Do we Cancel Everything? You still Travelling??

[KevinAu 441]

43 minutes ago, Alan_A said:

And all of us should also keep in mind that "restarting the economy" isn't going to be like throwing a switch.  What's more likely is a gradual restart of some activities - with continued economic damage because a lot of activity will still be restricted, and with the chance that we'll have to dive back into lockdown if there are new outbreaks or a second wave. The safe distance guidelines interfere with a lot of business, from restaurants to retail to manufacturing (i.e. how many people can you safely have on your factory floor?)  It's not going to be as simple as wearing a mask and getting back to (otherwise) normal.

To get a bigger, more effective economic restart, we should all be pushing hard for a massive testing and contract-tracing program.  If you can test and monitor, you can open up more activity.  If you can't, it's Russian Roulette. 

 

I don’t think the United States of America is capable of the kind of testing and tracing that you are thinking of. Through various combinations of ineptitude, unwillingness and size, it is a physical impossibility. The best we can hope for after a reopening is a public that tries to social distance, keep their hands clean and wear masks. That’s it.

Edited April 22, 2020 by KevinAu

[Alan_A 1,650]

17 minutes ago, KevinAu said:

I don’t think the United States of America is capable of the kind of testing and tracing that you are thinking of.

I agree.  My post was about what ought to happen - not what I think is going to happen.

The conversation seems to be turning to sentinel surveillance testing - where you sample a subset of the population to try to detect new outbreaks.  Could be somewhat useful but it's much lower resolution than population testing and it doesn't tell you or me what we're going to be exposed to on any given day.  It's a distant second-best.

[Penzoil3 480]

To keep this in perspective, the population of the US is 328.2 million. 42,000  is a drop in the bucket.

   Not to minimize anyone's loss. Each life is important.

 Sue

Edited April 22, 2020 by Penzoil3

[Alan_A 1,650]

1 hour ago, Penzoil3 said:

To keep this in perspective, the population of the US is 328.2 million. 42,000  is a drop in the bucket.

   Not to minimize anyone's loss. Each life is important.

 Sue

Just to keep this in perspective, the doubling rate in the US is currently nine days.  That's a bit longer than it has been because the lockdown has gotten traction.

What it means is that nine days from now, at the current rate, there will be 84,000 dead.

Nine days after that, there will be 168,000 dead.

A slowing rate might mean we don't reach those figures.  A too-fast return to normal life means we'll exceed them, because the doubling will then continue.

On February 13 there were 15 covid cases in the U.S. and now there are 787,752.

The first U.S. covid death happened on February 25. As of April 6-12, covid was the second-leading cause of death in the U.S.

Does nobody get how contagion works?

"That fire isn't anything to worry about.  Nothing is burning except the curtains."

Or: "That's just a brush fire.  It's not like it's going to wipe out thousands of homes in California."

It's not the absolute numbers that matter - it's the dynamics.  It's not where the puck is, it's where it's going.

My perspective.

[dave2013 1,130]

4 hours ago, Alan_A said:

And yet the data shows that when you act to prevent fatalities, the economy does better. 

This is a summary of the paper I linked to before.  And here's another summary that presents some of the data. And news coverage here.

All due respect, you can cite all the academic papers you like, but if you keep things shut down as they are now for more than a few months you ruin the economy and put millions of people out of work, out of money, and out of hope. The longer things are shut down the worse the situation will be. 

Some of this is just good old common sense.  Of course things will not return to normal instantly, but we must begin reopening and soon.  As the process of reopening unfolds in phases the experts can conduct their testing, surveillance, contact-tracing, isolating, etc. etc. and deal with cases as they are discovered.

Yes, you are right that we need a strong testing regime, and we're getting there.  Some of these folks complaining that we're not testing enough people need to realize that it takes time.  We're a very large country with a large population of 350 million,  It's easy to compare the testing that say, South Korea, has done and say that they have done a better job, but consider that South Korea is a tiny country of 50 million people.  It's a bit easier to access everyone in that kind of situation.  Plus, those heavily populated SE Asian countries are better prepared for pandemics because they've had to deal with so many in that part of the world for many years.  Could the U.S. have done better with regards to the testing?  Probably.  One can always do better.  But is it really helpful to just cast blame, point fingers, and criticize all the time?  Is it helpful to turn this pandemic into a political issue as so many are fond of doing? 

Lastly, for whatever reason, perhaps simple ignorance of how our system works(or is supposed to work), some fail to acknowledge that the States and their legislatures, governors, and health departments also play a huge part in the effort, and bear much of the responsibility for results both good and bad.  This pandemic has revealed that some States were woefully unprepared for something like this.  Maybe that will change now that this has happened and we'll be better prepared in the future.

Dave

 

[Alan_A 1,650]

@dave2013 - This is a difficult debate to have (though I'm happy to try!) because so much of it seems to play out as experts on the one hand and a strong sense of conviction on the other.

I'm just not finding strong arguments out there that support a fast return to normal, a low infection rate and a strong economy.  So far, what I'm seeing says that you can get one or two of those things but not all three together.  I'll keep looking for them, though - because again, I'm not saying economic shutdown = good.  I'm saying economic shutdown = less bad.

You're right that the testing is coming along, finally. It's not yet nearly strong enough to provide for the kind of surveillance you'd need during an economic ramp-up that's more than very, very limited (and so not all that helpful).  The Rockefeller Foundation just announced their plan for testing - it's the most comprehensive one out there.  Worth a look. 

About criticizing the U.S. response - without getting overtly political (which we shouldn't), I'll just say that it's relevant because we're just a few months away from an election where we'll decide who we think will do a better job of promoting the general welfare.  Track record factors into that.

About the idea of a federalist response - it's novel and I know it has its advocates.  Personally I'm not sympathetic to it because this is not a problem that can easily be handled within state borders.  Some things, like war, have always been federal responsibilities.  Roosevelt didn't leave the defense of Hawaii to Hawaii.  You're right that the states and localities deliver healthcare but to fragment resource allocation seems inefficient at best.

It is interesting to look at how different countries have responded - and this spills back to economic impact, to electoral choices, and, as we've been discussing, to some of the choices we'll have to make as a society if we don't want to repeat this experience.  Good roundup here of some of the different approaches.

Again, happy to continue in the spirit that debate is good and that none of this is particularly easy.

 

[Matthew Kane 1,343]

The USA should be looked at on a State by State basis instead of a singular nation. Countries like New Zealand or Norway or Iceland are nations manged federally and are therefore much easier to manage. The USA is a Unification of 50 different states and policies. As for the Feds I always considered them like the Mafia wanting their 'Protection Money' from everyone, beyond that they are only capable of so much.

[HighBypass 2,339]

So, what I'm getting from this is that the world needs to ramp up the amount of people being tested. Are testing stations going to be springing up everywhere so that we can get called up to go and have the test (social distancing applicable) and perhaps be issued with PPE to ease the economy back into life? Mind you, as long as we've got power, light, food and utilities (and the interwebz! ), I'm more than happy to stay at home, only going out for the odd bit of exercise and shopping. Sadly not the case for millions of people who aren't on furlough, I know...

Say for example, small groups of people have an allotted time slot to go to the town hall or some such, and get the test. An extremely refined version of going out to vote, I suppose.

As time goes on, the tests will get more refined (I hope!). Also we know what this virus is, what it looks like, correct? So why can't we test purely for that and not go looking for antibodies, unless those antibodies are quite specific and therefore anyone with those antibodies by definition have the virus? An analogy from mythology : Perseus holding the head of Medusa - he was the only one to slay Medusa Perseus is that specific antibody, Medusa is the virus.

Hope my questions make sense, sorry if I'm being a pain.

[Bob Scott 7,721]

We're crossing the line into a political debate here...finger-pointing, assessing blame etc is a bridge too far.  We've let this one go a lot further than we normally would, but we do not want it turning into a food fight.

Tread more carefully, please.

[birdguy 3,943]

I never went to college so I don't hold a degree in anything.  I'm just trying to make sense out of all of this.

1 - Even in the worst cases like New York and Italy the vast majority of the people did not contract the virus and of those who did the vast majority did not die.

2 - Of all the numbers I have seen none tell me how many CURRENTLY have the virus.  For instance if 100 people contracted the virus in a given area then 100 remains on the stats forever.  But if 20 of those people died then only 80 currently have the virus.  And if 50 got well then only 30 people currently have the virus.  Where do I find those statistics?  Are they hidden someplace?

I my area I have seen the numbers climb from1 to 5 to 18 and now 21.  21 has been stable for two weeks now.  What happened to those 21?  Were some moved to better facilities in, say, Albuquerque or Lubbock?  No deaths were reported of the 21 but how many got well and moved on?  By word of mouth I know of at least 2 who moved back to their home state but it is not recorded anyplace.

3 - Sacrificing lives for the economy.

Now the economy is very important.  The longer it is shut down; the longer people are out of work; the longer we let the supply chain deteriorate; the longer our educational infrastructure remains closed; the more people are going to suffer loss of investments, loss of income, poverty, depression, despair, and even death.

So are, say, a million lives (0.26% of the population) worth sacrificing to save the rest of us from a long term economic depression?  Two million (0.52% of the population)?  Is there a number we are willing to live with or do we save lives at all costs, even the cost impoverishing even more people to the deprivation of a long depression? 

Admittedly that is selfish way of looking at things, but self interest is very important to most people even if they don't openly admit it.

4 - Saving the economy involves risks.  If we open up schools and businesses and put people back to work we are taking the risk that some of those people will contract the virus, get sick, and some may even die.  Are people willing to take that risk?

5 - In a free society people should be able to opt to either protect themselves from the risk at all costs or to take the risk and try and get their lives back to normal.  It would be a personal choice, not a government choice.

Personally I measure the risk and act accordingly.  So far the risk is low where I live.  If it gets worse I will act differently.  I don't personally know anybody who has contracted the virus.  If friends and neighbors start getting sick I will adjust my behavior to fit the situation.

Noel

 

 

 

[MartinRex007 390]

Noel, have you seen this website from your Health Department, it has some pretty good stats for New Mexico. The dashboard on the lower right is pretty good. 

Martin

https://cv.nmhealth.org/

 

Edited April 22, 2020 by MartinRex007

[SteveFx 258]

On 4/21/2020 at 3:39 PM, dave2013 said:

I read another article yesterday about a study done in Los Angeles involving antibody testing.  It turns out that 40 times more people were infected with Covid-19 than previously thought, meaning that the death rate is much lower.

 

Dave mentioned this study which at the time I (and possibly Alan) thought was the same as the Santa Clara study. but it isn't - LA County is an actual place in LA, Santa Clara county is somewher else in California.

http://www.publichealth.lacounty.gov/phcommon/public/media/mediapubdetail.cfm?unit=media&ou=ph&prog=media&cur=cur&prid=2328&row=25&start=1

Reading the press release it sounds better than the Santa Clara study.  It seems to suggest that participants were recruited using a  database to get a statistically correct  population sample.   No further details are given so we don't know what the response rate was like and so whether there could still be  a possible bias with the people agreeing being more likely to include people who thought that they had been infected.

They tested on April 10th and 11th and estimated that 4% of the population had been exposed to covid-19 i.e around 300K.   

Following the logic in the Santa Clara study we should treat that as being the proportion 4 days earlier on 6th April. 

We need to then look 3 weeks forwards from that date to allow for the progression of the disease which gives  27th April as the date to use for the death figure.   

To date there have been a total of 660 deaths and its going up by around 40 a day.  So that gives us  860 as an approximate figure to use.

That suggests a fatality rate of 0.3% which is good news as its less than half the values being currently used (0.7-0.9%).

 

[Alan_A 1,650]

4 hours ago, HighBypass said:

Also we know what this virus is, what it looks like, correct? So why can't we test purely for that and not go looking for antibodies, unless those antibodies are quite specific and therefore anyone with those antibodies by definition have the virus? 

Short answer is that you need to do both because they have different advantages and they tell you different things. 

Antigen tests (the ones that test directly for the virus) are complicated and expensive, and involve multiple steps (which can mean errors).  They tell you who has the virus right now - so you can confirm a diagnosis, or decide who has to be quarantined, or when you have to trace a person's contacts.

Antibody tests are easier to do but don't tell you who has the virus now - they tell you who might have had it at some point in the past.  So those tests are more about epidemiology - finding out how many people have been exposed.  They might also tell you who's immune - assuming that being exposed makes you immune (seems likely based on experience with other viruses but it still needs to be proved).  In that case they'd let you certify people as being able to go back to work and help you restart things faster.

There are some other tests for the virus in the works, that instead of looking for virus fragments, instead look at things like hormones that indicate the virus is present - so-called surrogate markers. 

Here's a good rundown of what the different kinds of tests are and where they are in development.

[birdguy 3,943]

Yes Martin, I've seen it and check it daily although I like the John Hopkins one better because in addition to the individual county virus stats it gives the demographics of each county.   It tells me population density and probably lifestyle have a lot to do with it.

Noel

 

 

 

[Alan_A 1,650]

2 hours ago, birdguy said:

2 - Of all the numbers I have seen none tell me how many CURRENTLY have the virus.  For instance if 100 people contracted the virus in a given area then 100 remains on the stats forever.  But if 20 of those people died then only 80 currently have the virus.  And if 50 got well then only 30 people currently have the virus.  Where do I find those statistics?  Are they hidden someplace?

It's really hard to say - all we have are estimates and the estimates aren't very good. The figure you mostly see is for "confirmed cases." What that means is that somebody had symptoms (a case) and got tested (confirmed).  So that's already a subset of everybody who has the virus, because it doesn't count asymptomatic people.  It also doesn't count people who have symptoms but don't get tested - who could be anything from mild cases that haven't been approved for tests, to people who died at home without ever getting to a hospital. 

Anything else is an estimate based on models.  The models are basically simulations - you feed in data about a starting point (first case or first death) and some data or assumptions about how many infections or cases lead to deaths, and then you run them through the computer multiple times, and probably change some variables (like more or less economic activity) to come up with projections.  You could conceivably back out an estimate of how many total infections, but it wouldn't be very precise.  The other thing with models is that you have to keep rerunning them as new data comes in - pretty much like a hurricane forecast where you get a new report about position and conditions and then generate a new prediction.  And new starting point data changes things. For example, there's a story today that two deaths were confirmed in California several weeks before what we though was the first death. So the models will have to be run again with that new starting point and the projections might change. 

All of which really doesn't answer your question. The closest it gets is that the states list confirmed cases, deaths and "recovered" - the last one is confirmed cases that went through treatment and got well enough to be discharged and sent home.  So you could subtract deaths and recovered people from confirmed cases.  But you'd still be guessing about infections.

Here's another website to follow - it gives you data from the IHME model that hospitals use to project how many cases they'll be seeing.  It also produces the data that the federal government uses (and that you see in the White House briefings). Again, it keeps changing based on new information.

On the economic questions - steering clear of any politics or controversy - it's sort of the same problem because there's a lot of guesswork involved, or at least a lot of unknowns.  Again, we all tend to argue about it as though it's one set of options vs. another set and you pick one.  In reality, it's more of a smear or a blurry line because of the way the two parts of it - infections/deaths and economic performance - interact with each other.  In other words, if you turn on all the economic lights and then you get a big second wave of covid, you'd probably have a second shutdown and then maybe a much slower second recovery because people would be more cautious and reluctant to re-engage in normal life.  So in that model you get more deaths and a worse economy.  Realistically, something like that probably isn't going to happen.  What's more likely is that you get some kinds of activity restarting - so there's economic improvement but not to pre-covid levels. And in that case there's still the question of how people re-engage and what kinds of activity they're willing to do.  I don't think we really know what the reaction will be.  If you reopened in July and there was, say, a big Marvel movie opening, you might be able to fill the theaters because people have been cooped up and really want to have a normal Saturday night and go to the movies.  Or they might say, I'm not sure about being in a crowded space - the restaurant's open so I'll go pick up some takeout, but then I'm happier staying home and watching Netflix.  So the restaurant does OK, but the movie theater doesn't.

I don't think any of us knows.  We can look at 1918 for answers because back then, cities mostly acted on their own, and it's sort of this big experiment where you can see lots of different responses and what the results were. But it's not exact because back then people were mostly focused on their local community and didn't pay a lot of attention to what was going on in other cities.  Today we can see what everybody's doing everywhere else - which could lead to "those people are going out so I guess it's OK" or "those people aren't going out, so I guess I'll play safe too."

We'll probably get something like 1918 in terms of states or cities doing different things at different times.  But how people react to that and what that does to the economy is really hard to predict.