, you're trying to have your cake and eat it. Either COVID-19 isn't risky/dangerous for young people, (meaning we can safely vaccinate them), or it's dangerous to them. If you're trying to say that a vaccine for COVID-19 would have worse effects than the disease itself, I think this would be extremely unlikely, since it doesn't occur with other vaccines.
If a COVID vaccination has a 1 in 100K rate of deleterious side effects (up to and including COVID-19) in the general population, then vaccinating the US population (330M) would result in 3300 cases of COVID (or bad side effects). The benefit of this would be saving roughly 2M people from death, and countless others from hospitalization and long term complications.
As for the other content, it just shows you don't understand what kind of problems an insufficiently tested vaccine could cause. You should educate yourself better:
https://www.sciencemag.org/news/2019/04/dengue-vaccine-fiasc...
Of course no one wants to take a vaccine that didn't undergo proper clinical trials. The argument was whether a vaccine that had typical side effect ratios would be ethical.
I don't think we disagree about the new vaccine risk level, since we don't have a vaccine, nor know anything about its side effects.
If a vaccine is has differing risks based on age group, then I would hope that we vaccinate the lowest risk group; assuming the risk variance is significant.
As a society, vaccinations are naturally government infringement upon individual rights. But a well-functioning society routinely infringes on individual rights. We place children in protective services when their parents don't care for them properly (in the mind of the government). We (in extreme times) invoke a draft for military personnel. As my dad used to say, your right to swing your fist stops at my nose. Rights are not inviolable; though care should be taken to limit infringement.
As SC Justice Robert Jackson once said, the protections afforded by the Constitution "must not be discredited by an interpretation to mean liberty without law."
I don't feel that you answered my questions directly, but if I understand correctly, it appears that you would hypothetically favor compulsory vaccination of children for the greater good, even if the personal risk outweighs the benefit.
I wholeheartedly disagree, as I do with the draft. Similarly, I 'think the right not to be punched, is analogous to forcing someone else to vaccinate for your benefit.
As a society, we get to decide what impositions we impose on individual liberty. Where would you draw this line?
I draw the line at criminal charges for failure to vaccinate.
infection fatality rate is the observed death rate based on all (known+undetected) cases
the Swedish report indicates of infection fatality rate of 0.1%
That's incorrect. The IFR in Stockholm (the epicenter for COVID-19) in Sweden is .6% currently [0]. Only if you exclude anyone above 70 do you get an IFR of .1%. According to [1] 20% of the population is 65 and older, roughly 2m people.
[0]https://www.folkhalsomyndigheten.se/contentassets/53c0dc391b...
[1]https://www.indexmundi.com/sweden/demographics_profile.html
FWIW the IFR is getting tiny as for younger people so using the the same preventive measures for low risk people that we use for high risk ones does not make much sense
I have never been able flattening the curve. If people would just stay home for a month and take precautions this would be over as it wouldn't spread and those who have it get over it. The details of living like that are tricky but too many people didn't try.
https://calmatters.org/health/coronavirus/2020/05/health-car...
It could. Or it could be simply getting out of control (though specifically California is in much less trouble than Texas, Florida or especially Arizona at the moment). The point is that (1) it's fundamentally impossible to tell the difference until the bodies are counted and (2) the boundary between "well under capacity, we're fine" and "well over capacity, tens of thousands needlessly dead" represents just a week or two of growth.
We don't have time to wait and see, we need an answer now. And we can't get it until the demographics is done postmortem. So what is supposed to happen is that we all behave conservatively until the outbreak shrinks to the point where it can be contained via contact tracing.
And... that almost worked. It worked in Asia and Europe, It almost worked here, at least in the hardest hit areas with the early outbreaks. But... it didn't take. Half the population decided they didn't need to bother with this stuff (largely because of reasoning like yours) and walked back into enclosed indoor spaces.
And now we're right back where we were in March. Effectively no progress. While the rest of the industrialized world is finishing this off and coming back to life, we're having to talk about new lockdowns. It's so deeply frustrating.
https://91-divoc.com/pages/covid-visualization/?chart=states...
It is certainly true that survival rates have improved as treatments have changed based on experience. I think folks know better how to manage things at home, to some extent. Earlier testing also allows earlier intervention, which allows treatment that may avoid ventilator usage. Vent usage corresponds with pretty poor outcomes, although that too is improving.
Different people have different goals.
One goal would be to reduce the rate of new infections to a level that hospitals can handle.
A different strategy is to reduce the rate of new infections to a much lower level, so that contact tracing and containment is possible, and then open things back up.
If a vaccine is available at some point in the next year, the latter strategy saves many lives. It requires a sharp, relatively short (4-6 weeks) shutdown. Afterwards, it requires a high level of testing, quarantine for infected people, widespread use of fever checks in public places, a ban on large events, and extensive contact tracing. Many countries have now successfully deployed this strategy.
The US is stuck in limbo. Some states locked down hard, others didn't lock down enough. Things opened up too quickly, without the systems in place to contain the epidemic, and people are largely acting as if SARS-CoV-2 didn't exist any more. The consequence is that new infections never went down to a level where contact tracing is possible, and the rate of new infections is on the rise again.
I've never understood this fascination with fever checks. I've never had a fever where I couldn't tell I had a fever -- everyone with a fever perfectly well knows they have a fever. The problem is people trying to hide it, I guess? And if they suppress it with medication, your forehead scanner will be useless anyway.
The solution for that is to make quarantine less painful. Here's a list of grocery delivery services, here's a guarantee your employer can't punish you for taking time off work, here's a nursing service that'll call you to check in daily, etc. Enjoy your vacation.
The real reason though is people tend to think it ain't that bad and go out. Fever checks stop those people before they infect your shop.
If you want proper temperature checking you're going to have to get into oral checks, which nobody is willing to do. The forehead scanners are a placebo -- this has been known for a very long time: https://www.reuters.com/article/us-thermometers/accuracy-of-...
Umm, I think you mean the world. the nordics can't decide what do do with Sweden. New Zealand will be perpetually close to zero cases, but be sealed off from the world. Obviously US/Brazil tourism is good to go.
> Some states locked down hard, others didn't lock down enough.
On the world scale, India locked down hard, but failed because arguably, the hard lockdown created more problems. I think Sweden had fewer cases per capita at the peak than the UK, despite avoiding a formal lockdown, but Norway had even fewer. A lot of factors you'd think would be meaningful haven't been, and the ones we're left with is developed East-Asian countries did OK, isolated developed countries did OK, countries lead by populists haven't done so well, and North Korea still claims to have zero cases.
Not most of Europe and East Asia, and a smattering of countries that have had effective responses. They have suppressed the epidemic to the point where they can reopen most things. They have to be vigilant and monitor the R value, but as long as it hovers around 1, they're okay. The levels of their epidemics are also low enough that they can do effective contact tracing (see, for example, what happened in Beijing recently).
In the US, by contrast, there are tens of thousands of new cases every day. Contact tracing is impossible at that point, and parts of the US will probably have to go into lockdown again, unless the US is willing to accept hundreds of thousands of additional deaths. A sharp lockdown lasting about 6 weeks would have put the US in a much better position.
> the nordics can't decide what do do with Sweden.
Because Sweden refused to lock down. This is the fault of Swedish politics, not the other Nordic countries that took effective action to suppress the virus.
> I think Sweden had fewer cases per capita at the peak than the UK, despite avoiding a formal lockdown
The UK has had a particularly bad epidemic because early on, the government pursued a "herd immunity" strategy. They waited far too long before locking down.
Sure oxygen can be given at a hospital, but if we are overwhelmed, you can easily do oxygen at home.
Anyone have a different understanding?
There's a very short period of time between when a patient starts drowning in their own fluids and when they die. So you need to be oxygenating in a clinical setting because you need people immediately available to intubate in case your oxygenated patient starts drowning in their own fluids, which they do often. That's why it confers a 12% survival rate. If you've progressed to the point where supplemental oxygen doesn't work then you're pretty close to dying. I'll take 12% over 0% any day of the week.
As always you should look past the statistics to what actually needs to happen in those situations. Statistics provide very little assistance in determining whether an individual patient needs to be hospitalized or not. You can't look at someone and go "oh this guy is one of the X% that will eventually need a ventilator." You have to assume that any one patient that needs supplemental oxygen may be one of that X%.
So sending people home with supplemental oxygen should be a last-ditch effort if the hospitals become completely overwhelmed, not a routine activity. And to facilitate that, we should absolutely be trying to keep people from getting sick so our hospitals remain open for the unavoidable cases.
It's not as simple as "welcome to Wendy's, would you like the oxygen today, or can we supersize you to a ventilator?"
Kidney problems are popping up in some folks post-infection; that's also better dealt with in a hospital.
as for those that survive - most have serious breathing problems for the rest of their lives -
https://www.webmd.com/lung/news/20200415/ventilators-helping...
Well, the curve had somewhat flattened (but was still trending upward among the noise) before reaching the point of overwhelming the system before we started reopening and it unflattened. I think it was premature to say that it had been flattened enough to avoid rather than delay that outcome, though it's kind of immaterial anyway since we abandoned the effort to keep it flat and are heading straight for overwhelming the system.
The fire department was able to get that room where the fire started mostly put out, there's still a little bit of fire in the hallway, and they start putting the hoses away.
"There's much less fire than when we started, and people were getting really angry about the water damage to the surrounding buildings. We are all done here!"
Would you be happy about this situation, wouldn't you point out that even if there is less fire, nothing else has changed about the situation. Fire still spreads, it can still catch the building on fire, and that fire could still spread to the surrounding buildings.
The problem isn't over yet, and if the whole point of suffering the water damage was that my building wouldn't burn down, well now I have water damage and it might still burn down.
Can people really go 18 months with no employment? Can students miss 18 months of schooling? Can people go 18 months without other medical care? Can housing go 18 months without upkeep because the landlords have no money since they can't evict rent nonpayers?
A lockdown that extended is not feasible, even before you get to any discretionary economic activity.
Prolonged lockdowns have costs too, it's just not politically correct to compare them to peoples' lives so people like to ignore them.
What sources of information lead you to this conclusion?
150 cases out of 150 tests? Yikes! 150 cases out of 150,000 tests? Yawn.
California has been increasing raw number of tests but the positive tests percentage has been holding relatively steady around 4.5%
https://coronavirus.jhu.edu/testing/individual-states/califo...
Florida is a much different story, as their cases have increased the testing has not kept up, and the positive test rate has gone from 2.3% at the end of May to 12.2%
https://coronavirus.jhu.edu/testing/individual-states/florid...
One thing that everyone should keep in mind, even if you could attribute all of the increase in confirmed cases to testing, tests don't give anyone the coronavirus. The only thing increased testing can do is give you a more accurate picture of how bad the situation is, it can't make the situation worse.
https://www.bbc.com/future/article/20200622-the-long-term-ef...
So definitely not something to get infected with, especially as it is still not clear if surviving an infection gives you immunity.
If it does not - you might get infected repeatedly until it "rolls the dice" just "right" and damages your health and possibly even kills you...
The problem is that if covid doesn't kill you, stopping the economy will (or at least will make it worse for a large part of the population).
There might be a right trade-off of making heavy use of masks and preventative measures, but this is not currently the implied strategy of the government (as masks are not really enforced).
The difference with SARS-CoV-1 from 2002-2004 was that symptoms were much more aggressive and quick, and thus it was much more easy to trace and quarantine people. With the current one we have a mix of issues: lots of asymptomatic people or symptoms take time to develop.
Then you break active cases down by area (read: hospital) and carrier profile (e.g., age, pre-existing conditions, etc.). The point is, not everyone who tests positive is high risk. Not everyone who shows symptons will end up at hospital. Not everyone who ends up at hospital will need a ventilator. And so on.
As it is, this whole event has been a text book case of how not to use data and statistics properly.
Then halfway through the article it randomly changes to a different combination of cases, tests or deaths or a different time frame and different larger or smaller area.
And then finally it switches again, but about a totally different country or worldwide statistics.
Now you can procedurally generate multiple articles all day!
"Wow engagement is so high", said the Product Manager. "Our KPIs are through the roof, keep doing more of that our customers must love us."
I always thought, based on what I've read/heard, that one of the big reasons, maybe the biggest reason we're doing all this is to flatten the curb so hospitals don't get overwhelmed. For some reason headlines always seem to be number of cases or positive test results, and maybe then the number in the hospital is mentioned. The article does say "hospitalization and deaths are also believed to be a lagging indicator." so maybe that's why, but I don't get why (from what I've seen) hospitalizations don't seem to be all that important when reporting on COVID numbers in general. Could it be the people getting the virus now are less likely to end up in the hospital so that number won't keep going up to the point of causing trouble? Another headline on the site says "17+ students test positive for COVID-19 after beach trip".