stevenkesslar

Coronavirus pandemic cripples Seattle restaurant industry, with more than 50 closures in 2 weeks March 13, 2020 That's a fascinating story that may be predictive of what comes next. Note the date of the story, and the location. March 13th. Seattle. On March 13th Seattle was still the COVID Capital of America. Washington had 568 diagnosed cases and 37 COVID-19 deaths. New York had 421 diagnosed cases, and 0 deaths. Today, New York has 29,231 deaths. Washington has 1,086 deaths. Why was New York crushed, and Washington spared? Granted, New York is bigger. But even adjusting for population, Washington has 143 dead per million. New York has 1,503 - ten times more. Why? Here's one explanation, courtesy of a New York Times piece on the silent spread that set up the massive death machine: When I first read that, I was skeptical. I checked, and SF was the first city to lock down, on March 16th. That may help explain why California has 3,790 deaths, compared to the almost 30,000 in New York. But Washington state did not issue stay at home orders until March 23rd. Seattle did close public schools on March 12th. I checked around several articles from Seattle in early March. That article I posted above expressed the fear the clearest. Here's another quote from the same article that says it even more clearly: Again, that was written on March 13th, 2020. There were ZERO lockdowns in America yet. Zero. But you already had the restaurant business down 90 % in Seattle. Business owners were already scared shitless about being able to pay their rent. Not because of some government shut down. Because they had a public scared shitless, about deaths in a nursing home in Kirkland at the time. There's a similar theory about Florida. Mobile phone data shows that weeks before any shutdown, travel in areas where a lot of seniors live suddenly slowed. Many people stopped traveling more than a mile from their homes. There were no orders preventing them from doing anything. Everyone saw the horror unfolding in New York. In fact, some of them actually came from New York, to get away from New York. I terms of what happens next, I think this paints a picture. Something like 2 in 3 Americans have gotten this memo and agree with it. They have little or no intention to go to a restaurant. Regardless of any lock down policy. Just like on March 13th in Seattle, when the best restaurants in town had already lost 90 % of their reservations. The other 1 in 3 Americans will not be moved by hearing about a Gay nurse who lost 50 pounds because he probably got a real good dose of COVID trying to save someone's life. Those people will want to blame the lack of business on all the hysterics who want everything locked down forever. Except there won't be a lock down anymore. It will be like early March in Seattle. There will be an economy. But at least at first, most people will be too scared to play. They won't want to risk exposure to the virus. My guess, or at least my hope, is that Seattle won't go into lock down again. They already understood the risk in early March. So between public awareness of the risk, and the government running around testing and treating the virus into a corner, that may actually do the trick. Washington right now has a fraction of the new daily cases that Australia or Austria or South Korea did at their peak. Meaning 200 a day, compared to at least 1000 a day at the peak in each of those countries. And those places are all bigger than Washington. So if they can corner COVID, there's every reason to hope Washington can, too. Case Investigations and Contact Tracing Washington now has a web page up about their contact tracing. They are serious. I went hunting for data on whether it works, following on some very good questions @Charlie asked: How many tracers? How many people do they trace? How much infection do they find? How do they isolate them? Do they actually block more infection? How do they monitor or enforce compliance? I could not find any answers on their website. But I've read lots of articles about the virus detectives in Iceland or South Korea or Germany. Again, if it works there, Washington can probably figure it out. They sound very motivated to do so. Back to my middle-age lung buffet, I think that's Plan B. Assume instead that people in Seattle (or Alabama, or anywhere) are in "That Gay bodybuilder nurse is an exception. I don't give a shit." mode. To the more general point of the OP, they don't need any reminder of the risk of exposure to COVID-19. Because they think it is overblown bullshit. That sets up a lot of dead seniors. Which is what scared the shit out of lots of people in Seattle to start with. That seems to be why, by early March, they were no longer willing to go eat in a restaurant. But if that doesn't work, then you get your COVID-19 middle age worker lung buffet, I suspect. We are starting to see previews of that all over the US - at meat packing plants in Iowa, or Texas, or South Dakota. At Ford plants in Michigan. They are having to shut down. Or there is worker pressure to shut them down. Then add that 53 year old woman who owns the nail salon in Atlanta. Oh, and that other 47 year old Gay nurse - the one that works out at the gym in Dallas. If that starts happening all over the US, it's going to start to fuck everything up for corporate America and small businesses real good. If its "just" 3000 or so people hospitalized in Washington, which is the actual number right now, that's manageable for hospitals. And maybe for businesses. But if every business has to shut down for two weeks every time every one of their workers goes to a hospital to have their lungs snacked on by COVID, that gets real expensive for corporations and small business owners real quick. And they've already been through a lot that hurt their bottom line. Just to extend this to its even more absurd conclusion, corporations and small businesses could say we're just going to have to work through this anyway. So that Gay nurse is checking your blood pressure while COVID is snacking on his lung. Or some waiter is coughing little bits of his lung on your plate while he's serving you at one of Tom Douglas's chic restaurants in Seattle. Somehow, I don't see that happening. More likely then not, the middle-aged sick will be off to the hospital to (mostly) get well. And everybody else will be out of work again for a few weeks. It will be a huge fucking mess. This won't play out as simplistically as I laid out. But it may play out. It's already starting to play out all over America. Corporate America will not like it. They will not like it one bit. If things have to play out this way, which they might, my guess is that Ford and Smithfield and Amazon and lots of others will gradually become the biggest advocates of "test, trace, treat" - or anything else that works - in America. I don't think they can afford to have 4.5 % of their middle-aged workers cycling in and out of hospitals, with all the constant stop/start to workplaces that would involve.

My new number is 4.5 %. I wanna see how small businesses and corporations are gonna deal with that. It's gonna be a complete fucking train wreck for the total US economy. So that's what I want to see. I want to see how every large corporation and small business in America deals with the train wreck that completely fucks up their bottom line. 4.5 % is the percentage of 50 to 65 year olds who have to be hospitalized when they catch COVID-19. That's based on the new CDC data. So if the idea is that we'll just let the virus come roaring back, I want to see how every business in America deals with 4.5 % of their middle-aged workers having to be hospitalized. That is going to fuck their bottom line up real bad. The fatality rate the CDC is using now is 0.4 %. (Or maybe 1 %, worst case.) Do the math and 0.4 % is still well over 1 million Americans. But one reaction is basically, so what? Life goes on. And once you tell me those are mostly 70 and 80 year olds, you want me to stop the global economy over Granny, who is sick anyway? Or some Gay nurse who got unlucky because he got a big whopping dose of COVID while he was saving someone's life? Who cares! Granted, the polls are clear. Depending on how you ask the question 2 in 3 or maybe even 3 in 4 Americans don't feel this way. But you have a very small group, which @BnaC is not part of, that says it is their God-given right to not wear a mask and ignore any rule anyone establishes for a pandemic. 6 feet? Why not 12 feet? Up your ass, buddy. That's the attitude. Then there is a much larger minority, like @BnaC, that will go along with the rules. Partly out of social contract, and partly because they do get there is some danger to people they love. And to themselves. But they still think the whole thing is overblown. Obviously 100,000 deaths hasn't changed their mind. With good fortune, it may be that the problem takes care of itself. Over the last few months is we had massive public education. The main reason almost every affluent Asian country has about 99 % fewer deaths per million citizens than the US or UK is they fell in line immediately. because they'd been through this shit before. So they all got behind a whole bunch of steps, including masks and "test, trace, treat." We were clueless. We're not any longer. Now everybody got the memo on masks, and social distancing. And the testing part is coming together. 100 % of cases in Washington are now contact traced. I know California is putting an army of 10,000 contact tracers together. So there are some things the public will do on its own. Nobody wants two more months of lock down - now or in the Fall or ever. And at least in many places, like California and Washington, there are these back stops to find and kill the virus where it hides. Texas, true to form, calls them "SWAT teams". They just sent a viral SWAT team to some meat packing plant where they found COVID hiding out. So add all that up and maybe it will work. The lock downs were supposed to stop a virus that was totally out of control. They did stop the exponential growth. Maybe that will be enough to keep the virus under control. Then again, maybe not. Maybe we're just going to head into Round Two. The New York Times is saying if the lock downs had started one week earlier, 36,000 fewer people would be dead. I buy that. The first case of COVID-19 in New York was on March 1. On March 16, the day the first city - SF - went into lock down, there were 18 dead of COVID-19 in New York. Now there are 29,231. So one less week of exponential growth in infection at the peak could have made a very big difference in NY alone. This is exactly what Tomas Pueyo and a bunch of experts said in an essay called Act Today Or People Will Die on March 10: shutting town today, not tomorrow, will save thousands of lives. San Francisco and California listened. They were right. So my point is that this could all happen again. All it took is a month until it turned New York into a morgue with almost 30,000 dead. Lucky COVID-19. Now maybe it will get its chance in all 50 states. Yum! Lots of lungs to eat in California and Texas. Now, get the chorus ready. If it's Granny and Grandpa's lungs, repeat after me: "I DO NOT GIVE A SHIT! WHO CARES! I HEARD THIS SHIT! THE WORLD NEEDS TO GO ON! GET A LIFE!" That's where your delicious 50 to 65 year old lungs come in. Maybe not quite as tasty as your Gay bodybuilder nurse lung. But cell for cell, those middle-aged worker lungs taste pretty damn good to COVID. And there's tens of millions of em out there. Yum! Yum yum! COVID just can't wait! You can do a lot of great lung eating while a middle-aged worker is in a hospital bed for a week or so, until the immune system or some asshole doc like @purplekow busts up the party. So if 4.5 % of these 50 to 65 year old workers have to be hospitalized, that's at least a few million potential nutritious lungs for COVID to feed on through a hospital stay. It's not clear to me how corporate America or just about any small business in America with middle-aged workers is gonna deal with that. In a typical flu season fewer than 100,000 people that age end up staying in a hospital with the flu. And having a worker in a hospital with the flu doesn't mean your factory has to shut down. Or that every other waiter in your restaurant has to isolate for two weeks. So this is all new. And it is all gonna fuck up every business and every corporation and every factory in America completely. You wanna work? Ha ha ha. Spare me the bullshit. COVID has got some great lungs to feed on. Get in line. This isn't some crazy theory. This is reality. I keep bringing up South Dakota. Smithfield Foods and Sioux Falls were totally fucked. A meat packing plant that employed thousands had to shut down. 8 % of the 3000 or so infected needed hospitalization. And 85 % of that group were NOT seniors. I don't know the exact ages. But 4.5 % of them being 50 to 65 sounds about right. That was the age range of the workers who died. A Ford plant that just reopened in Michigan shut down a few days later and sent everyone home for two weeks. So IF we let the virus do what it did in March for a month, this will happen state by state all over America starting in June. We don't know how it will play out. Because it all happened the first time when most businesses were shut down. It's a whole different thing when you are trying to stay open. And your middle-aged workers are not only sick, but needing to go to the hospital in droves. I was screwing around on Washington's COVID-19 website, and it works that way there. To put this in perspective, there's just under 20,000 confirmed cases in Washington state, 3,287 hospitalizations, and 1,061 deaths. So everyone under 40 is 36 % of the cases, 12 % of the hospitalizations, and 1 % of the death. Cue up the chorus: WHO THE FUCK CARES! Everyone over 60 years is 30 % of the cases, 63 % of the hospitalizations, and 90 % of the deaths. Cue up the chorus: THEY'RE OLD! WHO THE FUCK CARES! But that leaves your 40 to 60 year olds, who are 34 % of the cases, 26 % of the hospitalizations, and 9 % of the deaths. If middle-aged workers are 1 in 4 of everybody that needed to be hospitalized, I have no problem believing that at least 4.5 % of all the middle-aged workers that catch COVID are going to need hospitalization. So that's your success story, or that's your next shut down. One of two things can happen. If Washington truly got the memo (they have about 250 new cases a day these days) between an informed public and "test, trace, treat" they won't have a big explosion of cases like New York or New Jersey did. But if they do, it will be like what's happening to Ford and Smithfield and many others right now. Except in Seattle, it will be Amazon, or Microsoft, or Starbucks. And God knows how many small businesses. It will be impossible to keep them open with all those sick middle-aged workers in the hospital. Not to mention all those great lungs for COVID to infect and feed on. So fuck the Gay nurse. WHO CARES! Either people will decide pro-actively that they will do whatever it takes to prevent exposure. Or we will have a middle-aged work and hospitalization crisis. Which will lead right to another shut down. That's the choice. You can't have 1 in 20 of your middle-aged workers sick enough to be in a hospital, and just ignore it.

Florida reports 650 coronavirus deaths at nursing homes May 9, 2020 So what's your take on this? At least 5 % of the state's facilities - 197 out of 3800 - failed to "figure out best practices to where there were no deaths." They failed, right? Should they be sued? Or closed? And if several hundred institutions in Florida screwed up on best practices and seniors died of COVID-19 (that's more than the total number of institutions in Johnson County) does that mean the policy failed? Florida prioritized keeping seniors in nursing homes safe. And yet by the standard you are saying - "to where there were no deaths" - hundreds of these places failed! Bottom line: how could hundreds of these nursing homes in Florida be letting seniors die of COVID-19? Hundreds! There's something very wrong here. So I'll give you some of my personal takes. My Mom and Dad collectively spent years in nursing homes, and died in them. My Dad died of pneumonia two years ago, aged 96. My Mom died of dementia, also aged 96, last year. Mom was nonverbal and almost vegetative by the end. So I get the idea that we don't want to stop the entire US economy just to protect really old people who lived long, happy lives. Mom and Dad both fall in that category. My Dad actually was in the rehab center/nursing home three times: twice for a month each for rehab on a knee and hip after falls at home, which happened like 5 years before his final time, after another almost fatal fall at home. During the two rehab stints he was an A+ student whose focus was to do his job with rehab and get home to his wife ASAP. Then, after my Mom had a stroke and was admitted, he drove to visit my Mom there every day for years. He was adamant about living independently. He kept referring to the nursing home as a place "people go to wait to die". I intervened with staff on issues with my Mom or Dad a number of times. Whether it was my Mom's involvement in activities, my Dad's rehab, Medicare reimbursements, or whatever, the staff kind of blew my mind with their professionalism. As well as their understanding of my Mom and Dad's specific needs. And even how they interacted with each other. There was one exception, a social worker who my sister and I tagged as "The Airhead". One time he came up to me in a hallway to start telling me something about my Mom. It took me a few minutes to realize he was telling me about a woman who was not my Mom. So he was sort of the exception to the rule. In general, the more time I spent in that home the deeper I respected the professionals, mostly women, who worked there. My sister, who happened to also be a county employee and was friends with several of the women who worked there, was far harsher about the home than I was. My own take was when Mom needed lots of attention to keep her diapered and fed and dressed, I wasn't as concerned about whether her hair was combed, or how she was often alone in her room. My point is that within my own family, the expectations around "best practices" varied widely. I have a really hard time with your definition of "best practices". I guess it would be easy for someone to say that if someone dies of COVID-19 in a nursing home, then that home can't be following best practices. Whereas if people don't die of COVID-19, well that home is following best practices. What does "best practices" mean to you? What practices have you observed that you think reflect quality care? What things did these inferior places do that allowed residents to die of COVID-19? By your standard, hundreds of these institutions in Florida have failed, and perhaps need to be closed. And the state as a whole has failed miserably. I hyperlinked a Slate article on Florida and nursing homes in a prior post. Two of the more obvious "best practices" are daily temperature checks, and mass testing of employees. That's why I asked. What are the specific things these Kansas homes did or did not do that you think are "best practices"? The problem in Florida, as that article said, was testing was "great but way too late", according to one nursing home administrator. Some of these homes put "protective measures" in place a month before the state got around to it. So that would be a good "best practices" standard: having a written pro-active plan that is communicated to all staff. But if you don't have testing, you are still flying blind. Even with temperature checks, you'll miss people who are contagious but asymptomatic. The best home with the best practices could, in theory, kill dozens of seniors because of one asymptomatic employee. Do you agree? Do you agree with Merkel's idea about "immunity passports"? Florida has 200,000 people who work in these senior facilities. And every one of them is capable of bringing COVID-19 to work with them every day. It's a massive problem. If there is anyplace where "immunity passports" make sense to me, it's nursing homes. Testing is the next best thing. But you'd have to test every employee almost every day, or at least once or twice a week, to keep COVID-19 out. You said "you do not know the protocols they will be using". So what you are basically saying is this. If a nursing home in Kansas let people die of COVID-19, they are not following best practices. But if nobody died of COVID-19, they are following best practices. That seems very facile. In Florida, I would not jump to the conclusion that over 200 nursing homes are inferior, or are following bad practices. Even though residents in all of them died of COVID-19. That article above was in early May. I'm quite sure that weeks later in Florida it is far more than 200 facilities, and more than 5 % of all the facilities that have had COVID-19 deaths. The reality that you really won't accept is that having 50 % or 60 % or 70 % of the population infected with COVID-19 means mass illness and mass death. And that is inevitably going to filter into about 100 % of nursing homes. If you have 200,000 employees, in a state like Florida, and most get infected, it is going to be very hard to avoid. Right now, Florida has more seniors who died in nursing homes than Johnson County, Kansas has total COVID-19 infections (711 cases). Senior nursing home deaths in Florida (1,024) increased 24 % in the last week alone. Florida long-term-care facilities’ resident deaths from coronavirus jump by 199 (23.9%) in past week MAY 23, 2020 So it's very easy to pick a US county where there is low community spread of COVID-19, and say most nursing homes have kept it out. That's because very few people in the community have COVID-19. When more people in the community get COVID-19, it inevitably spreads into more nursing homes. You want to play Anders Tegnall and pretend it won't happen. Even though it does - everywhere, every time. Then when it happens, you want to blame it on them. People died of COVID-19, so obviously that is not "best practices". Woo hoo! You get the Tom Friedman award of the week. "I have no idea what the work is. But it is hard and difficult work. And it can be done." :oops: Come on! Give me a fucking break. So here is a very good Florida articulation of protocols. You might want to learn a little bit about what you are preaching about. Nursing Homes Safe. Smart. Step-by-Step. That is a really good list, as far as it goes. That said, if I were running a nursing home, I would agree with the administrator quoted. Gloves and gowns and sanitizer are great. But without testing, I'm being asked to fly blind. Even with testing, if I have hundreds of employees, there is every reason to fear that one of my rehab therapists or aides is going to walk through the door one day with an asymptomatic COVID-19 infection. And they have to touch people to dress them or feed them. So how do I stop her from infecting people? I think the only good answer to that question is to keep her from being infected in the first place. By the way, the nurse or aide or rehab therapist doesn't want to be infected, anyway.

This is also from that Canadian article above. I have to give Canadians credit. Even when they are making arguments I don't agree with, they are always very logical about it. Everywhere in the world, COVID-19 is first and foremost a brutally efficient senior citizen killing machine. So as the authors say, that should be Priority Number One. The experience in Canada seems to be more lopsided than in most places. They say 95 % of the cases in Canada are people 60 or older. In California 80 % of the deaths are 65 or older. I will keep bringing up South Dakota in part because the state's data is clearer and more detailed than most. So while it is only one snapshot, it is a very clear snapshot. And in South Dakota I think COVID-19 can be thought of as a "workforce disease". It started in a meat packing plant and moved out from there. 85 % of the cases are workforce age, meaning under 60. But what's interesting about South Dakota is that even though they have a disease that primarily impacted the work force, it primarily killed seniors. 10 of the 50 deaths were people under 60. So 80 % of the deaths were over 60, even though 85 % of the cases were under 60. My point is that I think you have to think of COVID-19 both ways. It is a senior citizen death machine. But it is also a workforce disease. I think herd immunity advocates tend to dismiss the workforce part. That quote above captures what I am now used to reading. Maybe we need to tinker a little bit with the idea that some young Black women have diabetes, or some young White guy is obese. But mostly, if you are under 60, it's either the sniffles or nothing it all. That's an exeggeration, of course. But in the real world, workers everywhere are freaking out. More important, in the real world, meat packing plants and car factories are being shut down as soon as someone tests positive. This is happening all over the US. So for anyone who wants to avoid lockdowns, the workforce part of this is critical. It's not just an incidental problem where some rare younger Gay nurse bodybuilder loses 50 pounds after a few weeks on a vent. It's not just an exception to the rule. It's a massive problem. I think it is actually the weakest part of the herd immunity argument. COVID-19 Pandemic Planning Scenarios That's the new CDC guidelines that state a "best estimate" fatality rate of 0.4 %, alongside scenarios that range from 0.2 % to 1 % fatality. I think it bears noting that the two biggest antibody studies that covered the most testing of the largest populations - Spain and New York - both suggest the actual fatality rate is about 1 %. For purposes of this post, I'm going to simply dismiss the idea that anyone under 50 could die. In South Dakota, two of 50 deaths were people under 50. As the Canadian authors argue, you can say that's like your chances of dying in a car, or whatever. So I'm just going to pretend like it doesn't matter to workers, even though of course it does. So here's the herd immunity workforce problem I want a solution to. There are 55 million Americans aged 50 to 65. I'm going to assume all of them work. In South Dakota, to use that example, a fair number of deaths start to show up after age 50. So 3 of the 50 people that died were under 50. 7 were in their 50's, 7 were in their 60's. 33 were 70 are older. Of the actual people who worked at Smithfield who died, based on what I read, they were all over 50. In a typical flu year, like 2016-2017, 38 million people get the flu. I used that year because 38 million is the average of all of the last ten years. So it is a very typical year. In that year, 7.5 million of the people who got sick were aged 50-65. Of those 7.5 million people, 78,986 required hospitalization. That's a hospitalization rate of about 1.1 %. And to sound like a herd immunity advocate, the typical technique is to argue something like this: Well, we never hear of such a thing any other time. So why all of a sudden is it such a problem? Here's the problem. On the face of it, the CDC is now saying the hospitalization rate for COVID-19 for people aged 50 to 65 is 4.5 %. It may be 3.6 %, or it may be 5.7 %. But I'll go with the "best estimate", which is 4.5 %. So now, instead of 78,986 people requiring hospitalization for the flu, you have 335,000 (out of 7.5 million) requiring hospitalization for COVID-19. And these are not 335,000 older people, who are heading into their senior citizen death machine lottery. These are "younger" workers, aged 50 to 65. But wait. It's much worse. Part of the problem is that the hospitalization rate for COVID-19 is about four times higher than a typical flu season: 4.5 % rather than 1.1 %. (In the real world, in South Dakota, the actual hospitalization rate was 8 %. Even though most cases were people under 60, it's quite likely that half those hospitalized were over 60. So something like 4.5 % for people aged 50 to 65 probably accurately describes reality in South Dakota.) The even bigger problem is that the infection rate is far higher. So in 2016-2017, we actually had 7.5 million people out of a total of 55 million people aged 50 to 65 that came down with the flu. That's about 14 %. With herd immunity, by design, it has to be much higher. 50 %? 70 %? 100 %? This is where it gets really complicated. And why I keep wondering, "Okay. So what is the plan?" Friedman's "harmonious balance" theory is essentially that the young part of the herd happily goes to work and gets the sniffles so that old part of the herd is spared death. Sounds harmonious to me. (Check with that black 40 year old grocery clerk with diabetes, though. She may not agree.) What I wonder is where all these 50 to 65 year olds fit in. I'm no math genius. But, in theory, for all seniors to be spared from the death machine infection lottery, it would probably mean that most 50 to 65 year olds have to play the lottery. I'm just going to arbitrarily say that under herd immunity, whether by design or because of ugly inevitability, 50 % of those aged 50 to 65 are going to get infected. So instead of 7.5 million people with the flu, we have 27.5 million aged 50 to 65 with COVID-19. Instead of 78,986 of those 7.5 million people who actually needed hospitalization in 2016, at a rate of 1.1 %, we'd have 1,237,000 of 27.5 million middle-aged workers needing hospitalization, at a rate of 4.5 %. The "good news", based on the new CDC estimates, is that "only" 55,000 of those workers will die, at a rate of 0.2 %. But that still leaves you with over 1 million workers who need hospital beds. How does this work into the herd immunity plan? You like to keep pointing out that lockdown is not good for people's mental health, @bigjoey. You are right. Then again, death isn't good for people's mental health, either. So if you wanted to come up with a plan to destroy the mental health of every CEO, every human resources director, and every small business owner in America, this would be it. The list of practical problems is enormous. How do you cycle through 1 million middle-aged workers being hospitalized? How do you keep factories open when every week some new worker just got sick? And how do you deal with age discrimination? Because my guess is employers would do the math and find a reason to hire a 22 year old and not hire a 52 year old. To me, the "workforce problem" is an even bigger reason than the "senior citizen death machine" to do "test, trace, treat" with the goal of containing COVID-19. My guess is the goal of corporations is keeping this out of workplaces completely. At least right now, the standard for Smithfield or Ford is to shut down when workers get sick. The more workers get sick in factories, the more pressure to soften that standard will grow. Which will just make it easier for the virus to spread. That is an organic race to the bottom in the making. I can't imagine that anybody in corporate America would be behind a plan like this. It creates huge uncertainty, huge stop/start, huge costs, huge problems. I'm actually counting on big corporations from Apple to Ford to Amazon to be smart enough to demand a really aggressive "test, trace, treat" protocol in every state. That seems like a much better plan to keep factories open. And to allows workers to work safely. You just can't do that with herd immunity. Again, if i am missing it, please spell it out.

Opinion: We are infectious disease experts. It's time to lift the COVID-19 lockdowns Canada needs a hospital capacity-based approach to guide local lifting and reintroduction of restrictive measures as necessary I think you will like this article, @bigjoey. It's sort of an argument for herd immunity, Canada-style. It's primarily based on the assumption that the goal is "flattening the curve". Which presumably means avoiding hospitals being crushed while the virus continues to spread. You can't have concurrent strategies to both eradicate the virus, on the one hand, and encourage and manage its further community spread, on the other. That said, some of the methods that work for one approach also work for the other. I think a national debate about herd immunity would be helpful. If you advocate herd immunity, for example, it really is important to come up with a clear plan to "bubble wrap" seniors for a year. Or for however long you think natural herd immunity will take. It's now known that COVID-19 is a senior death machine. So having a debate about how to give "special protections" to seniors is a good thing, anyway. I think the article is helpful. That said, I'm going to cut and paste sections of it that raise more questions than they answer. Being Mr. Wall Of Text, I get that the authors have word limits to deal with. But the devil is in the details. If we don't want 100,000 more dead seniors, some leaders are going to have to go beyond just throwing around words like "harmonious balance". That's the closest I've seen to an answer to the question: how many people have to die? I could take those numbers and estimate how many people would die in the service of herd immunity, based on actual rates of hospitalization and death in Germany. I'm not going to bother. My point is that it doesn't surprise me that Germany, which has been ahead of the curve, is thinking this way. As Anders Tegnall has said, this is an advantage of a national health care system. Both Sweden and Germany can think about how a nationalized medical system can best serve national objectives in a crisis. The US can't do that. If I am reading it right, Germany is saying they think their hospitals can handle 500 new cases per week for every million citizens. There are 83 million people. So while their concern is local hospital capacity, on a national level that's 41,500 new cases per week. The actual number of new cases in Germany in the last week is 3,742 cases. That compares to a peak of just under 7,000 new cases in one day. They had 273 new cases yesterday. That's a 93 % reduction from the peak. If Germany is trying to eradicate the virus, like many other countries, they are well on its way. Or is Germany trying to manage herd immunity? If so, it needs to pick up the pace. My guess is that most Germans are hoping to contain or eradicate the virus. That said, if Plan B is controlling a long and ugly slog to natural herd immunity, they have that worked out, too. The methods toward Plan A and B are somewhat similar. COVID-19 is like a wildfire. It certainly was in New York City. It was also a wildfire in Sioux Falls, and everywhere else in the US - like Ohio prisons or Navy ships - where it popped up. The only positive thing about Sweden, to me, is they have proved that you can at least manage community spread among working age adults. How far along the path to herd immunity they are is completely unclear. Anders keeps saying "soon". And yet by his own projections, most people in Sweden have not been infected, and don't have antibodies. This is also one of the few articles on herd immunity I've read that articulates what "herd immunity" might mean. If it is proven that infection from COVID-19 does confer immunity for 13 years, that would be a significant fact. As the authors say, we don't know when to expect a vaccine, or what it might do. If it turned out three months from now that a vaccine was going to be much harder to develop than we thought, but people who were infected and recovered from COVID-19 seem to have lifelong immunity, that would be a game changer. For now, we have absolutely no clue. That statement is very Friedmanesque. They introduce an idea, check the box, and move on. In this case, the idea is that COVID-19 is a senior death machine. At least they don't use the words "harmonious balance". But having said COVID-19 is really good at killing seniors, and we should think about special protections, they just move on. Again, I realize that you can't just tweet a plan to save millions of seniors from dying. My emotional reaction to reading this is that it's just not very responsible. It's like saying that it's perfectly okay to have sex without rubbers. Actually, it's not. I use this example because the best way to prevent transmission and death with AIDS is to bubble wrap a penis. So until Friedman or these doctors can tell us how to bubble wrap seniors in a way that actually works, I don't buy it. What seems inevitable, IN EVERY COUNTRY, is that herd immunity leads to mass senior citizen death. Because there are simply not practical ways to stop a virus spreading like wildfire from getting to seniors. Not in Canada. Not in Sweden. Not in Italy. Not in Spain. Not in the US. Not anywhere. That's said, I'll hyperlink to this article that talks about nursing homes and seniors in Florida. I agree with the author that Florida is more good news than bad. But I would not hold them up as a poster child. As it relates to seniors in Florida, the single best point I've read repeatedly is that they are well educated and got the memo early. This article talks about how they started to stay at home, based on mobile phone data, long before the government told them to. It is relevant that seniors don't seem to be advocating herd immunity. They seem to understand that community spread of COVID-19 does not work out in their favor. As far as nursing homes go, the story describes a sound basic nursing home protocol: constant temperature checks, constant testing for infection or antibodies, constant social distancing (try that if you are dressing Granny, or changing her adult diapers). What struck me the most, again, is early and often public education. In Florida many nursing homes got the memo early and took preventative measures where they could. As one person said, the state testing effort was "great but way too late". I still stand by my point. These are all good barriers. But to think that you can have broad community spread of COVID-19 without it getting into nursing homes is naive to the point of delusional. The best way to stop it from spreading to seniors is to stop it from spreading, period. That is what I think the polls say most seniors, and most people, agree on. One final note on that point. The protocols that work in nursing homes - constant temperature checks, ubiquitous testing, masks, social distancing, targeted lock downs (like not letting outsiders in) - are the same tool kit China or South Korea or Germany are using. But they are using it to "test, trace, treat" the virus into eradication, or at least containment. So in China there are temperature checks at airports, train stations, office buildings. In South Korea you get your temperature checked to enter a restaurant. I think that is what California will soon require. If you test positive, in China you went to a "fever clinic" where you were tested and, if needed, isolated until you were well. Which is exactly how they eradicated almost all the community spread. Again, the goals may not be the same, but many of the methods are. Why would we would want to keep playing constant "whack a mole", if just getting rid of the moles or putting them in a cage is an option? I get the fact that getting rid of the mole, or putting it in a cage, is not easy. It may be impossible. But it sure seems like a lot of countries and trying it, with pretty remarkable results.

America’s COVID warning system I'm putting this website up as a counterpoint to Marko's analysis. First, it has a bunch of data that Marko misses. It's data I think Marko actually needed to know and report, to understand why the lockdowns worked. And where we can hopefully go from here. Second, the set of people behind this website are the science and math and medical folks I really trust and respect. They include Tomas Pueyo, who called it exactly right in March, in my view, and said California needs to shut down right now. Pueyo, and the experts around him, were heard. So this website gives you snapshots, by state, of where we are at right now. And where "test, treat, trace" could take us. So, first, what Marko completely misses in his analysis is the nature of the problem Fauci and Birx were actually trying to solve. Which is a virus that was completely out of control, growing exponentially, spreading in all 50 states, and killing indiscriminately. So if you go to that website, and click on New York State, here's what it tells you that Marko doesn't. Back at the peak in mid-March, COVID-19's reproduction rate in New York was 3.0. It was doubling the number of people infected every few days. We now know that 20,000 or so of those people ended up dying in the last few months. We also know that if there has been no lockdown and no other intervention, millions more would have become infected, and tens of thousands more would be dead. So the goal was to stop a virus that was out of control. It was right around this time that Pueyo's crowd was telling leaders in California that every day sooner that they shut down would save thousands of lives. I think Pueyo was right. Had California not shut down, and if we had the exact same rate of infection and death that New York City has actually had, we would have had about 80,000 dead in California alone. Newsom keeps saying if we went for total herd immunity, you could put another "0" on that number. So no, Marko. I don't think the lockdown in California killed more people than not having a lock down. For whatever pain it caused, which was considerable, it saved tens of thousands of lives. Californians did, and still do, strongly support it. New York achieved a low R value of 0.65 in early May. It has been flat lining between that and 0.75 during May. That's all good news. The number of cases has gone down 80 to 90 percent gradually. Way fewer people are dying, and hospitals are no longer being crushed. This website keeps getting better every time I look at it. One new thing they've added for each state is some estimate of contact tracing. In New York's case, it is very low - only three percent of contacts are being traced. The state still has over half their ICU capacity filled. If you look at the whole New York page, that's actually progress - during all of April the ICUs in New York were over 100 % of aggregate capacity. (Meaning NYC was way over 100 % of capacity.) So if the virus were to start reproducing at an R over 1 again, things could look ugly in New York again pretty quickly. Now take a look at Texas, Florida, and Georgia - three of the Southern states that are getting some shit for theoretically opening "too soon". I don't think "too soon" is the right metric. The right metrics are these ones: is the virus growing, or being contained? Do we have the hospital beds we need? Do we have the ability to contact trace to reduce community spread? Those are the variables that will literally determine whether people live or die. So the first and immediate piece of great news, which Marko completely missed, is that these three states had reproductions rates of 2.2 to 2.3 in mid-March, before the lockdowns. So if the goal was to reduce the rapid spread of the virus, that worked. At worst, the virus is now at least not growing exponentially like it was back then. But if the goal was to reduce the number of infections, it did not really work in those states. Texas and Florida both have reproduction rates just above 1. So if people are saying the virus might gradually start to surge back, they are not wrong. Texas in particular seems like it is gradually reporting more new cases, not fewer. Hopefully, that's because they are doing more testing and tracing, so more positive tests ideally means less viral spread. I'm actually surprised that Texas and Florida have more contact tracing than New York. But it's not a complete surprise, since I've read about the virus "SWAT teams" in Texas that swoop in and test and trace. They just targeted some meat packing plant somewhere in Texas. Again, this is exactly what Fauci and Birx were saying SHOULD be happening. So these are signs of success. For the life of me, I really have no clue why some people think herd immunity makes any sense - ESPECIALLY if you want an economic recovery. I just read some story about a Ford plant in Michigan that barely had reopened and then closed after a few days - because a few workers tested positive. By definition, herd immunity means this would be happening all the time. What employer in America would want that? Of course, Ford could implicitly say, "We don't give a shit if you get sick. We just hope too many of you don't have to go to the hospital, or die." My own bias about corporations is they are actually much smarter than that. Even if they are not, it is horrible PR. And even if they don't give a shit about the PR, having workers cycling through illness and hospitalization, and at least in some cases dying, is just a really ineffective way to make cars. I have to imagine corporations would view it as way more cost effective to test and trace the virus into oblivion - or at least as close to oblivion as we can. I have to imagine that workers don't like a constant stop/start work cycle. They'd probably prefer to just come to work using basic precautions, like masks and some distancing, and feel safe, and not catch COVID-19. I also can't imagine that Google, or Apple, or Amazon, or Ford, or Smithfield want to have to go through this shit every single week. My own bias is that Georgia is one of the places more likely to blow it sooner rather than later. The good news for them is that the viral reproduction rate has NOT spiked above 1 since they reopened. The first line of defense is an educated public. So it may actually be a good thing right now that people in Georgia hear the negativity, and are out to prove to the naysayers that they have their shit under control, and will do just fine, thank you. The smart government bureaucrats like Fauci and Birx are always smart enough to say that the most important thing is good citizens doing the right thing. Not government bureaucrats telling citizens what to do. There are two things that worry me. First, there is this single digit set of losers that really do think it is their God-given right to ignore masks, social distancing, or any other simple tool that saves lives. These people probably also make good drunk drivers and wife beaters. They just don't give a shit. And as Dr. Birx keeps saying, their indifference can have lethal consequences, even for the people they love. Second, meat packing plants in South Dakota and auto factories in Michigan shut down for a reason. It is great that most everyone got the memo on masks and social distancing. But the virus is going to spread, anyway. That's what testing and tracing is for. Texas clearly gets it. They have their SWAT teams ready to go. Their infection rate is about half the rate in Ohio, Florida, and California. Those SWAT teams may be part of the reason why. But everything I read about Georgia suggests complete indifference to this point. People in Georgia no doubt feel they are doing the right thing. But these other tools in the toolbox appear to actually be quite helpful to keep the viral shit from hitting the fan. That website above says Georgia's contact tracing rate is only 4 %. As a counterpoint, Oregon has a contact tracing rate of 69 % on that website. That is one of the highest of any state. Perhaps not coincidentally, they have the 4th lowest infection rate in the country. Only Alaska, Hawaii, and Montana have fewer infections per million. Washington has 100 % contract tracing. When this started, Washington had the most deaths, and about the highest death rate per population. Now they are # 21, and at 141 deaths per million are about 50 % lower than the national average. I'm pretty sure my Mom and Dad's generation, and maybe my grandparents' generation, understood this testing and tracing stuff much better than we do. In 1918, of course, we didn't have viruses or vaccines identified. But public health efforts to use new tests and tracing to eradicate diseases like polio or measles, or more recently STDs, are hardly new. Nor are they rocket science. I think partly we are victims of our own success, These are all tools that have worked well for us before. But through our good fortune, we allowed them to grow rusty.

This post is about really interesting data from JP Morgan's Marko Kolanovic. I think it proves that it is possible to be a top notch quantitative analyst, which Marko is, without being a gifted epidemiologist, which Marko is not. So I am going to post the headline to the story and the two key data charts here. I won't comment on the content of the article itself, other than the data. The charts strongly suggest that the lock downs have worked. Hopefully, they set up individual US states so that they will be able to stay open, without a resurgence of the virus. Lockdowns definitely had the intended effect in many countries around the world. They reduced the number of new infections by something like 80 to 90 % (Germany, France, Italy, Spain) or virtually eliminated them (Australia, New Zealand). Again, there are other countries that NEVER had a full lock down, mostly in Asia, but also places like Iceland. And they have been able to effectively control the virus as well. The lock downs were less effective in the US (other than New York and New Jersey), where they stopped exponential growth, and mostly flattened the number of daily infections without reducing them. So here's the headline: Many US states have seen LOWER infection rates after ending lockdowns that are are now destroying millions of livelihoods worldwide, JP Morgan study claims What's funny about this, and sad, is that the headline only makes sense if you believe that people like Dr. Fauci or Dr. Birx set about to destroy the US economy. I just don't think that was their goal. I think their goal was actually what the headline says: to LOWER infection rates. In fact, I know that was their goal. Fauci and Birx are both excellent communicators. And they both said clearly and relentlessly that their goal was to suppress the virus, and drive down both the number and the rate of infections. If we just go by actual death, as opposed to any projection, we now know that COVID-19 is far more deadly than anything since the Spanish flu. In about two months, we are at 100,00 deaths. That's about triple the average annual death rate for the flu in the last decade. We're in the ballpark of the 100,000 deaths for the Hong Kong flu and Asian flu in the 50's and 60's, although the US population was lower then. And these 100,000 deaths happened AFTER unprecedented steps that have NEVER happened before. So nobody can reasonably argue that if we had just done nothing, we would have had fewer deaths. In fact, if we project out New York City's actual 20,000 dead and presumed 20 % infection rate, Dr. Fauci and Dr. Birx are right. Absent any attempt to stop it, COVID-19 could have killed 2 million people, just like they said. In theory, it still could. So the idea that the lock downs actually killed more people than doing nothing is just absurd. Like I said, Marko is great at data. But he shouldn't be hired to replace Dr. Fauci or Dr. Birx, probably. Fauci and Biirx were also also very clear about another reason why lockdowns made sense. That's because of the testing challenges @Charlie noted. Testing and tracing sounds like challenging work. If you have 1 million sick people, and you have to trace their contacts and self-isolate some of them, it's impossible. 100 people or 1000 people is a whole different story. Fauci has been very clear about that in multiple interviews I've read. As an objective measure, China had about 3,000 diagnosed infections in Wuhan at the time they locked down. They ended up with about 80,000 know infections by the time it was over. That included probably tens of thousands of people who had already been infected, but were undiagnosed and needed to be isolated somehow. If I recall, they actually had more than the 10,000 contact tracers California is hiring and training. It was a small army. So they were able to handle testing and tracing that involved those kinds of numbers. Many other countries all over the world are demonstrating they can do the same thing, without using the same methods, when it involves maybe 500 to 2000 new infections in their country a day. They are showing that, so far, they can incrementally reduce the number of new daily infections. That is the precise goal. So if they are achieving that goal, that is a victory. So here are the two JP Morgan charts that demonstrate that goal appears to be being achieved all over the world, and in the US: I've actually read about ten different versions of news reports about this JP Morgan study. Because I've been looking for the study itself. If anyone is curious and can find the original study, please post it. Because the charts leave a lot of questions unanswered. For example, it would be very interesting to learn which countries are identified in that top chart. I can pretty much guess which ones some of them are, anyway. That top chart makes perfect sense to me. When Germany went into lock down, they had a peak of just about 7000 new infections a day. For each day in the last week, they had between 273 and 672 new infections per day. So that works out to a 90 to 95 % reduction in daily infections. However Marko calculated what he calls the "daily infection rate", Germany obviously drove it way down during the lock down. Again, that was the goal. That's victory. The complete victory, if possible, would be to literally get the number of new cases down to zero. Small island countries like Iceland and New Zealand have more or less done that. That's probably not possible in Germany. But we'll see. They are certainly doing their best to track down and eliminate the virus wherever it pops up. So in most of the rest of the world, it seems like these lock downs did what they were supposed to do. That top chart shows that a whole bunch of countries went from infection rates of 4 % or 6 % or 10 % or 14 % down to just about 0 to 1 %. Again, I'd love to know which countries. Because before the lock downs, some of those countries had daily infection rates of 20 % or 30 %. Meaning the number of cases was doubling every three to five days. Which is to say, the virus was completely out of control, and growing exponentially. So if it went from exponential growth BEFORE the lock down to being crushed and almost eradicated AFTER the lock down, that's a victory. A big victory, actually. I think some of the headlines about this JP Morgan study were based on the erroneous idea that the number of infections, or infection rates, were SUPPOSED to go up after lock downs ended. What Fauci in particular has been very clear about is that the idea of lock downs is to get out of control infections under control. After the lock down, Fauci kept saying, you can hopefully track the virus down and kill it, or at least contain it. That was exactly what the CDC in the US was trying to do in January and February. They failed, of course. First and foremost because of the lack of testing kits that actually worked. Now, hopefully, that problem is solved. Fauci has said it's likely that at some point - maybe now, maybe in the Fall - the virus will form a second wave. But the idea is , first, that we have a much more educated public. We are doing things we weren't doing in February or March. Second, we hopefully have adequate tests and tracers - at least in many states, if not all. And if that doesn't work, then we have to go back down the road to partial of total lock downs. Which is obviously what nobody wants to have to do again. In terms of that second chart, the two big winners are not even on the chart. New York has cut the number of new infections from over 10,000 a day to between 1,000 and 2,000. New Jersey cut them from about 4,000 a day at the peak to about 1,000 a day now. It's a bittersweet victory, because New York and New Jersey had to endure nightmares that @purplekow eloquently documented for us. The idea that Marko could suggest that the lock downs might have killed more people than they saved is a stunning idea. 100,000 dead people, about 40 % of whom lived in New York and New Jersey, is a hell of a lot of people. So I'm pretty sure that the lock downs saved many lives. Especially in places like New York and New Jersey. Again, I think there is some fundamental misunderstanding of what Fauci and Birx were saying all along. The goal was to get caseloads way down, to manageable levels. New York and New Jersey did that. The seeming good news for all the author states listed on that chart is the the reproduction rate of the virus is under 1. As long as that's true - meaning 1 infected person infects 1 or fewer new people - the virus is in decline. That's victory. Again, I'd like to see the numbers. I've been looking at the Georgia and Texas websites. In both cases, the number of cases are going up, not down. Hopefully, that's because they are testing more people, and reducing the spread of the virus incrementally. It's just too early to tell. As Fauci says, it may not be until Fall that we know. But by then the whole idea is to have an educated public, tests, tracers, and a whole toolbox to keep the virus at bay. There is certainly no obvious bad news right now.

The article you posted did promote herd immunity. There's just no question about it. I cut and pasted the quotes already. Again, I think this is a good debate to have. My biggest problem is that bullshit phrases like "harmonious balance" (Tom Friedman's) mean nothing. Herd immunity means most people get infected, and some die. I think the hit on the economy to achieve herd immunity - if such a thing actually exists - through maybe 200 million infections and recoveries and a few million deaths in the US would be far greater than what we have chosen to do. But if Freidman or others have a better plan, they should spell it out. Absent that, about 4 in 5 Americans are behind lock downs until it is "safe". Unfortunately, we don't have a very clear or common understanding, let alone consensus, around what 'safe" means. Which is why we need to have these debates. I'm an optimist. I think it is becoming increasingly clear we can avoid organic herd immunity by buying time for a vaccine - aka artificial herd immunity. In the mean time, "test, trace, treat" and public education (wear a mask, socially distance, beaches are better than bars) are the tools we can use to reduce and hopefully almost eradicate the spread of the virus. That was not an option in 1918. But COVID-19 is more or less being eradicated in many nations, big and small, island and not island, East and West, right now. So I'm am optimist. I've watched lots of Tegnall interviews. Trevor Noah, to his credit, had him on The Daily Show weeks ago, and treated his ideas with an open mind. That was a particularly good explanation of his views, I thought. Tegnall was wrong on one big thing, which is the idea of protecting seniors. His other main theory is one I think you share, which is that herd immunity may be inevitable. This is going to be around for years, we won't have a vaccine in time, testing and treating won't work, etc. He may be right. That Minnesota research piece you posted a few weeks ago suggested that COVID-19 might become an annual event, because antibodies won't protect us for more than a year. That's a theory, not a fact. That research paper didn't address the question of vaccines and their efficacy. But, again, Anders could be right. We certainly need to consider his perspective, if only as the worst case scenario. That is how I view it: the worst case scenario. And that is pretty much where I think 4 in 5 Americans are at. In this case, I believe the herd is right. Tegnall has also said (not in this interview) that this set of options makes sense in part because of a framework of things that are just what everybody accepts in Sweden: a great public health system, sick pay, etc. The part I find naive to the point of delusional is that you could let a virus penetrate deeply and broadly into any society, but somehow keep it away from seniors - in nursing homes, in their own homes, anywhere. I think reality has spoken clearly, without exception: allowed to make its way through any society, COVID-19 will efficiently find seniors and kill them Every time. Everywhere. There is no way to just bubble wrap older people for a year. With both nursing home and in-home care, too many college students and young Moms need to feed them, clean them, dress them, toilet them, and touch them every day. If the virus is spreading among those people, seniors are sitting ducks. When I was looking for some other information, I stumbled on this chart, which is a pretty good comparison of Sweden to the US, and its immediate neighbors. When you factor in that Sweden did its economy no particular favors, I see no advantage in herd immunity. In terms of the other 5 to 10 % who are sort of today's version of the anti-vax or "COVID-19 party" crowd, I can't say much without sounding political. But I think I can say this as a totally apolitical three word slogan: let them die. Period. If they want to die, let them die. It's their choice. Arguably it is the same as people who want to do extreme sports, and end up dead at the bottom of a cliff. In that case, if they are a 25 year old extreme sports fanatic, it mostly just kills them. They won't kill anybody else with the risks they take. But if people insist on taking the risk, let them. That said, I won't be inviting them to my house for dinner. And I won't be their friend. And it's not mostly because I am worried about them infecting me, although I am. And it has nothing to do with politics. Because some of these people are on either side, or no side. I just find it offensive when adults can't buy into the basic idea that "I am my brother's keeper." In my eyes, their idea is, "I am my brother's virus spreader." They don't see it that way, but I do. So my view is simple: let them die, if that is the risk they want to take. This is not a new moral category to me. It is not essentially different than escorts I knew who didn't particularly give a shit if they got an STD, or spread an STD. I'm quite aware of the fact that life is not risk free: whether that means a car crash, a plane crash, cancer, or an STD. But part of why I feel grounded about this is I know quite well what it means to manage the risks of things like STDs responsibly, both for myself and those I had sex with.

Former CDC head on coronavirus testing: What went wrong and how we proceed Who should seek a test? Should we test everyone? How much will that even help? Let's clear a few things up. There's a good overview article on that by Tom Frieden, former head of the FDA. The part that is probably most relevant right now is this: My guess @Charlie is you know more about this than me, thanks to your work on HIV and AIDS. Thankfully, COVID-19 is NOT as lethal as HIV. It is worse than HIV in terms of ease of community spread. And ability to fuck up an economy quickly. But I think a lot of the measures are the same. So "test. trace, treat" is a tool, not a Band Aid or a single solution. HIV testing matters. But it matters less if you just stay HIV-negative. So what matters most is public education. One huge benefit of what just happened is massive public education. No offense to Asians, but they are not inherently smarter. But they did have close encounters with SARS and other viruses that did some really useful public education. So part of the difference between the US and South Korea or Taiwan is that they saw the handwriting on the wall, and sprang into action immediately. The public had a much clearer idea of what to expect and how to prevent it. Including, but not limited to, mass testing and contacting tracing. So Asia is full of countries with citizens that are going to kill the virus, period. Whatever it takes. It obviously helps their project that the virus is out to kill them. I think the "treat" part matters, as well. As far as I can tell, for anyone over 50 or 60, the sooner we learn we have COVID-19 and the earlier we seek really good care - if we need it - the less chance of going what seems like the COVID Cliff, which is still not very well understood. The fatality rate kept going down in China as doctors and hospitals got up to speed, and people got earlier and perhaps better treatment. And, as you say, we need to isolate. It's that, or infect people we work with or live with. Here's a great article that talks about a comprehensive framework that "test, trace, treat" fits into: Coronavirus: The Hammer and the Dance You have to read the whole thing. I posted that once already a month ago. Someone took a pot shot at a chart I posted without bothering to understand what the chart actually said. Pueyo, the author, is based in California. There are links in there to several other articles he wrote, starting in early March. He's been pretty much been dead right on everything so far. In early March he said this is far worse than we think, and shutting down NOW - today - will save thousands of lives and prevent the spread of this lethal virus. We can thank or blame a handful of influential people like him that California started the ball rolling. We now have 95 deaths per million people in California, versus 1500 deaths per million people in New York. That is not to be disrespectful to New York. Like with AIDS, it is to be respectful of the agony and pain they had to go through, because they were the first hit. I hope we can learn from the people that got hit by the first wave, so that everybody else can avoid the same outcome. If you want to really geek out just on testing models, here's a white paper with a title that speaks for itself: Why We Need To Test Millions a Day. Your point about speed being of the essence is right on. China was able to test and contact trace thousands of infected people, and crush the virus. I think they knew that if they had millions of infected people, there was no way you could test and treat your way out of that. In California, Newsom is building an army of 10,000 contract tracers. All these efforts are based on what worked - not in theory, but in the real world. In China, in Australia, in Germany. California now has about 2000 cases a day. So that is fewer than Wuhan had when China threw a similar-sized army of testing and contact tracers at the virus. It worked there. Austria, at its peak, had a roughly similar number of cases - about 1500. Now they are down to 25 to 100 a day. There's now dozens of countries that have shown this works. Your basic point is correct. If you are starting with 100,000 infected people a day, or 1 million, it is just too many. Fauci keeps saying one goal of lock down is to get the total number of infected down to a manageable number. Again, there is a simple alternative. Herd immunity. Tens of millions of Americans will need hospitalization, and millions will need to die. We will be relieved of the cost or complexity of figuring out how to test or trace. We can just let what played out in New York happen in New York again, but 2 to 3 times as deadly. They have maybe 20 % herd immunity for 20,000 dead. So I'm guessing they need at least 60,000 dead in NYC to get 60 % herd immunity. If there actually is such a thing. Multiply that across the US and to get 60 % herd immunity its 2.4 million dead Americans, mostly seniors. I think that would be fuck up the economy way more. As well as cause a lot more death. But it is certainly an alternative. Outside of Sweden (by choice), and Brazil (by default) it is not a very popular option globally. In terms of the cost, check with Bill Gates. His problem 5 years ago is no one wanted to spend tens to hundreds of billions preparing for a big pandemic. Now the question is: how can we afford not to? We just spent $3 trillion on federal Band Aids. The hit to the economy in the US alone is trillions more. So if we could have spent hundreds of billions to avoid losing and spending trillions, that would have been smart. We're being penny wise, pound foolish. The high end range of the most expensive national testing protocols is maybe $250 billion. Compared to .............. ? You can go down the line of Asian countries and they all moved to mass testing and tracing very quickly. It actually saved their economies money. In 3 to 6 months we can compare the GDP hit we took to the one China took. But I'm pretty sure our's will be bigger, and deeper. Like I said, South Korea and Hong Kong and Japan have been able to avoid total lock downs, I think. Testing and tracing are the tools these countries have been using, for months, to keep their economies open. Not to lock them down. I keep coming back to reality, not theory. Like it or not, Smithfield Foods in Sioux Falls had a huge work force and meat production problem. Meat packing probably lends itself to virus spread. But the same basic thing has happened in call centers, churches, and auto factories. So my HIV equivalent is that if you don't have testing, it's like not knowing your HIV status and walking into a bath house and having sex without rubbers. It's just asking for trouble. It doesn't even involve oral or anal sex. All you have to do is breathe or speak near each other. So think that one through as an employer. (Smithfield's main investor is a Chinese billionaire. American cattle men don't like that.) Even the 35 % or so of infected workers that are asymptomatic are freaking out, and contagious. At least half of them are clearly sick. In this case, 7 % of the people who got sick needed hospitalization. Almost all the sick were force force age (20's to 65). Then some seniors got it when workers brought it home. I'm guessing at least 3 to 5 % of those workers ended up in a hospital. At least a handful of them died. So how do you deal with that as employer? There's really only one answer. They tested and traced like crazy. AFTER they shut the factory down. So I'm pretty sure this is something that employers like Ford and GM and Smithfield wat to get on top of. And workers and the American public have now, I think, gotten the memo. This is a disease that you don't want to be caught off guard with. It may not be as bad as AIDS. But it still going to fuck things up real good if you let it. I don't even think we have a choice in the matter. I really don't. The worst thing for the economy is to let a pandemic just run its course. At least so far, everyone else in the world seems to be finding that testing, tracing, and treating is the most cost effective way to contain and control this pandemic.

You're completely misrepresenting one side of this debate. So please stop doing that. I'm tired of the argument that I am against a Black bus driver or a Hispanic grocery store clerk going to work. I am not for lock downs. Please stop using this language that suggests anybody is for lock downs. I can post videos of the actual Black bus driver and Hispanic grocery store clerk that died of COVID-19 is you wish. They were not seniors citizens. They were working age people, who wanted to work. They did not want to die. And yet they did die. So that is the actual problem to be solved. I did not wake up one morning and say, "Geez, I think I'd like a depression today. I think it would be great to destroy the economy." I woke up one morning and said, "Geez, why are Black bus drivers and Hispanic grocery clerks dying? They don't want to die. How might we stop them from dying?" I use those examples because both involve people going to work and doing "essential services". Like driving buses, and making it possible for me to buy food. So this bullshit "health v. wealth" debate is just that, bullshit. Millions of Americans have been working through this, in the public, at risk. They want to work. But they don't want to die. So this has nothing to do with "pro-lock down" or "anti-lock down". If you want to characterize my position, do it this way. I am "pro-work" and "anti-death". The countries that have been best at "test, trace, treat" have actually avoided lock downs, either entirely or partially. I don't think South Korea or Hong Kong or Taiwan or Iceland ever closed all the restaurants or stores. China did, but mostly in the areas that were the hot spots. So in none of these places was the goal to lock things down to fuck up the economy. In many of the places I just named, including huge chunks of China, they were far enough ahead of the curve to avoid the blunt instrument of a lock down completely. Had we done what South Korea did in January, when the first cases appeared, things in the US might have been very different. But that's a moot point. We are where we are. The question now is how do we reopen or stay open in a way that does not simply lead to another lock down in one month? If the answer is herd immunity, the best models of where that gets us is Sweden, or Brazil, or New York City at the height of the crisis. I for one am NOT for that. If the answer is "test, trace, treat", I am FOR that. While we have a very tricky and lethal virus to fight, the world appears to be learning how to fight it. South Korea at one point was the poster child of what NOT to do, because they missed a big sect that caused close to 5000 infections. So trial and error worked. Now they are a global poster child. Singapore was a poster child, but they forgot about the fact that they have all these immigrant workers living in cramped dorm rooms. Again, trial and error worked. They went back into lock down, and are now cleaning it up. So it is trial and error. But the overwhelming lesson, so far, is that the virus can be contained. And the economy can be made "safer". Until there is a vaccine and everybody gets its, we can't have an economy as safe as what we had a year ago. But if we want a safer economy, we have to contain COVID-19. With infection, its is black and white. Gay men know this about AIDS. There is no such thing as more HIV infection being a good thing. Less HIV infection is the only good thing. I think COVID-19 is just as black and white. That is the difference between "herd immunity" and "test, trace, treat". The goal of herd immunity is to promote infection. The more infected people, the better. Why? Because that is the only way to create antibodies, which creates immunity, which IN THEORY protects people like seniors. They can't afford to become ill, or they will die. That is why I keeping asking, appropriately: how many people have to die? 200,000? 2 million? What "special protections" actually keep seniors safe in the mean time? I don't think there are any good answers. The good answer is the exact opposite. You do not promote infection. You promote testing and tracing, to crush the virus completely. Either you are promoting infection. Or you are promoting the complete suppression of infection. You can't have it both ways. Former FDA head Gottlieb is one voice of science on this. Obviously we can't go from 25,000 new infections a day to zero in one day or one week. But we now know that Spain and France and Italy did go from around 5,000 to 10,000 new daily infections to about 90 % less pretty quickly. So either we are working to completely contain the virus, or we are not. And if we are not, we are pretty much in a position where a huge wildfire can break out anywhere. Again, Sioux Falls learned the hard way that what Dr. Birx keeps saying is correct. New York had only 10 cases at one point. You can easily have 1,000 cases before long. That has been her consistent message. Sioux Falls went from one diagnosed case to over 3,000 in about one month. It wreaked havoc on their local economy and workers. Here are two examples of why I think it is fair to call herd immunity advocates "anti-work" and "pro-death". Daily New Cases in New York Daily New Cases in Texas So let's talk about the logic of herd immunity in New York. Everybody knows that NYC hospitals were turned into a morgue. So you could say to New Yorkers, "Hey, you folks have 20 % herd immunity built up. Congratulations! Why not go for 60 % or 80 %, so you don't have to worry about COVID-19 anymore?" My read is that most people would say, "Buddy, you have a mental health issue. We had 20,000 deaths. We don't need 60,000 or 80,000 more." You might also want to check with the hospitals, and doctors and nurses, too - some of whom died. And, again, it's not just seniors. When 20 % of NYC was getting infected, about 20 % of the NYPD was out sick. Dozens of cops died. So are we saying we want 60 to 80 % of the NYPD out sick, and hundreds of cops to die? New York is now like Italy or Spain or France. They have driven the number of cases down close to 90 percent. That's from over 10,000 a day, to between 1,000 and 2,000 a day. Meanwhile, Texas is also between 1,000 and 2,000 cases a day. But for Texas, that is MORE cases than ever before, not less. Why not just have 2,000 cases a day? That won't crush the hospitals, right? The only problem is this. There were 1,342 cases in New York on March 18th. By April 4th, two weeks later, there were 11,506 cases. THAT is why New York has to shut down. There was a sudden and massive wall of illness and death. So the danger for Texas and New York right now is this: what's to stop that from happening again by June? Because we know - from every poll in America today - that if that happens in Texas or New York, it will lead to another shut down. 75 to 80 % of Americans say they will want a return to shelter-in-place if the the number of cases and deaths skyrockets. Think about that, @bigjoey. Promoting herd immunity promotes the exact conditions that 4 out of 5 Americans say will lead them to demand more lock downs, Which will of course fuck up the economy even more. I view herd immunity as "pro-death" and "anti-work". What's the alternative? First, the public is now educated. Public education is always the first goal of public health. Every Gay man knows this. How do you stop AIDS? Wear rubbers. That is how public education saves lives. Now it's not wear a rubber. It's wear a mask. Second, there's test, trace, treat. Daily New Cases in Austria Austria is a good apples to apples with Texas and New York. On it's worst day, March 26, Austria had 1,321 cases. Now it is between 25 and 100 new cases a day. Their economy is open again. Probably the single most important thing is public education. But some people are going to get sick. So if we don't have testing and tracing, we're simply asking for trouble. It is encouraging to me that Texas has "SWAT teams" of testers and contact tracers that they send out to met packing plants. Or any hot spot where the virus appears - as soon as the virus appears. Other countries have learned they can actually do that pro-actively. They are able to find the virus through testing before anyone even knows it's there. Again, this is black and white. You can't try to stop the virus before it infects meat packers, and also say we'll just let meat packers get sick so we can all develop herd immunity. You have to pick one. I think it's clear already that letting meat packers experiment with herd immunity is bad for the human herd. It promotes sickness, hospitalization, and death. It fucks up the economy. The goal of those meat packing plants is to slaughters animals. Not humans and jobs, right?

Nothing. I've never heard the idea that this is seasonal presented as a fact. Like a lot of other things, it's a theory that, like the flu, there may be seasonal differences. I think the best scientific group think is that this is NOT seasonal. Brazil and Australia were not excluded from the party, just because it was warmer there I personally run counter to "group think" on this one. I've wondered whether (in order) Florida, California, and especially Texas have lower infections and deaths because of warmer or more moderate weather than in New York or New Jersey. Some people who think the lock downs are stupid are arguing right now that things may be going better than expected in Georgia because the weather is getting warmer there. (Cases in Georgia are increasing, albeit slowly. So it's not clear yet how well things are going there.) The theory I've read that makes sense to me is that weather matters, but indirectly. In nicer weather, people can go outside more. The virus does way more poorly on airy beaches than in crowded bars or cramped restaurants or subways with poor air flow. But, again, if it were that simple the weather, everybody would be flocking to Rio. Rio is quickly becoming a global death hot spot. I think Australia and Brazil are excellent examples of the difference between using "test, trace, treat" as a "buy time and contain" strategy on the one hand, and herd immunity on the other hand. Although what I hear from Brazil actually sounds less like any kind of plan, and more like an impulse. The impulse being, "You think I give a flying fuck?" So I would put Brazil's dance with death down to that, much more than the weather. Brazil has 200 million people, compared to 25 million in Australia. So here's the difference between two large Southern hemisphere countries Brazil is now runner up to the US as the country with the most confirmed cases. They have 341,048 cases, which works out to be 1,628 per million citizens. Australia has 7,111 cases, which works out to 284 cases per million. Since the adjustment for population is built in, this is infecting about six times as many people in Brazil as in Australia. Brazil has a total of 21,682 deaths, which is 103.5 deaths per million citizens. Australia has 102 deaths, which works out to 4.1 deaths per 1 million citizens. Which leads to an obvious question: why would Brazil have six times as many infections as Australia, factoring in population, but about 25 times as many COVID-19 deaths? My guess is that having a good public health system like Australia does, where everybody who gets really sick from COVID-19 can get the best quality care, might make a big difference. It seems like the death rate might be quite variable, like from 0.4 to 1 % if not even more, based on how hard a country gets hit, and what their health care system is like. And it gets worse: 74,000 Missing Deaths: Tracking the True Toll of the Coronavirus Outbreak There's now another clear global reason to be against herd immunity. In every country where there are huge COVID-19 spikes, there are also thousands of "missing deaths". Meaning that there is a huge spike in overall deaths. But even when you subtract out all the additional deaths that are diagnosed from COVID-19, there are still a huge number of deaths left over the long term averages. So in that story, about 6,000 of those 74,000 "missing" deaths comes from five large cities in Brazil. If you add those deaths to the total, that's now about 28,000 deaths in Brazil, or 30 times as many deaths as Australia relative to their populations. I've read some pro-herd immunity arguments that point out that people who have had heart attacks or strokes can't get adequate medical care and die, because hospitals are overwhelmed. Or simply because everything is all about COVID-19. It's a strange argument, and an illogical one. It's very likely that people died of strokes when they didn't have to. It's also possible, we know now, that the stroke could have been caused by COVID-19. Either way, you still end up dead. So whether those 6,000 "missing deaths" in Brazil were because of undiagnosed COVID-19, or because the hospitals were so overwhelmed that people died for other reasons, is kind of irrelevant. These are all arguments against herd immunity. Because allowing a lot of people to get infected to achieve herd immunity requires conditions - mass illness and mass death - that lead to hospitals being overwhelmed. And to "missing" or "unnecessary deaths". That is exactly what appears to be happening in Brazil, but not Australia. I think the theory in Brazil is that we should just man up and let the virus run its course, so it won't fuck up the economy. That way people can go to the beach, or go shopping at the mall. What that means in practice is that more and more people are ending up in hospitals and cemeteries. Meanwhile, in Australia, people are headed back to the shopping malls and beaches, in much safer conditions. Conditions are never the same in two countries, so comparisons always fall short. But Australia and Brazil are examples of two more or less polar opposite strategies for managing COVID-19. I don't think it is mostly about the weather. I think it's mostly about whether you have the will and the way to actually contain the virus and stop it from infecting and killing people.

Sorry, but no. We don't agree about herd immunity. Maybe there is a semantics issue here. I respect your intelligence, and I do not want to get into a semantic debate. But when I read what you wrote, it sounds like an argument for herd immunity. If I am reading it right, my point is exactly the opposite. There is nothing inevitable about this. There is no particular reason why "more and more of a population is exposed". So let's look at polio: I think we both agree that the key action that changed the game is the introduction of a vaccine. To use the magic words, the vaccine created artificial herd immunity. Your point may be that until we have a vaccine, the only kind of herd immunity we have available to us is organic herd immunity, aka disease, sickness, and either recovery or death. But it's also important to point out one minor scientific fact: nobody knows what COVID-19 antibodies actually do. They may confer some immunity for six months, or for six years, or for six decades. or they may not. We just don't know. For that matter, we don't know how effective a vaccine will be, or when it will be available. So we also agree that one strategy is to delay until we get to the red line above - the introduction of a vaccine. It's at that point that I think you and I part company. Anyone who believes in herd immunity as a concept, which @bigjoey clearly does, essentially believes that inducing infection is a good thing. Why? Because absent infection, recovery can not occur, and antibodies can not develop. (Nor, of course, can sickness and death occur. But that's just a minor point. Not really anything to worry much about.) To quote the screed he posted that set me off, our "virgin" bodies are stuck at home, free of infection, pining for the outside and growing increasingly resentful of the assholes who took our very lives away. (Did I mention @bigjoey likes drama?) In fact, in places like South Korea or Iceland or Hong Kong or Australia, there are not virgin bodies stuck inside. All along, they've been going to restaurants, malls, and the beach. If you believe the Kiwis, there are actually tooth fairies and Easter bunnies prancing about. Egads! Clearly that sounds better than The Grim Reaper! Those countries either NEVER had a full lock down, or have had ones that were quicker and more effective than our sort of shit show. The main difference is that, for whatever reason, they really did embrace the idea "I am my brother's keeper." That said, if they didn't, they got fined, or bitched at by the cops. At the end of the day, it worked. And the infections pretty much went away. It's not quite right to say this is all or nothing, or completely black or completely white. But to make the scientific and medical point as clearly as I can, it really is all or nothing. At least with this virus, if 1 % or even 0.01 % of the population is infected, it will spread. So the whole idea behind "test, trace, treat" is that you have to beat it back constantly, and universally. It does therefore make sense that this could be marginally easier in societies where what an individual feels is their right is less important than what is good for the society as a whole. So maybe America is fucked. Maybe 1 million of us just need to die, to protect our individual right to get infected and die. If that makes any sense. That said, it's not like people in the US don't understand the words, "I am my brother's keeper." It's not like Dr Birx isn't being perfectly clear when she says that her grandmother didn't really want her own mother to die, which she did of the Spanish flu. So whether it's the idea of "don't kill Grandma" or "I don't want my Mommy to have to die," these are concepts people in America can easily understand. Dr. Birx's point, which is simply science, medicine, and fact, is that if you get enough of the herd saying, "it is my right to get and spread this virus without knowing it," you are fucked. That has nothing to do with politics. She is simply speaking as a medical professional, about medical facts. I've been following @mike carey's very informative posts, both in terms of anecdotal stories, and studies and research he has posted. My strong impression is that in Australia, which is as individualistic as the US, people just decided that the virus was going to be fucked, not the people. (Mike didn't quite say it that way, of course. I'm just the crude asshole around here.) So, semantics aside, if we want herd immunity, we really do want the virus to spread, albeit it in a way we at least try to control - which is kind of like controlling a wild fire. If we want to do "test, trace, treat", Birx and Fauci and the rest of the world are right. We really do have to use testing and tracing to push the virus back, constantly and universally. The evidence so far is that you can actually stop the spread of the virus in very large populations of people. Presumably while everybody hopes the vaccine is soon to arrive. That is the other reason I posted that polio chart. Note that, with polio, the disease took several years to completely kill, even after the introduction of the vaccine. In fact, there was a final spike of transmission in the late 1950's. So it's not like this vaccine was just sprayed in the air, or everybody drank it in the water. My point is that the things we have to do to buy time are actually very similar to the things we have to do the day a vaccine arrives. Both before and after V Day (the day the vaccine becomes available to everyone), there is a set of collective behaviors that matter. As we know with other vaccines, for example, if 5 % of the population refuses to be vaccinated, others may be placed at risk as well. So the entire set of behaviors that prevent illness and death both before and after a vaccine all do very broadly boil down to, "I am my brother's keeper." The final point that I think really matters to me is that everything I said above is what is good for the economy, not people's health. I just don't get the idea that the best plan for the economy is to have middle-aged Black women and Hispanic men with diabetes working at Walmart who will get sick and go to a hospital and die. While they are also infecting some customers. To me, this is a good plan for terrorizing seniors and workers. And for keeping customers out of Walmart. What am I missing? The better plan, if possible, is to do what China and Australia and Germany are doing. Just keep the virus out of Walmart completely, by keeping it out of the county and state Walmart are in. That also keeps it out of restaurants, and gyms, and hair salons. I think that is what Dr. Birx wants to do. I think she's right. That way seniors don't have to be terrified about shopping in Walmart with a mask on.

There's some amazing new stuff that has come out from the CDC and JP Morgan, mostly encouraging, that I think goes further in nailing some things down. To quickly summarize: The CDC has a new guidelines saying that they think the fatality rate is about 0.4 %, but it may be as high as 1 %. I argued above it's probably between 0.5 % and 1 %, depending on the circumstances. Like if hospitals gets crushed, and seniors are dying in droves at home, it's probably going to be more like 1 % of everybody infected. I think there's more and more evidence that these numbers are all in the ballpark. JP Morgan has done a bunch of really cool quantitative analysis. This study (on page 3) summarizes about a dozen antibody studies, and uses them to estimate fatality rates. The range is broad enough (from 0.00 % to 1.06 %) that you could argue there's no point to the exercise. But I think part of the problem is some of these studies are small samples (like 1000 people in Scotland) of populations with low infection rates (like 1 % of the entire population). Minor variations in false positives and false negatives can wreak havoc on those small studies. Three of these studies either sampled a lot of people, or happened in areas with high infection rates, or both. So I think they are more accurate, and reinforce the idea of a 0.4 % to 1 % range. The biggest study was of 60,897 people in Spain - one of the hardest hit countries. They estimated an overall mortality rate of 1.06 %. New York State tested 15,000 people for antibodies and determined a fatality rate of 1.00 %, according to JP Morgan. Some news accounts I read said the estimated NY fatality rate was lower - like 0.5 %. But if you include the deaths of seniors at home, which perhaps JP Morgan did, it works out to be about 1 % of everyone infected. Germany tested 500 people in Gangelt and found a 0.4 % fatality rate. Of all the studies, that one found the highest overall population infection rate: 14 % of the entire local population. The next highest was NY State, where 12.3 % of state residents are estimated to have been infected. I keep thinking we ought to be thinking of this as both a senior citizen death machine, and a work force disease. In order to avoid future lock downs, if we can, we really have to be thinking about how we prevent workers from getting sick, being hospitalized, and dying in droves. You just can't have Apple stores and grocery stores where 5 % of workers end up in hospital beds, and customers therefore - especially seniors - are afraid to go inside them. Even if it works out that very few of those workers actually die in the end, many of the seniors will. It is something to be avoided, not encouraged. That is why I think the German study is interesting. Gangelt is a small town where they had a Carnival celebration, which ended up being a huge vector for COVID-19 transmission. One thing that helps prove, which New Orleans reinforced, is that mass gatherings are very good transmission vectors. But I also think, given the nature of the gathering, that the people infected tended to be younger. So it is probably consistent to say that only 0.4 % of those people died, whereas in Spain and New York - where the virus ran amok among older people - that fatality rate was 1 %, which is of course two and a half times higher. I know part of the reason Germany has had fewer deaths than many of its neighbors from COVID-19 is that it started as a "ski diseaase" that Germans and Austrians brought back home from Italian ski lodges. Overall, the average age of patients in Germany was much lower than Italy or Spain, hence a lower fatality rate. Again, I think something like 0.4 % to 1 % is the correct range, depending on the circumstances. JP Morgan COVID-19 infection tracking and the search for second waves of infection I can't find a postable JPG of the chart, but on Page 8 of that JP Morgan study there is a fascinating image that explains why America is maybe fucked, and maybe not fucked. As a caveat, since the goal here is the facts, the facts, and only the facts, I am going to use the word "individualism" the way JP Morgan does - as a behavioral concept that may help us to understand viral transmission and death rates. This may get at some of what @bigjoey means when he talks about "the American personality". The reason I say America (and the UK) may be fucked is that it may be, according to JP Morgan's research, that more individualism simply means a lot more death from COVID-19. That chart on Page 3 compares red dots ("collectivist" nations) to blue dots ("individualist" nations). It's hard to see the abbreviations on the dots. But the red dots include China, Hong Kong, Japan, South Korea, and Taiwan. As I indicated above, their death rates per million citizens have been low single digit numbers - like 3 or 2 or 1 or even less than 1 per million dead. I think it goes without saying that Americans would rather not have 100,000 or 1 million more deaths. On the opposite end of the chart, the US and the UK are two of the most individualist nations, and they have two of the highest death rates per million in the world. As I said above, it is 300 dead per million in the US right now. In the UK it's now up to 550 dead per 1 million. Implicit in that is that the number of dead in the US could double quickly, just to catch up to where the UK is at. And if the ultimate fatality rate is 1 %, it means the fun won't stop until both the US and the UK gets to about 10,000 dead per 1 million. Buckle your seat belts. If herd immunity is the only option, we may be fucked. What I find encouraging is that some of those blue dots also have very little death. So if the question is: "Can we have an individualistic society, and still NOT have mass death?", the evidence suggests the answer is YES. We just have to be thoughtful about it. So Australia and New Zealand are two of the countries that are both as individualistic as the US, and have also essentially stopped the virus. There are others as well. JP Morgan summarizes the actions of the Asian countries. But what Australia and New Zealand and some of those other low death countries did is basically the same. It is "collectivist" mostly in the sense that it takes steps - masks, tests, tracing, cell phone apps - that prioritize public health, and the common good. Those are hardly radical ideas. While it stems from a specific religion, I think every religion and therefore every nation in the world believes in and practices some version of this behavioral concept: "I am my brother's keeper." That is essentially what this "collectivist" action that has prevented mass death boils down to. People in the US and the UK understand "I am my brother's keeper." Just like people in Australia and New Zealand have proven they do, too.

I understand that you are looking for ways to have herd immunity and avoid the mass death of seniors. That is your goal. Good luck with that. It is going to be extremely difficult. It may be that the rest of the planet is wrong, and herd immunity is "inevitable". So it is definitely worth thinking about how we let 200 million or 300 million Americans get sick, without having a mass death of seniors. But it is going to be a very difficult thing. And since the rest of the world seems to be proving that mass death is not "inevitable", it might be worth considering that, too. Unless you feel that somehow the mass death of seniors fits the "American personality" better. You'll have to explain what "the American personality" has to do with this, because I don't get that. Tegnall is relevant because, to my knowledge, it is the only country in the world that tried what you want to do. Have herd immunity, and somehow offer "special protections" to seniors to prevent their mass death. It did not work. In fact, it had the opposite effect. It unleashed a virus that did what it is very good at: COVID-19 found seniors, and killed them. So it is wonderful in theory to say that "harmonious balance" is a totally cool thing. In theory, a few people get COVID-19, they shake it off like a few sniffles, and seniors get margaritas and free porn. It's awesome. That's what my vision of what "harmonious balance" means. In reality, "harmonious balance" means mass illness and mass death. Thousands of seniors will be unable to breathe or eat, and they will die slow and horrible deaths. That is not what is happening in theory. That is what is happening in reality. So Anders will always have his wonderful theory. But if it doesn't actually work out that way in reality, there is a word for that: FAILURE. Can you please show us where "harmonious balance" has worked? I can't actually name one actual place on the real planet Earth where it has. On the real planet Earth COVID-19 finds seniors and kills them. Brutally. That is what COVID-19 is designed to do. It does it job very well. In Northern California in particular, which led the lock downs nationally, the opposite of Sweden is what actually happened. Leaders that were led by scientists, and in some cases actually are medical professionals, came up with an interesting concept. They decided that if they wanted to keep mass illness and mass death out, they had to keep COVID-19 out. It was pretty much that simple. So the whole idea of lock downs was to suppress the spread of the virus using a very blunt instrument, until more surgical tools like mass testing and contact tracing could be quickly put in place. It is no surprise that California is building an inventory of mass tests and an army of I believe about 10,000 contact tracers. The plan is to suppress the virus, track it down, and kill it. That is the exact opposite of herd immunity. Herd immunity means allowing the virus to track seniors down and kill them - in nursing homes, in their own home, at work, in the grocery store, or wherever they breathe air or touch things. One of the focal points of mass testing will and should be nursing homes and anywhere where there are lots of seniors (for example, many church communities). That way the virus can be tracked down and stopped before it is allowed to run amok and kill indiscriminately, as it would be allowed to under the herd immunity model. Here's an interesting fact about herd immunity. In New York, there have been 18,998 known COVID-19 infections for every 1 million state residents. In California, there have been 2,297 infections per 1 million residents. So that suggests neither state is close to herd immunity. But New York state may be at somewhere around 20 percent, based on the antibody studies. So herd immunity does mean, by design, much more infection. In New York, 1,495 people have died from COVID-19 for every 1 million residents. In California, 94 people have died for every 1 million state residents. In New York, that totals 29,090 deaths. (This does not include at least 5,000 people New York City says died at home, mostly seniors). In California, there have been 3,708 deaths. We do know from the California website that 79 % of those deaths were among people 65 and older. So we know two things: 1) COVID-19 has a huge potential to sicken, hospitalize, and kill workers aged under 65, which creates a massive state work force problem, and 2) that said, about 4 in 5 people who actually die will be seniors. So, again, it seems incredibly clear and factual that wherever it is allowed to run amok, COVID-19 will be brutally effective in findings seniors and killing them. It does that just as effectively in California as it does in New York. To me, this is a very good argument against herd immunity. There are no doubt things that nursing homes can do to protect seniors in the middle of a massive plague. Much as humans can protect themselves in a middle of a massive hurricane or flood. But most people would probably agree that - if possible - it is safer to simple prevent the plague, or the hurricane, or the flood. This is actually what happened in Northern California. The core idea was exactly the opposite of Sweden. Sweden said lets basically let a virus run amok, and see what happens. It did not end well for seniors in nursing homes. Even Anders had to admit that. In Northern California, they did the exact opposite. They said let's not unleash the virus. Let's not just see what happens. I think it is quite logical to argue that the reason they did not have mass deaths in nursing homes in California is simply that they used an entirely different strategy, which worked. It did not allow COVID-19 to do its job, which is finding and killing seniors. To be very specific, it seems like the cirtical action taken in California was that we blocked a plague from being unleashed that was certain to kill many senior citizens - in nursing homes, at home, or at work. Do you disagree? Is there any example anywhere in the world where some community or state or nation tried to do what Sweden has done - let the virus run amok - without having a similarly disastrous outcome for senior citizens? You are citing states that have much lower statewide infection rates than New York - like Florida and California. That's fine. What that actually means is that the best way to prevent seniors from dying of COVID-19 is to prevent them from being infected by it, by blocking the transmission of the virus in the entire state. If that is your argument, we agree. If your argument is that Florida or California could instead sit back while 10 or 20 or 30 million of its residents got sick, but still find a way to keep seniors from getting sick and dying, that simply has not worked. In fact, it failed badly in the one country that tried - Sweden. So, again, please tell us where that strategy has actually worked.

Actually, no. If you start with a bad assumption, everything after that initial bad assumption is wrong. Your initial bad assumption is that this process is "inevitable". That is wrong. If you are correct, it does mean maybe 3.3 million Americans will die. So hopefully you are wrong. You said "as I understand it". That is correct. This is as you understand it. Your understanding is flawed. Pretty much every nation in the world, including the US, is operating on the assumption that herd immunity is not "inevitable". There really can't be any confusion about this. All this stuff about "lock downs" and "test, trace, treat" that has been the entire focus of everything happening on the planet for months is all based on the idea that herd immunity is not "inevitable". The most dramatic example is China, which decided it was going to crush the virus. That is 100 % the opposite of herd immunity. Herd immunity would mean China decided, either by choice or by submission, that they had no choice but to let the virus infect over 1 billion people. They would let the virus roll, and see what happened. It is obvious and undeniable that China did exactly the opposite. They crushed the virus. As a result, China has one of the LOWEST rates of death of any large nation on the planet: China has had 3.3 deaths per million citizens, compared to 299.5 deaths per million citizens in the US. You can make a lot of arguments about whether what China did is a good thing or bad thing. Let's save that for the politics section. Here, I think the idea is simply to gain a more helpful understanding of the facts, the facts, and only the facts. So the fact is that China did demonstrate that herd immunity is not "inevitable". I think it is fair to say that had they NOT made that choice, they would have had at least 299.5 deaths per million, like the US did. Spain actually has had 612.7 deaths per million, because the virus silently penetrated so far into the population before they took dramatic action. Like China, they has to act quickly and dramatically. COVID-19 has killed almost 30,000 people in Spain now, and sickened and hospitalized hundreds of thousands more. So whatever you think about "herd immunity" as a goal, there is no question as a matter of objective fact that it involves the idea of sickening, hospitalizing, and killing millions of people through an "organic" process called "disease spread". Spain's rate of death was 200 times greater than that of China. This was objectively based on actions taken in each country to prevent the natural progression of herd immunity. A few more specific examples. When the Bubonic plague was around, your model works. We didn't understand viruses, or have microscopes, or vaccines. So basically you got sick or you didn't, and you died or you didn't. There were forms of "social distancing" back then. But science was not of much help. Same with 1918. We did not understand viruses, or have vaccines. So social distancing had a lot to do with why Philadelphia and Pittsburgh had two or three times the number of fatalities per million from the Spanish flu than other cities. But people were still essentially sitting ducks. News flash. This is not 1918. There are things called microscopes, and vaccines. At some point, somebody said, "Hey, let's get rid of polio, and smallpox." So scientists figured out how to use vaccines to safely induce artificial herd immunity. This is a very important distinction, so it's important to really focus on it. The idea of herd immunity is that you let smallpox and polio roll through a nation and sicken and kill as many people as it can. One might do that because they like mass death. Or one might do that, more likely, because they have no better idea of what to do. But the inevitable outcome of this type of herd immunity is mass disease and mass death. Millions and millions will get sick and die horrible deaths, just like they have all through history. The idea of artificial herd immunity is the exact opposite. Some very smart men and women said, "Geez, what if we try to avoid the mass death of millions and millions of people?" And guess what? It actually worked! That's science for you. They found they could intentionally inject people with "stuff" and prevent mass illness and mass death. So the idea of artificial herd immunity is to use science and medicine to create the same state as what would have happened if millions of people got sick and died. Except now - viola! - we can do it without millions getting sick and dying. Pretty cool idea, huh? So there does seem to be some real confusion about this idea of herd immunity. There are endless articles where doctors and scientists say the whole concept was created to figure out how to safely induce artificial herd immunity through vaccines to prevent mass illness and mass death. If you Google "Dr. Fauci" and "herd immunity" you'll find lots of citations where he talks about all the great work scientrists like him have done to induce herd immunity to prevent mass illness and mass death. One failing so far is that scientists still have not really figured out a vaccine for AIDS, that would completely prevent the transmission of that virus. So this is not easy stuff to do. But that is exactly why scientists like Fauci get paid the big bucks, and you and I don't. We just get to be grateful that these really smart men and women save our lives. One other key point. Since COVID-19 has only been around for months, what most countries are doing is "test, trace, treat." That is not a vaccine. But it does seem to temporarily block the natural progression of herd immunity. In other words, it stops millions of people from getting sick and dying. You can think of it this way: "Buy time to prevent mass death". Some people think that having a swab put up their nose is better than being dead. You can agree or disagree. But it is understandable to me that given the choice between having a swab up my nose, and spending two weeks dying in a hospital, I might choose the swab up my nose. So in South Korea, there have been 5.1 deaths per million citizens. In Hong Kong there have been 0.5 deaths per million. In Australia there have been 4.1 deaths per million citizens. In Taiwan there have been 0.3 deaths per million. In Thailand there have been 0.8 deaths per million citizens. In Japan there have been 6.3 deaths per million citizens. In New Zealand there have been 4.3 deaths per million citizens. Again, in China there have been 3.3 deaths per million. Again, in the US there have been 299.5 deaths per million. Which of these ones is not like the other? Other than the US, all those other nations have been laser focused on one huge project: using "test, trace, treat" to prevent mass illness and mass death. As an objective fact, it appears to be working. Now, some might say, "A swab up my nose? That ideas sucks! I think that whole 'hospital/ventilator/my dead body in a frozen meat truck' thing sounds way more cool." So herd immunity is a perfectly legitimate choice. But just be aware that it means that instead of 1 or 2 or 3 dead per million Americans, it means 4,000 to 10,000 dead per million Americans. Those numbers are based on fatality rates of 0.4 % to 1 % - which is the rate the CDC and JP Morgan both have a ton of very solid research around. To put this in perspective, if China had 300 deaths per million like the US currently has, instead of only 3 per million, it would mean 418,000 more dead Chinese. That's what the merry road to herd immunity would look like in China, right now, if it were just like the US. Instead, they've had 5,000 reported deaths. So I kind of understand why all those countries decided that "test, trace, treat" just sounded better than herd immunity. If Australia had deaths per million like the US, right now, that would be 35,000 dead Aussies. Instead, they've had 102 actual deaths. Go figure. Does it makes sense that herd immunity is not "inevitable"? Because if it were inevitable, we would know that. There would be at least hundreds of thousands more dead people now in all those countries I named. At fatality rates of 0.4 % to 1 %, if we want herd immunity it means the US needs to sort out how to have between 1.3 to 3.3 million dead people. And we have to factor in that your Black bus driver with diabetes and your middle-aged Hispanic Walmart employee and your aging Gay man who has a housekeeper coming in every week are gonna be the ones that get hit hardest. Then again, we could choose to do that whole, "Okay, God damn it. Give me that swab up my nose" thing. One way or the other, these are all choices citizens are making. There is nothing "inevitable" about herd immunity.

Anybody who wants to have a reality-based discussion about the relative merits of herd immunity versus "test, trace, treat" as a way to contain the virus might also want to consider where the American people are at in a new poll on this question. In a way, this makes @bigjoey's argument about "group think". You can make a reasonable argument that if 78 % of Americans will quickly support another mandatory lock down if there is a second wave of infection, that is "group think". That said, it is also reality. Maybe 78 % of Americans are wrong. But if you believe that, and you want to change their minds, you better have pretty solid arguments, driven by lots of facts. I think it's fair to say that herd immunity advocates are not only saying that a second wave is inevitable. They are actually arguing it is desirable. The point of herd immunity, in their mind, is to be done with it. So they tend to go a little bit, but not very far, down the road of talking about how we can offer "special protections" to certain vulnerable people during a second or third or fourth wave. Meanwhile, everybody else just shakes COVID-19 off without really breaking a sweat. It's a perfectly fine argument to make. But it isn't based in reality. First, most Americans just don't see COVID-19 as a "shake it off" disease. Second, if and when the virus comes back in full fury, Americans are already saying loud and clear that they are not going to vote for herd immunity. At least not right now. I think this is a very important part of the discussion. I have come to deeply resent being told that I am somehow against a Black grocery store clerk or a Polish American factory worker or a Hispanic bus driver being able to go to work. I'm not. It's actually the grocery store clerks and the factory workers and the bus drivers that are saying - very loudly, and very clearly - that they want to be able to go to work. But without getting sick, or being hospitalized, or dying. The only way in the world we know how to do that is test, trace, treat. Sweden is trying a somewhat different route. But so far what they have to show for it is more death than their neighbors, but no better an economy. One of their main ideas - keeping seniors in nursing homes safe - has been a spectacular and lethal failure. They admit that. To me, reality is telling us what we need to know, and do. Whether meat packers even are aware of the dangers of COVID-19, what happens in reality is that when a bunch of them start to get really sick, and end up cramming ICU units, somebody actually does need to do something. So what does somebody do? Get on a platform and tell everybody, "Hey, folks. We're gonna do herd immunity now. It'll be great."? No. That does not happen in the real world. In the real world, they shut down the factory and cart out the test, trace, and treat protocols that are working everywhere else in the world. That is not a theory. That is what happens in the real world. In Sioux Falls, South Dakota. Now they have figured out that it is better to do it pro-actively. That way they can hopefully avoid having to shut the factory down, or have an ICU full of sick people. We have no clue whether this idea of testing and contact tracing and marginally improved treatments will work for six months, or a year, or two years, or however long it will take. But we do know it is working now. Meanwhile, we have absolutely no clue whether anyone who got sick from COVID-19 in the last few months could get sick again next Fall or next Spring. All these herd immunity theories are completely untested. The 100,000 deaths are real, and happening right now. The theoretical herd immunity pay off is simply a theory. And if it happens, it happens somewhere down the line. No one can really tell us when, or how. So when I read that 78 % of Americans will respond to a second wave by demanding another lock down, it makes perfect sense to me. Maybe if the herd immunity folks had better and clearer arguments, Americans would feel differently. But based on what they know now, it is incredibly clear that they simply don't want to take the risk of letting the pandemic play out however it happens to play out, like in 1918. Given all that, for people who DO NOT want another lock down, like me, there is really only one practical choice. We have to do everything we can to make testing, tracing, and treating work. It is the best practical hope we have in the real world we actually all live in to avoid a second lock down, when the virus tries to come back in a fury. Fortunately, this approach is actually working relatively well, at least for now, in the real world we actually live in. And when it fails, it is not hard to figure out why. Singapore was doing a great job. They had the best somewhat invasive phone app ever. Oh, but geez. They simply forget they have all these crammed dorm rooms with low-wage immigrant workers that might spread the disease. Oops. And when you have low-wage workers, letting them all get sick and having a lot of them filling up hospitals beds and ICUs is not viewed as a good outcome. So Singapore screwed up and learned from their ignorance, as did the rest of the world. That is how trial and error works. If the herd immunity folks can come up with a better plan than this, go for it. Let me say it yet again. We have ZERO guarantee that what Iceland or Germany or South Korea or Singapore - or Sioux Falls, South Dakota, for that matter - is trying to do is going to work in the long haul. Maybe there is a better way to do it, by letting hundreds of millions of Americans experience what Tom Friedman calls "harmonious balance". Here's a news flash. Americans are not stupid. So if you want them to buy into "harmonious balance", Tom, you really do need to spell out what it means.

I completely agree with that point, as well. Which is why I agree with the idea that "group think" is inherently bad, and should always be challenged. Let’s Remember That the Coronavirus Is Still a Mystery That article by Nicholas Kristof is a nice reminder about humility. His main point is that the real experts are the ones who are being very clear about how ignorant they are right now. Because this is a brand new virus. I think it is now clear that Fauci himself was blindsided by how contagious this virus was in January and February. At the time, he talked about how the few cases that were going on in the US were being tested and contact traced. He specifically said at a few points that it was unlikely that asymptomatic people would be speading the disease widely. I'm not in a position to say Fauci was wrong. Fauci himself was in a position to say he was ignorant, and we all need to have more than a little humility. I think airplane travel is a good analogy for where we are at right now. People won't get on airplanes if they think the plane is going to crash. So, like it or not, poll after poll shows that most people are not going to go out to eat, or out to a mall, or out to a movie - even if they can. This is no surprise to me. In California, business is way down among the carry out restaurants I've gotten food from. It shocked me at first. These are carry-out places that should be thriving in these circumstances. No one is locking them down. No one is telling me I can't go patronize some small business that sells pizzas. And yet, for some strange reason, their business is down 50 % or 75 %. Can anyone guess way? Could it be that people simply don't want to die? Even if it means leaving their house to get a pizza they don't really need? Sorry, but I'm a capitalist. That's the free market speaking. Most economists agree that until we contain this virus, the economy is fucked. Period. If you follow the airplane analogy, that means we do not have two choices, which really sucks. And we do have two choices, neither of which are very appealing. The choice we do not have is normal. Most people get on planes every day and don't think much about whether it will crash. "Normal" actually depends on an almost total absence of fear. And "normal" also actually depends on having a huge army of air traffic controllers and pilots and engineers and a massive government bureaucracy, all of whom are quite disciplined and very good at doing what they need to do: make flying safe. It works great most of the time for flying. But we simply do not have that option now. Nor do we have the option of not flying at all. If you are a Black woman with kids who works at a grocery store, you actually have to go to that grocery store. First, you need work. Second, you need food. In Georgia right now, there are more Blacks than Whites that died of COVID-19. So this stupid elitist "health versus wealth" debate might be interesting for affluent Gay men who don't have to go to work. But it's actually not even a real option for Black women who work in grocery stores. Or Hispanic minimum wage workers. Or, of course, White factory workers who take the subway to work. So they want to go to work in a meat packing plant. They need the job. But they don't want to get sick or be hospitalized or die doing so. That is a very reasonable expectation. And these Black women and Hispanic men and factory workers also probably understand that they are the part of the herd most likely to be "negatively impacted" by "herd immunity" . I use the euphemism "negatively impacted" because part of my point is that these "herd immunity" advocates should cut the bullshit and be clear and honest, like Dr. Fauci and Dr. Birx are being. Fauci and Birx said, honestly, our best guess is a couple million Americans will die. The author of the screed @bigjoey posted is perfectly willing to score points slamming Fauci as an unelected pinhead. Good for him. The author has that right. But he actually won't spell out what "herd immunity" means. Or what impact it might actually have on Black women or Hispanic men or seniors who fear death. So that leave us only two options. We can fly blind, by choice. Or we can try very hard to build the airplane controls while we are flying it. Either way, the polls are telling us reality, and we should believe it. Depending on the economic activity, 60 % or 70 % or 80 % of Americans WILL NOT do it. They just won't. They don't want to be on a plane that is flying blind, or that is under construction as it is flying. They would rather stay home. Meanwhile, you have countries like Iceland and Germany and South Korea that are, in fact, building the plane as it is in the air. And what they are doing is actually very similar to what we know works with airplane safety. They are using similar tools. They are building armies of testers and contact tracers. They are building or expanding links between private for-profit corporations (like drug companies) and government bureaucrats (like contact tracers). And what they are finding is that they can incrementally whittle away at the number of citizens infected by disease. They are using the same kind of daily rigor and discipline that happens every day all over the world so that you and I can safely board an airplane and fly. Except normally we don't think about any of what it takes to make that work. Unless we go see a movie like Sully. Now, it could very well be that everything I just described is a fantasy. It could be that what seems to be working in Germany or South Korea or Iceland - oh, and let's not forget China - is simply doomed to fail. Sorry, but the "test, trace, treat" airplane is going to crash. It is doomed. That is exactly why I keep reading these herd immunity articles. I know enough to believe, like most Americans do, that it is a bad choice. But what if it is our only choice? What if @bigjoey is right, and we are going to have a second and third and fourth wave? (By the way, that is exactly what Fauci and most scientists are saying.) Has anybody ever heard of Tom Friedman? Has anybody ever heard of the New York Times? If Tom Tom Friedman writes something in the New York Times, is that what we call "censorship"? The reason I ask is that the author who wrote @bigjoey's screed is using what I view as a lame and bullshit rhetorical technique. He is whining about how people like him, who are willing to tell the truth about herd immunity, are being censored. Sorry, that is 100 % bullshit. Friedman keeps writing op/eds about the beauty of herd immunity, and I keep reading them. I agree with Freidman 1000 % that we should be having an honest debate about the idea. And we are. When he keeps writing about it in The New York Times, that is not what I call "censorship". It is actually because I read what Friedman writes that I have a very, very, very bad feeling about herd immunity. Friedman likes to use the phrase "harmonious balance" to describe the beauty of herd immunity. On the one hand, younger employees who face no real risk from COVID-19 should be free to go to work. On the other hand, at-risk seniors or people with diabetes or pregnant women should be given "special protections" to keep them safe. Who could be against harmony? Who could be against balance? There's a few big problems. There's a 41 year old NYPD cop with a widow and orphaned kids. There's a Broadway star who is young and healthy in an LA hospital with no leg and ruined lungs. There's a huge meat packing plant in Sioux Falls full of young workers who got sick, or were hospitalized, or in some cases died. And the way they are trying to solve the problem in Sioux Falls is aggressive testing, tracing, and treating - exactly what is working in Iceland, and Germany, and South Korea. So unless Tom Friedman wants to talk about all that, he is really only talking about a comic book reality. Not the real world where 100,000 Americans are actually dead. The even bigger problem is that senior experts say that COVID-19 is a brutally effective senior killing machine. If Friedman has spent time in nursing homes, it was a drive by. He has no clue. He does not articulate what "special protections" he would offer seniors, or how they would work in practice. He does not articulate how the army of college students who serve food or clean floors, or the army of young Moms who change senior diapers or dress Mom and Dad, would somehow be tested so that we knew they were not the weak link in the chain. Meanwhile, the reality in every nation on Earth that Friedman simply ignores is that wherever there is a community where the virus has spread broadly, it is always effective at finding seniors and killing them. It finds and kills seniors in nursing homes, at home, at work, or wherever they are. Friedman just won't deal with that reality. If we are going to debate herd immunity, this is the real debate should have. Sorry, but Tom Friedman spouting about "harmonious balance" in The New York Times, when reality is 100,000 dead seniors, is my definition of out-of-touch elitism. He is not being censored. But he is also not being honest, in my opinion.

I did read the entire article, multiple times. I've read all the articles you've posted on herd immunity, as well as many others. Like the author, you won't spell out what herd immunity actually means. So, like him, you seem to want to lob bombs at respected people like Dr. Birx and Dr. Fauci. The author trashed the idea that we might have had 2.2 million dead Americans, had we done nothing. Which is, of course, what Fauci and Birx said. He has every right to trash them. So do you. And I agree with you that questioning "group think" is always a good thing. But if you are going to do that, you actually have to spell your alternative out. Now what you are doing is mirroring the intellectual dishonesty of the author. "Oh me, oh my. I'm being censored. The media won't let me speak." Nobody is censoring you, @bigjoey. If you won't spell out what herd immunity means to you, and why you think it is worthy of consideration, you are only censoring yourself. But since you won't spell it out, I will. The author speculates about certain outcomes, which he still fails to spell out numerically - perhaps because he actually understands how bad they sound. So let's actually look at what he says. There's a lot in that article, but I think those paragraphs spell out the core of the author's case for herd immunity. And I'll repeat what I said above. One very good reason to think about this is that a second, or third, or fourth wave might be inevitable. Maybe Jacinda Arden is really only good at talking about easter bunnies and tooth fairies. We just don't know. As optimistic as the lessons from many countries look, they are hardly proven science. So, again, I'm 100 % with you on the idea that group think is bad. I do find it interesting that the author cites only one other nation - Iceland. It's easy to dismiss Iceland, since they are tiny. What the author does not mention is WHY Iceland was so good at testing. They actually ended up testing 18 % of their population so far - not 5 %, as the author cites. The goal in Iceland is NOT herd immunity. It is the exact opposite. They tested and traced in order to stop the virus, not to let it continue on its course and kill more people. And they have beat the virus. Check out the numbers. These are facts, not theories. That have had a total of 10 deaths. They are now down to one reported case a week. That's not promoting herd immunity. That's the exact opposite. Relative to population, Iceland has had 29 dead per million. Sweden has 384 dead per million - which is about 13 times more death. Oh, and Iceland's economy is actually doing better than Sweden's. They never had a lock down, because they got ahead of the curve. So if your point is we should have honest intellectual debate, I'm 100 % with you. Let's debate facts. But these are all the relevant facts. How many died? What impact did it have on the economy? Was a lock down necessary? If you want honest debate, these are the facts we need to debate. What Iceland has done is one example of a national success that suggests mass death and illness is simply not necessary. The author is entitled to his own biases. But why would he fail to mention Iceland's success? And let's spell out the very dark picture he paints of New York and the US, without really telling us the details. Because, again, he might be right. Maybe we will have a second and third and fourth wave. So his point is that New York City achieved 20 % herd immunity. Let's go with that. That came at a cost of 20,000 deaths, if I use the NYC data - including people they say died at home. I am going to assume that herd immunity means 60 % infection, which is probably low ball. The author should spell that out, but he doesn't. So, assuming he is right, a second and third and fourth wave of infection that finally achieves herd immunity would mean 60,000 dead in New York City - again, assuming herd immunity is achieved at 60 % infection. If we assume 80 %, it's of course 80,000 dead. Extrapolating to the entire US is easy. The population of the US is about 40 times the population of the NYC. So if it takes 60,000 dead in New York City to achieve herd immunity, that would mean 2.4 million Americans. Which is in the ballpark of what Fauci and Birx said (2.2 million). What happened in New York City - in the real world, not theory - actually confirms that the horrific numbers Fauci and Birx used could actually happen. Now let's do the same thing with Iceland. They had 10 deaths in a country of 364,000 people. I'm going to use very simple math and say there are about 1000 Americans (330 million) for every Icelander. So the equivalent number of deaths in the US would be 10,000. Meaning that if we had the option of doing what Iceland did, and used very aggressive testing and tracing to contain the virus and avoid the herd immunity route, it might have meant 10,000 Americans died, rather than 100,000 and growing. And, critically, Iceland has NEVER HAD A LOCK DOWN. Again, the lock down is of course NOT the goal. The goal is to stop the virus from sickening, hospitalizing, and killing an unacceptably high number of people. Lock downs are blunt instruments. Testing and tracing are more refined surgical tools. So you can tell me if you think I am being unfair. But I am using real numbers based on real deaths in real places. I think what this means is that had we done what Iceland did, we might have had 10,000 dead Americans before we stopped the virus. If we instead assume we need to play out NYC all over America, and add a second and third and fourth wave until we finally achieve herd immunity, it could mean something like 2.4 million dead Americans. If you think I am not being honest or fair, please let me know how. But if you are going to promote herd immunity - either as a choice, or as an unfortunate inevitability - you ought to be willing to actually spell out what it means to you. I just did. You simply won't.

I'll take your use of the little emoji as a statement of your lack of real intellectual curiosity, or intellectual honesty. If you want to have a serious discussion about herd immunity, go for it. One very good reason to have such a discussion is that I will be the first to admit that I have ZERO proof that China or Germany or Australia or Austria or Iceland or South Korea or Taiwan or New Zealand know what they are doing. Maybe it is really just bullshit, easter bunnies, and tooth fairies. Maybe, like in 1918, it is going to work out that it it is simply impossible to avoid a horrific level of mass death and illness. Maybe this Fall we'll be burying people in our backyards, like families did in 1918. Or maybe we could stop the virus, but it would be at a cost so high that it isn't worth it. The idea that 100,000 dead seniors is acceptable is implicit in all these arguments about how the lock downs were a mistake. I think it's pretty factual to say that if we had no lock downs, we would have had many more dead. But then when you say we could have had 2 million dead, the critics say, "Oh, that's just bullshit. Who elected these scientists? Who elected Dr. Birx or Dr. Fauci?" So if you don't want group think, fine. But then you have to be honest. Fauci spelled it out. Birx spelled it out. That number 2 million comes from a lot of people, including them. It is simply not intellectually honest of you to say that herd immunity is a good thing, and we should seriously think about it, without spelling out what it actually means. How many dead? How do we know herd immunity even exists? When do we find out how long antibodies give us immunity? And how many people will be dead by that point? You keep saying you want an honest discussion. So let's have it. Spell it out. These are very fair questions.

So what is an acceptable number of dead Americans to you? 500,000? 1 million? 2 million? You seem to like articles that have almost nothing to do with reality, and that never talk about actual dead people. So if we are focused on data, here's the data: we have 100,000 dead Americans, mostly seniors. Oh, by the way, the article you posted seems to overlook that minor fact. How much bigger do you think that number should be? 500,000 dead American seniors? 1 million dead American seniors? You are speaking out against "group think". Good for you. I'm with you on that. Group think is bad. So please be clear. Don't be an intellectual wimp. Tell us the truth. How many dead Americans is herd immunity worth? I think herd immunity means 2 million dead Americans, mostly seniors. Is that worth it to you? Should our goal be to promote herd immunity, at the cost of 2 million dead Americans? Is that your idea? Again, you don't want group think. You want clarity, and reason, and fact, and honesty. So give us clarity, and reason, and fact, and honesty. The articles you post are pretty much devoid of honest, factual presentations. Nowhere does the author bother with the tiny little fact that at least 100,000 Americans, mostly seniors, died in two months from COVID-19 - despite an unprecedented lock down. Nowhere does the author deal with an honest discussion of the alternative - test, trace, treat - that has been used everywhere in the world. The author bad mouths China, but doesn't mention that they actually did stop the virus, and have a fraction of the deaths in the US. The author praises Sweden's herd immunity plan, but fails to mention they have actually had a rate of death double or triple that of their neighbors, Norway and Finland. Oh, and the economy of Finland and Norway did better than Sweden's economy, too. My simplistic theory about that is that dead people and sick people just don't go shopping. So what exactly is the thing Sweden did that we are saying is good? Killed more seniors? Had a shittier economy than Finland and Sweden? Spell it out, since the article you posted doesn't spell it out at all. It just posits theories about how much herd immunity Sweden may have achieved, without bothering to mention the pesky little details of dead older Swedes. And since we are being honest and factual and not engaging in group think, what is the death toll in Sweden that you think makes herd immunity worthwhile? My own view is that you are the group think guy. Just about every country in the world that has tried has shown that some combination of lock downs, suppression, targeted closings, and especially testing, tracing, and treating have gotten the virus under control. The countries that did it best actually never had to lock down their economies, because they were way ahead of the global curve on getting the virus under control. Again, key point. Countries like Taiwan and South Korea and Iceland that avoided lock downs and focused like a laser on testing, tracing, and treating did not do it to promote herd immunity. They did it for exactly the opposite reason. Their goal was to prevent death and illness, which it works out is bad for the economy. That is why the economies of countries like Taiwan or South Korea or Iceland -and, importantly, China - are doing better than most others, including the US and Sweden. Herd immunity turns out to be bad for the economy, not good. Lots of medicals professionals and scientists actually object to the use of the term "herd immunity" in the context you keep using it. Their point, which is valid, is that scientists came up with the notion of artificial herd immunity through the use of safe vaccines. And the word safe is critically important, because nobody likes the idea that the cure is worse than the disease. This idea that it is somehow a good thing to let a lethal disease sweep through a society is actually a pretty rare idea. To the degree it was even speculated about, like in the UK, it went down very, very badly. Thee seems to be an emerging global consensus (aka "group think") that "test, trace, treat" - also known as prevention - is better than the mass illness and death that natural herd immunity requires. The author fails to mention how the idea of letting a disease sweep through a society and kill some unknown (500,000? 1 million? 2 million?) number of people is a real intellectual outlier. Most doctors I don't know don't set out to see people get infected, or hospitalized, or end up dead. Your author is honest enough to mention that there might be one little problem with herd immunity. Which is that it doesn't exist. Like most of the stuff you post, it is comic book in nature. Great theory. Nice stories. Fun to read. But pretty much devoid of facts. If it turns out that in the real world there are 100,000 dead Americans while we speculate about whether antibodies actually will protect people, or for how long, you wouldn't know that by reading your comic book fantasy. If you have any actual data about actual deaths, actual GDP, that suggests that herd immunity is a good thing, or anything other than make believe and abstract theory, please share it with us. I am 100 % with you that group think is bad. I am 100 % with you that we should be objective data seekers. But when you keep posting vague articles that fail to mention that 100,000 Americans actually died, and it also don't honestly say that 2 million more Americans will die, it's not being very factual or honest. The author does mention 2 million dead Americans, but only by way of trashing honest people who did put forth estimates of how NOT mitigating the virus wouldkill millions of Americans. So I don't buy it, @bigjoey. You have a tremendous capacity to just overlook actual mass death, as if it is some small thing that doesn't matter on the way to exploring some wonderful comic book theory. I posted the data from The Netherlands on actual deaths by age cohort. I said that if you played those death rates out in the US, 2 million Americans are going to die to achieve herd immunity. Almost all of them are seniors. And that's a death rate of about 0.6 %, which is actually on the low side of what most people, including Dr. Fauci say. So I am being honest, and taking an honest non group think position. Herd immunity means 2 million dead Americans. Herd immunity also means a work force of younger adults that is sick, hospitalized, and in some cases dead. None of these comic book herd immunity fantasies come within a mile of explaining how a crippled and sick work force is good for an economy. Meanwhile, I don't need to theorize about how crushing a virus through testing, tracing, and treating is good for an economy. All I need to do is point to China, or Germany, or Austria, or Iceland, or Australia, or South Korea. Those are not comic book theories. Those are real nations, with almost no real COVID-19 deaths. So please, explain to us how the reality of those 1 billion + real living people fits into your pro-death comic book herd immunity theory. Spell it out. How many people do you think need to die in the US to achieve herd immunity?

Yes, it's just one case. We should not focus on just one case. United States Coronavirus Cases: 1,613,950 Deaths: 96,018 That guys is a hero for being willing to tell his story. And - duh! - I doubt his goal was to fuck up the economy or scare people. I suspect his goal was to focus on what we can do to avoid being intubated for six weeks and losing 50 lbs. I'm still wondering how it helps the economy for nurses like him to be hospitalized for six weeks. As opposed to in a hospital working, helping people get well, and going to the beach with his friends. Isn't the goal supposed to be to make it so that we can actually make the economy safe, so we can go to work and play without getting sick or being hospitalized or dying? Be a pal, Shill. I don't know anybody who has been in a hospital on tubes for six weeks and lost 50 pounds. Maybe if you feel this is much ado about nothing, you could trail blaze for us and try it out and let us know how cool and sexy it is. Then you can also explain to us how you being out of work and in an ICU helped the economy, too. Because I just really don't get how mass illness and death is good for any economy. I do get that the countries that have had the least economic blow did so by getting way ahead of the curve. That is why nurses like him didn't get sick, and didn't have to spend six weeks in an ICU, fortunately surviving.

An interesting study I missed when it came out a few weeks ago: The article that paragraph comes from is mostly a Stanford study that provides "evidence" that perhaps COVID-19 is no more dangerous than the flu. At this point, I really don't think it's possible to take that argument seriously. New York and New Jersey have now both had about 10 times as many deaths, in a few months, as they normally have from the flu every year. And that is after an unprecedented lock down to suppress the spread of the disease. So after that, and Spain, and Italy, and France, and pretty much the entire world's experience, the idea that this is no more dangerous than the flu is both laughable and tragic. It just invites death, by keeping people off guard to a lethal menace. It's not clear what is going on with some of these studies that come up with seemingly absurd results, like maybe the death rate is 0.02 % or something like that. My guess is they are doing antibody testing on very small segments of populations. And when you are testing a small group to reach conclusions about large populations, a few false positives or false negatives can screw the numbers up. For that reason, I think that Spain study is much more noteworthy, as the article I cited is honest enough to point out - even though it undercuts some of the absurd arguments the article makes. The Spain antibody study tested a whole bunch of people in a country that was really hit hard. So whatever testing errors they might have had would have less impact on the final outcome. The Spain study squares with the fairly large New York antibody testing study that was done last month. For the same reasons, the New York study is likely to be the most accurate of the antibody studies done in the US to date. That study estimated that 14 % of state residents and 21 % of city residents had been infected. Based on those estimates, they extrapolated a 0.5 % statewide fatality rate of all those infected. At the time the study came out, I checked the number of deaths in New York. If 21 % of New York City residents were infected, that would be about 1.7 million people. There's about 20,000 COVID-19 deaths in NYC now. But if I recall at the time the study came out, it worked out to about a 0.6 % fatality rate in NYC based on the number of state-reported hospital deaths at that time. NYC was also reporting that another 5,000 probable COVID-19 deaths had occurred at home. If you included those, the fatality rate was just about 1 % of all 1.7 million people estimated to have been infected. The best abstract studies, like in the Lancet, have used numbers like 0.67 % for a few months. Fauci keeps saying about 1 %. So I think we now know enough to say somewhere in the ballpark of 0.5 % to 1 % makes sense as a range. The 1 % figure - or a bit higher - particularly makes sense if you factor in pandemic conditions. Meaning mass illness, ICUs filled to capacity, people dying at home. Those things actually occurred in New York City and Spain. That is, in fact, what lock downs were intended to avoid, or end. So it would make sense that the fatality rate would end up higher in NYC or Spain than in a place like Germany, or California, or Australia, where hospitals were not under similar extreme stress or overcapacity. Add @Unicorn's point about unrelated and potentially fatal outcomes- like heart attacks or gunshot wounds - and it only aggravates the state of emergency more. If you count people who unnecessarily died of other causes because they could not got adequate care, either, then the death rate just goes higher. I think the worst case scenario now is "flatten the curve". Meaning most of us will get sick of COVID-19, and whoever is going to die will die. And the very best we can hope for is to manage it so it is the minimum amount of hell it has to be for hospitals, doctors, nurses, and patients. For whatever reason, it is clear to me that some minority of people are going to be pessimists. They believe that the only way out of this is what worked in 1918. Meaning people will have to get sick, and in some cases die, until the virus just can't find enough people to sicken or kill anymore. I'm increasingly optimistic based on the experience of most of the rest of the world that 2020 is not 1918. We actually know what viruses and vaccines are now. So Europe and Asia and most other places clearly have decided that they think they are smart enough to take shelter and wait out the storm. Yeah, it sucks for the economy. But it's actually probably less sucky for the economy than a full blown pandemic, with 2 million or so dead Americans. The real winners in this game of Russian roulette are the countries that have either avoided lock down for the most part, or had short but intense lock downs that crushed the virus quickly. All the winners have become masters of the protocols of test, trace, treat. I think California, Ohio, Texas, and Florida are the states to watch. Nothing against the other 46. But they are not states that were already crushed, like New York or New Jersey. They are large, and diverse. And they all have managed this crisis about as well as Germany, which for whatever reason did one of the best jobs of the larger European nations. So my guess is that a lot of what we are going to learn about dealing with COVID-19 is going to be learned by the best practices in those states.

How many people was that? New York City is estimating about 5,000 people died from COVID-19 at home, who are not accounted for in the state's hospital death totals. Whether they were too sick to go to the hospitals, which were basically crushed by demand, or too afraid to go, who knows? The TV images showed long lines of people waiting to get into hospitals because they were sick. The death totals from New York (and many other hot spots) show a huge spike in deaths above long term averages, even after accounting for all the diagnosed COVID-19 deaths. Meaning, the COVID-19 death totals in these hot spots are very likely low ball figures. It was even worse than we thought. Obviously having a stroke (which could be related to COVID-19, actually) or getting shot or being in a car crash in the middle of this mess in New York City is part of the reason that the lock downs occurred. The hospitals knew they were going to be crushed. And they were. It could happen anywhere. It completely filled the ICU's in Sioux Falls, SD, of all places. Who'd have thought? Wasn't this ONLY supposed to happen in big cities? What were people who had heart attacks and strokes in Sioux Falls supposed to do? I'm not completely sure I understand your point. Are you saying instead of a lock down in NYC, it would have been better if 50,000 or 100,000 New Yorkers fell ill and died? Would it have have made it easier for people with gun shot wounds or car crash injuries to get treatment if the hospitals were so crowded that people were dying in hospital hallways? Is that your point? If it's not, what is your point? If your point is that people with normal reasons to urgently need an ER - like a heart attack or a gun shot wound - are going to have a huge problem all through 2020, at a minimum, if we let this virus run amok, you are correct. That is an excellent reason to control the virus, like most European countries now have. Italy is generally thought of as a country with first rate hospital care. That wasn't how the people who worked in those hospitals felt a few months ago, though. In fact, some of the doctors and nurses got sick and died of COVID-19 themselves. Now, hopefully, with the virus controlled through testing and tracing, they can get back to providing first rate care for the people who need it for the "normal" reasons. I hope you are right that Georgia is going to open in a way that does not bump up the infection rates much. As @bigjoey said already, it is too early to tell. That said, I think one of the biggest indicators that "it can and will happen here" is if people are thinking "it can't happen here". Conversely, the single most important lesson from Europe in that article I posted above seems to be that we don't need to fly blind, and we shouldn't fly blind. Iceland and South Korea are perfect examples, among many, of countries that very wisely used testing and tracing precisely so they could avoid lock downs. There's no question that complete lock downs are more blunt object than surgical intervention. It is the equivalent of amputating a leg rather than healing it. At this point in the game, we should be smart enough and prepared enough to be using these more surgical tools to control the virus, like other countries all over the world are doing. As Dr. Fauci and Dr. Birx and Dr. Frieden and many others keep saying, that is actually the point of the lock downs: to get prepared to fight the virus smarter and faster.

A very handy summary of what has happened so far in Europe. The Results of Europe’s Lockdown Experiment Are In The article raises a bunch of interesting questions about why individual countries had the outcomes they did. I strongly agree with the main conclusion the author reaches: I've viewed this "health v. wealth" debate as bullshit from the beginning. Most scientists and economists seem to agree: the economic problem is being driven by a public health problem - a lethal virus. So if you want to deal with the economic problem, you have to deal with the public health problem. You have to control the virus. Period. So the real question is: how do we best control the virus? Lock downs are supposed to be a crude and almost desperate step. The best play is to move quickly and smartly. Most citizens of every country I've seen surveys in strongly agree that this is the right way to look at the problem. In the US poll after poll after poll shows that the public places safety and health first. People are more worried about ending lock downs too early than rushing to reopen things and allowing the virus to come back stronger than ever. That said, what is absolutely clear is the the countries that got their shit together the quickest had the best outcomes. Meaning that lock downs were shorter and/or less severe. Iceland and South Korea are not on that list, but I don't think they even had a full lock down. They are two of the poster children for how to test, trace, and treat the virus into control. This article also confirms the impression I've had that Germany and Austria also did better than most countries. My sense is that both countries were very good at messaging and getting the public on board. Austria in particular was very stringent, from some of the anecdotes I read. But I think that the idea they got across effectively is that this has a beginning, a middle, and an end. It will not last forever. And the more everybody cooperates and does what they need to do the quicker and safer we will be able to leave our homes again. I think it worked. Implicit is all of this is the idea that none of these countries, except possibly Sweden, are going for herd immunity. They are obviously going for containing or suppressing the virus until a vaccine confers artificial immunity, and then (hopefully) things can really start to get back to normal. The chart shows death trends, not cases. But in all the big countries cases loads are now down by 90 % or more. So all of them are showing that even when the virus was completely out of control, like in Italy and Spain and France, it can seemingly be put back in the bottle. That said, the article is exactly right that the smartest move was to never let the genie fully out of the bottle in the first place. One thing this article doesn't speak to is the intensity of how quickly the pandemic seemed to hit in some of these places. My impression is that Italy had to lock down quickly, because within a matter of days they were literally in a horror movie. They actually started the lock down in one part of the country, and then quickly expanded it. It at least felt while it was happening like "desperate people do desperate things." They were the first Western country that got hit really hard without knowing what was coming. Meanwhile, my impression is that Germany had the advantage of having at least a few weeks before their first big wave hit. They seem to have used the extra time they had very wisely. The chart in this article does not reflect this, in that it shows Germany having its first case slightly before Italy did. But as it was happening there was no question that it seemed like Italy was where all hell was breaking loose all of a sudden. This article makes me want to learn more about what both Germany and Austria did. Meanwhile, it's no surprise that the UK (and the US, which is not on the chart) fared the worst in terms of deaths. Both countries lagged in getting their shit together. The comparison between the Nordic countries raises lots of questions, too. The data shows, no surprise, that Sweden fared worse than its immediate neighbors in terms of deaths. None of the Nordic countries fared all that poorly economically, compared to Spain or France or Italy. What is also interesting about the charts in the article is it appears that even though Norway and Finland had more stringent lock downs and therefore far fewer deaths, they actually took no economic hit. They appear to have done slightly better economically than Sweden. This data reinforces what appears to be a growing wall of data that the sweet spot, which is found in places like Germany or South Korea or Australia, involves acting quick and smart to get the virus under control, and then using a very aggressive testing and tracing program to keep it under control. As far as the economy goes, it is very clear that if you get to the point of New York City, you are fucked. Nobody is going to go to Starbucks, even if it is open, if they know that outside every hospital is a refrigerated truck with dead bodies in it. But the flip side is that the people arguing that they should just be able to ignore everything because I live in Bumblefuck and we don't have that virus here are just wrong. Sioux Falls didn't have the virus, either, until a few meat packers started to feel sick. Before they knew it the meat packing plant was closed, 3000 people had COVID-19, workers were dying, and the ICUs in the local hospitals were completely full. So any Bumblefuck in America or the world can have the misfortune of finding themselves in a big fucking mess of death and disease in a matter of weeks, if they want to try flying blind. That is also part of the clear lesson. This is encouraging. As the author notes, we ought to be able to get smarter and smarter at beating the virus as we go.

The context of my comment about Sweden is that Anders Tegnell is much better at stating theories than facts. And his theories don't hold up so well in practice, we are learning. We can only speculate about his theories about herd immunity. But I think we know for a fact that his theories about "special protections" for senior citizens just don't work. In theory, I think senior citizens should be able to live forever. That sounds very nice in theory, doesn't it? And it sounds very nice when Tom Freidman, the US version of Anders Tegnell, pushes the idea of bubble wrapping seniors for a year or so. He calls it "harmonious balance". Sounds wonderful in theory, right? Who could be against harmony, and balance? The problem is that senior citizens don't actually live forever in practice. So as much as my theory that seniors should live forever sounds nice, it just never works. And other than sounding nice, "special protections" for seniors does not work in practice, either. Again, it didn't work in France, or Italy, or Spain, or New York City, or anywhere. I think it is fair to single out Anders Tegnell and Sweden. Unlike those other places, which were suddenly hit by a tidal wave of death they did not anticipate or plan for, this was actually planned for in Sweden. I could post many endless walls of text about how this worked in practice with my Mom and Dad in nursing homes. It just makes no sense. It is bat shit crazy. If these people ever spent serious time with a loved one in a nursing home, it sure doesn't show in their theories. Who puts the plate of food in front of Mom? The minimum wage college student? How do we know they are not asymptomatic? Who hands Dad his meds? The nurse with two kids at home? She tested negative two weeks ago, but how do we know her kids didn't bring COVID-19 home from school two days ago? And, sorry, you have to have lots of people that put the fork in Mom's mouth, and dress her, and lift her on to the toilet seat or change her adult diaper. I don't even think it's fair to blame these deaths on the nursing homes. I have a huge amount of respect for the people who work in those homes. What does "special protections" even mean? These are mostly skilled women with good hearts who work hard and don't get paid all that well. If Tom Friedman wants to talk about "special protections", he should go feed seniors and clean up their shit in a nursing home for a few months. Then I'd like him to explain, in detail, what "special protections" actually means to him. If we are going to be honest about herd immunity, I think we need honest vocabulary. So we should not be talking about "special protections". We should be honestly talking about the "special deaths" and "special pain" seniors get from COVID-19. Here is what "special death" looks like in the UK: This is happening all over the world, wherever there is a COVID-19 hot spot. Even when you factor in the huge spike in deaths from COVID-19, there is still a gap between COVID-19 deaths and the total increase above average deaths. In the UK, that worked out to be slightly less than 15,000 "extra" deaths not diagnosed as COVID-19 in one month in the chart above. In New York City, the estimate is that about 5,000 additional people, mostly seniors, experienced "special deaths" from undiagnosed COVID-19 in their home, probably alone. In some cases in New York City, people figured it out when the body started to stink. That's what COVID-19 "special deaths" are like. So people can talk about "special protections" all they want. It sounds like a wonderful theory. But in reality, what sounds far more real and much less fun is "special death" for senior citizens at home. And Anders Tegnell and Tom Friedman need to think about "special pain" for seniors a lot more before they cart out their "special protections" nonsense. In theory, the idea that we are going to shower care on seniors in their home to make sure they are safe and well fed sounds wonderful. But, in reality, seniors are telling house cleaners and care providers to stay out. They don't want to take the risk that someone asymptomatic or suffering from "allergies" is going to unintentionally leave the virus behind when they leave. And the more we let the virus run amok, the greater the chance that someone asymptomatic is going to unknowingly give you the "special pain" you don't really want or need. This is the single best article I've read about the massive challenges COVID-19 has created for in home care. This line sums the challenge up: Because Parkinson is right, allowing COVID-19 to spread deeply and broadly into any community is always going to be a disaster for seniors. Forget about the fact that grocery store workers and factory workers and cops are going to die. Seniors don't need those people coming into their homes, if they still live independently. What about the care workers? Who is going to make sure they are tested, and safe? And if we let the virus spread as far and wide as it wishes, doesn't that just make it much more likely that the people coming into your home are unknowingly bringing the virus with them? This one is a special sore spot for me. There were two times my Dad got regular in-home care after my Mom had to go into a nursing home. Both times I interviewed and hired the agency. The staff members were all good caring people who my Dad really liked. But the first time we hired, he gradually undermined the idea because he thought they were too expensive. So then I organized two of my brothers to help me pay for the care, since my Dad needed it but didn't want to pay for it himself. Penny wise, pound foolish. Then my brothers gradually undermined that idea, because they pandered to my Dad's desire to not have to be taken care of by anybody other than my Mom, who by that point was in a nursing home. So I lost that battle to Dad. His life, his choice. But then the predictable happened. A few months after the in-home care people stopped coming, my sister went over to my Dad's house and found him naked and unconscious by the toilet. There was a trail of feces all through the house, from his bedroom to the guest bathroom where my sister found him, still alive. We worked out that he probably fell asleep sitting on a kitchen stool, banged his head on the floor, and spent two days in some altered state he never remembered a thing about, trying to stay alive. The emergency alarm system one of my brothers insisted was a decent alternative to daily in-home care never worked, for whatever reason. That was the beginning of the end for Dad. He went straight to the nursing home from the hospital after that unfortunate brush with death, and never went back home. So I think if we are being honest, this is the kind of "special pain" Anders Tegnell and Tom Friedman are promoting. Even though they don't have a clue that that is how their theories work out in practice. I told the story about my Dad because what I'm reading suggests, at least anecdotally, that seniors don't want cleaners or even caregivers coming into their homes. So their kids show up, and find Mom or Dad in bed or sitting in a chair in their own feces. COVID-19 is not creating any "special protections" for seniors who don't want to live in nursing homes, like my Dad. It is only creating many more opportunities for "special pain". Knowing how my Dad felt about independence and in-home care, even before COVID-19, I can't blame them. But anyone who doesn't realize that the consequences of this are going to be very bad for many seniors living at home is just engaged in wishful thinking. If we want them to live safely at home, we have to keep the virus out of the community. Period. Once it is allowed in, in every country in the world COVID-19 has been very effective at finding seniors, and killing them. If Tom Friedman or anyone has a serious national plan for safely bubble wrapping seniors living at home or in nursing homes for a year or two, while a lethal virus runs amok, I'd like to hear it. All I hear is hollow rhetoric about "harmonious balance" and "special protections". Translated to the real world, that basically means "special death" and "special pain", I think.