stevenkesslar

Who says that? I've never heard that. What I've heard Fauci and Birx describe as a "gateway" is that a state (or maybe a city) should have a consistent 14 day decline in infections, as well as capacity to manage a fatal pandemic that has killed over 60,000 Americans with widespread testing and tracing. Fauci has repeatedly said we need to have more - like double or triple - the amount of testing available in order to reopen safely. Neither Fauci nor Birx has specifically elaborated on the number of contact tracers needed. The number 300,000 nationally is used by a lot of modelers. Fauci and Birx mostly talk about the urgent need for contact tracers, even if they don't put a specific number on it. What they do talk about is that absent such testing and tracing we are sure to have outbreaks in prisons, meat packing plants, factories, and similar places with high concentrations of people. He says with testing they can be caught early. Without it, they will break out into the general population and you'll have a New York City , or a Sioux Falls, South Dakota. Meaning mass infection, a lot of death, shut down. Sort of really bad shit for the economy, you know? Could you please share with us these people saying lock downs need to be extended until there is "universal availability of a safe and effective vaccine". I've never heard that. I'd like to hear their argument. Are you saying Fauci and Birx are wrong? Are you saying their 14 day gateway concept is wrong? Because no state has actually met that standard, to my knowledge. We're stuck nationally at about 30,000 new confirmed infections and typically over 2000 deaths a day.

One other exercise in coronavirus numbers. The death is starting to get emotionally exhausting. But part of the emotional exhaustion is that I keep reading these articles that boil down to this: "What death? There's no death." Some of it is politics, so I'll save it for a different forum. But some of it is what appears to just be really dumb math skills on the part of really smart people. Here's an example from Joe Nocera, a Bloomberg writer and co-author of one of my favorite books, All The Devils Are Here: This one really perplexes me. It is true that if we are all lemmings, and we don't all jump off the cliff, we won't all die. The idea that we will all die is based on this original model: "If we all jump off the cliff, we will all die." The fact that we chose not to jump off the cliff and die does not make the model wrong. If we had jumped off the cliff, maybe we would have died. Am I missing something? So the idea that the lock downs may be unnecessary is based on some model of an alternative reality that never happened. But I think we're now at a point where we can make some intelligent guesses about what that alternative reality would have looked like, based on what actually did happen. We know in New York state there have been 23,780 deaths. We know that antibody testing suggests that 14 % of New Yorkers are infected. The alternative reality that is often posited is that if we had just let the virus run its course, the healthy 70 % of the population would get infected and recover. Pretty much no sweat. This whole pandemic thing would just be a tiny little bump in the road, soon to disappear in the rear view mirror. The biggest problem with this theory is that in the one country that championed it, it hasn't worked. One third of the deaths in Sweden were seniors in nursing homes. So if we are coming up with a reality-based model for how letting the virus spread would work, I'm leaving off the idea that seniors can be safely bubble wrapped for a year or two. I just don't find it realistic. So to get from 14 % infection to 70 % infection in New York, I'm doing simple math. 5 times more infection will lead to 5 times more death. So New York tops out at 118,900 dead. Again, that's assuming 14 % have been infected, and 70 % will be if we let the virus do its work. So I took the actual number of dead in New York and multiplied by five. New York is 20 million Americans out of a total US population of 330 million, or about 6 % of all Americans. So if we assume the same rate of infection nationwide, 70 %, you end up with 1,961,850 deaths in the US. Again, that's just taking the actual deaths in New York, adding the additional New York deaths needed to get to 70 % infection, and multiplying it out over the country. The Imperial College model suggested 2.2 million Americans would die. That was before the wave of death even started in New York. Seems like they were pretty close to me. Am I missing something? If we just let what was playing out in New York continue, and do the same in the whole US, is there a reason to expect things to have played out differently? Nocera notes that the estimate was "revised downward significantly" and now we get 67,000 to 120,000 deaths. That's like saying the numbers of lemmings that would die from jumping off the cliff was "revised downward significantly" because they all decided not to jump. What changed wasn't the model. What changed was the behavior the model assumed - no social distancing or other mitigation. By the way, since I am using New York as my model base, it does work out that in New York and the US you would end up with a death rate of 0.6 % of all those infected. That's 2 million out of 330 million. That's at the low end of the range of death rates most epidemiologists have been projecting. So there's every reason to have confidence that if we let the virus infect 70 % of all Americans, 2 million of us will die. I think 2 million is a useful number to consider, because you can then fold it back in to the kind of multivariate analysis some posters prefer. Example: So we can say that an estimated 1770 children die in the US each year from abuse and neglect. We can say that this is a horrible thing, and that any increase above 1770 would be more horrible. We can then calculate we can have no lock down, and therefore no additional emotional stress leading to child death from abuse and neglect. We can calculate this would only require 2 million COVID-19 deaths nationally. That gives us a sense of the multivariate trade offs, so we can achieve what Tom Friedman calls "harmony". Then again, we might want to factor in that 2 million COVID-19 deaths might not be quite that harmonious. Mass death could lead to a certain amount of emotional stress. That could, in turn, lead to more child abuse and neglect. So it does get complicated. Lucky for me, I suck at numbers. But I do think that the people who calculated that 2 million Americans will die from COVID-19 if we just let it run its course are pretty fucking smart.

Two possibilities. If I find the virus that turns me into an Australian, I'll share it with you. That would be the easiest solution. We can just move to Canberra. The other solution is we have to find a way to do what pretty much every other country in the world has done, including Australia. Which is reduce the number of cases per day. And that gets to be a challenge, particularly in the US. There seems to be a pretty clear trend, in terms of the countries that I would call the "Let's Try To Contain The Virus " countries. The US is not one of them. There's a half dozen or so that never had many more than 1000 new cases in one day. And pretty much every one of them now has only a handful of cases a day. All of them have done a standard protocol of steps: social distancing, masks, etc. But at least some of them have been able to maintain substantial levels of economic activity beyond what we are calling "essential". As well as various levels of schooling. The big thing that took a hit across the board are mass gatherings - stadiums, entertainment, beaches, marches, etc. Although in South Korea the cinemas are open. It's just that, for now, people don't feel very safe going to them. And the other common trend is testing, testing, testing - and lots of it. Alphabetically: Australia, Austria, Hong Kong, Iceland, Japan, New Zealand, South Korea, Thailand. Israel is an interesting example because they mostly belong in this group, but they have a specific subpopulation - orthodox Jews - who just are not as happy with the rules: they tend to be big families for whom physically close group worship is a priority. So Israel has it under control, but with over 100 new infections a day rather than just a handful. And that seems to be the reason why. There's now a second tier that had much higher levels of infections - like over 5000 a day - and are now on a substantial down slope. So they are mostly the European "extreme lock down" countries where they had pretty harsh enforcement - like fines if you broke the rules. Another country in this category is China, which was way more draconian. But the harshness paid off in the sense that much bigger outbreaks have been cut by roughly a half to two thirds. France is the best example. They went from a one day peak of over 17,000 new cases - which I think is the day they reported a lot of nursing home infections - to a low of only about 500 new cases a day two days ago. So Italy, Germany, Spain, the UK, Belgium, The Netherlands, plus Canada and Iran are all somewhere in the ballpark of 1000 - 2000 new cases a day. For most of those countries that is a massive decline from the beginning of April. So on the one hand, the lock downs led to huge reduction in new infections and deaths. On the other hand, these countries are now about where the first tier countries were at on their WORST day. The question is can they reopen without having things get worse again? Or, can they reopen and get the caseloads down to a handful a day like the first tier countries? We don't know. I'm pretty sure "test, trace, treat" is a core strategy for all of them to try to continue the declines. But it is not clear how much each country has that in place yet. And then there is the US. We are stuck at about 30,000 new cases a day. So we are definitely the global outlier. There's no indication that that number is headed down. Most experts are saying that as the economy "reopens", the number of cases will go up - until the skyrocketing number of cases and deaths and outbreak clusters at this factory or that meat packing plant lead to more closures. So we're just in this dead zone - sort of literally. And at these kind of absolute numbers - 30,000 confirmed cases a day, which probably means maybe up to several hundred thousand actual new infections a day - there's no feasible way to try to do test, or, trace, or treat effectively, really. So that leaves you your crashing hospital strategy. Talk to @purplekow about that. It's really just a matter of how many people you can cram in a hospital. And how long it takes for it to be like that in most hospitals. As far as your specific situation goes, with 65 year old people and high risk types, I was personally hoping Sweden would be of some help. They are the one country that set about to let the virus move about in a somewhat restrained way, and then focus on keeping seniors alive. That didn't work so well. A third of those that died were seniors in nursing homes. So the brilliant guy who came up with that idea said it hasn't worked so well, and they are trying to fix it. But for now I'd recommend Norway or Finland, until Sweden figures out how to have safe nursing homes in the middle of a raging pandemic. And, frankly, I think that one could take a while to problem solve. And everywhere else - forget it. As we all know, deaths among the old are through the roof. Then you've got to factor in your "I'm A White Rat In A Maze And I Am So Fucking Confused" model. Which maybe is sort of the US model. Visually, this gives you a view of the multivariate distribution of key components: Now this is a highly complex multivariate model, as is obvious from the image above. So we factor in things like your spousal abuse, your lack of education, your school lunches, your child poverty, and what not. So unlike these sort of slacker countries in the first tier, like Australia or those Asian wannabes, we are factoring in more complex things like our concern for children's education and health: So this is where it gets super cool and compassionate. So in the US yesterday we had 2,201 COVID-19 deaths. So we factor in that keeping people pent up leads to more child neglect. That leads to a 20 percent increase, which is over 2,000 kids dying a year from abuse or neglect. So by reopening, we stop that marginal increase in neglect and abuse. Now, from the reduction in bad stuff- like keeping kids at home - we factor in a 20 percent increase in infections and COVID-19 deaths. That gives you approximately 2,600 deaths a day. So when you look at this from a multivariate perspective, it is obviously a lot better. Because you can prevent 300 more kids dying every year by having 2600 deaths a day - pretty much none of whom are kids. So that is your basic multivariate model at work for the common good. Pretty cool, huh? Frankly, a lot of these slacker countries in the first tier aren't very good at multivariate thinking. They focused on this very simplistic idea that by using lock downs and "test, trace, treat" effectively to get national infections down to a handful a day, they could just have schools and businesses open. Fortunately, here in the US, we're able to make things a lot more complicated than that. Pretty cool, huh? Now, all of that was sort of by way of springing the bad news on you, in terms of your personal situation. The multivariate model works out to about 500,000 to 2 million US deaths, what with your 0.67 % death rate, and a broad range of multivariate infection spread. And that pretty much is concentrated on your older than 65 group. And that whole Stockholm getaway just isn't looking as promising as we'd hoped. So that kind of gets us back to the "I'm A White Rat In A Maze And I Am So Fucking Confused" model. There is good news. The way those first tier slacker countries are thinking about it is that in order to get people to fly, you have to make it so that almost nobody dies on airplanes. So here in the US, with our more balanced and harmonic multivariate approach, I'm figuring after reopening we are only talking 3000 to 5000 COVID-19 deaths a day. So imagine it this way. If only 3000 to 5000 people died each day in plane crashes, you'd feel safe to fly, right? So from a multivariate perspective, people over 65 in high risk groups should be just fine. Glad I could help work this one out for you.

There are some great multivariate analyses that were done about how this worked in 1918. The lesson is basically that we can improve economic activity and schooling of children by reducing social distancing. The multivariate outcome is that you have less loss of education, and less domestic abuse. All good outcomes. It makes common sense. People need to get out of the house. You do have more parent death and more spouse death as the infection rate skyrockets. Personally, in terms of a richer multivariate view, I think having an orphaned child and a dead wife is better than having a kid who can't go to school and a nagging wife who won't work. We shouldn't be stuck on simplistic notions like social distancing and closing down businesses unnecessarily. We could have better and richer multivariate outcomes, like this: My mother, the Spanish flu orphan

Has anybody ever heard of a virus where - if I become infected - I become an Australian? I love these people. They are doing it right. Coronavirus recovery: ACT becomes first state or territory to be free of known cases of COVID-19 Australia Coronavirus Cases: 6,766 Deaths: 93 Recovered: 5,739

'A drug can block this virus': Fauci hails Covid-19 treatment breakthrough Positive data from the NIAID trial would be a landmark in the race to find a coronavirus treatment. It's nice to be getting some good news.

Weeks ago I posted a video of the Seoul subway and how they are sort of making a show of disinfecting it. I think some part of this is actually more marketing than science. Since I assume 99.9 % of us really would like to do everything we can to save small businesses, this matters hugely. Because people will need to feel relatively safe to patronize small businesses. The real issue in Seoul was not known infections on the subway. It was a large infection cluster at a call center. So, again, it seems like the work force challenge is wherever you have people working for long periods of time close together, there is risk. I don't think there is anything specific about a meat packing plant in South Dakota or a call center in Seoul that would make it more risky. Honestly, my guess is that the meat packing plant in South Dakota would be less risky, simply because the nature of the work means constant exposure to nasty stuff. Either way, these are where outbreak clusters occur. So my understanding of what happened in Seoul is that they figured out that a lot of these workers at the call center rode the subway to work. So then they figured they have to make a symbolic point of showing that you are safe in the subways. Even if you just happened to be sitting next to some call center worker who got infected at work. They actually interviewed a small business owner of a little concession in the Seoul subway who talked about how she appreciated the effort, because it kept things clean and made people feel safe. Obviously that is just one more person whose livelihood depends on safety and people who feel okay about riding the subway. To stretch it a little bit, that particular story is not unlike New York right after 9/11. I still lived in Portland then. And the Mayor of Portland, Vera Katz, was this awesome woman who grew up in New York. So she actually took a contingent of Portland people to New York to see plays or shop or whatever. The whole point was that she wanted to say that America and Portland stood with New York. I was in NYC escorting, and they were requiring IDs to get into hotel rooms. So in a few cases I had to show my ID to somebody, which was an Oregon license. So people were aware of this Portland group. They asked me if I was part of this group with the Mayor, which I said I wasn't. But it was clear that it meant something to them. They appreciated the symbolism. And of course the risk that there was going to be a 9/12 or a 10/11 was very low. My point is that I think the void here is that there is some part of America that wants to pull together and stand together, if we feel there is a safe way to do that. We did do that after 9/11. I think that is actually the national unity they are feeling in Seoul. Even if it is hidden behind the image of people darting around in masks.

Yes. I think that is almost a proven fact. While it was authoritarian, part of the reason infected people in China were forcibly removed from their homes and put in quarantine centers is that the # 1 form of transmission was among families, at home. It of course makes sense, since it's people in close contact for long periods of time. So doing that broke the predominant chain of transmission. I think that's pretty much a fact, at least based on China's methods. Arguably, it also not only prevented more infection, but helped the infected person survive by forcibly being in a treatment center, in effect. I don't see the involuntary part as an option even worth debating. But the science of how transmission works seems to be solid.

Airborne Coronavirus Detected in Wuhan Hospitals Do other people buy this? I don't really. It is similar to the findings on one of those cruises. They found COVID-19 RNA a few weeks later - like in cabins, on floors, all over the place I think. But I searched and I could not find anything that said the virus was still alive and contagious weeks later. My assumption is that passengers were unwittingly spreading it everywhere - through hands, touch, hugs, kisses, close breathing, door knobs, plates, whatever. But I never read that you could get it from something left behind two weeks prior. In a few interviews I've watched Fauci has suggested that, outside of lab experiment conditions, the virus mostly doesn't last on surfaces for more than a few hours. I've been assuming two days is a pretty good margin of error. This One Number Shows Why Measles Spreads Like Wildfire What I've read about measles is that it has such a high R nought for one specific reason: aerosols. Some of what I've read suggests that anybody who is essentially breathing from the small piece of air of someone with measles is going to end up with measles. We know for sure that it is one of the most infectious diseases. COVID-19, on the other hand, is one of the least infectious diseases, at least by the standards above. Maybe I am in denial. But I have a hard time believing that virus hanging in the air for hours is a path of transmission. If that were the case, like it is with measles, it seems like the exponential growth would be way higher. If anything, the idea that you can be contagious and asymptomatic for days and still ONLY two or three people catch it suggests this is not the most contagious virus ever. In a typical four days in a big city a worker who commutes and hangs out with friends could be within 6 feet of hundreds or even thousands of people. I think what we know from cluster outbreaks is that they tend to be in places where people spend a lot of time together: # 1 is among families, at home, China found; # 2 is at offices, like the South Korea call center outbreak. Other candidates are churches, where people sit close together and hold hands or share food or drink. I think we do know that doctors, nurses, and hospital staff have gotten it. I think there are at least three factors in that. First, those settings are viral petri dishes, by definition. Second, the lack of adequate PPE. Third, which is the part I understand least well, the severity of symptoms in part depends on the race between the virus spreading through a body, and the immune system trying to kill it. So if a doctor is getting exposed to higher doses of virus, or getting it more frequently, it may give the virus a head start in the race. There's two other generic situations I can think of having read about that involve airborne infection: restaurants, and airplanes: Restaurant’s air conditioning tied to 9 COVID-19 cases among diners who sat near single infected person My takeaway from that diagram is that the social distancing rules of 6' or so basically make sense. The issue in this diagram is not that people were more than 6' feet apart, or sat at the same table two hours later. It is that the air flow apparently moved live viral particles immediately. Assuming the people at Table B may have been 10' to 20' feet away, it seems quite doable to move live viral particles over that distance. The part that is less clear to me is Table C, if in fact the air flow was moving only in the direction indicated. 'We’re a part of the spread': flight attendant's guilt over Covid-19 I've not read any examples where everybody on a plane or most people on a plane or even many people on a plane all got COVID-19. In this case, several crew members appear to have gotten it from people they came into close contact with. As the flight attendant said, there may have been a number of passengers on the flight that were spreading it unknowingly. I posted these two examples because even if I am right, and it is hard to get COVID-19 simply from breathing the wrong air, I still think that restaurants and airplanes are screwed unless we can get the number of cases way down - from like 30,000 new cases a day to maybe 300 new cases a day in the US. 300 cases a day would be ten or twenty times the number of daily new cases in a whole bunch of nations that have populations in the tens of millions. I think the numbers are very simple, and the vast majority of Americans get it. If you are in a place where lots of people are infected, like a hospital ER, your chances of infection skyrocket. That is why everybody is afraid of being in an ER right now. If you live in a country where 30 people a day get it, and you wear a mask and socially distance and practice proper hygiene, your chances of getting it or spreading it are actually extremely low. Until we get to that point in the US, I don't see how most people are going to get on planes, or go eat out. Maybe the exception is healthy young adults, or people who need to travel for work, or a certain percentage of people who just don't take it seriously. But until people feel safe, there's going to be an ongoing massive loss of revenue, I think. Every single poll strongly suggests the vast majority of people would rather be safe than sorry.

You have written many very humanizing and compassionate things. But this stands out. I find it very human and compassionate that some guy whose life you are trying to save is noteworthy because of his black bikini underwear. We should all be so lucky.

Hope this is okay to post on your thread. It's probably has been posted elsewhere. But it's good to focus on good news, or at least better news. WATCH: BATES ALUM JACK ALLARD LEAVES HOSPITAL AFTER COVID-19 BATTLE [MEDIA=twitter]1251148677768286213[/MEDIA] I assume that is his Mom and Dad waiting for him outside. 25 years, a great athlete, no pre-existing conditions, and in a medically induced coma on respirator for a few weeks. And, happily, he lived and walked out of the hospital. I remember reading some story a few years back about how some young gorgeous bodybuilder in his 20's died of the flu. I don't even recall, but I think somehow he ended up in septic shock when bacteria got into his blood stream. All that stuff is above my paygrade. My point is that it is fair to say that healthy young men and women dying of the flu every year is not exactly normal, but it is possible. But this is different. There's just too many stories of healthy young people like this guy almost dying, or getting strokes, or at least being laid up in the hospital, sometimes on respirators. And as you say it seems somewhat inexplicable. Some people, for some reason, just nose dive. There is story after story of that happening. This guy is from New Jersey, although he ended up in a clinical trial in a Pennsylvania hospital. Thank God for the doctors and nurses and all the support staff that are dedicated to keeping everyone they can alive.

I assume that is what he meant. That has the clip of the quote, but not the context. I posted it partly because he just is a very geeky and almost robotic speaker. Public presentation is not his strong suit. That said, I kind of like the idea that my life in part depends on what this handsome geek does. He certainly didn't fuck me over when it came to same sex marriage. And he is one of very few people I regret not being fucked over by. I think he must have meant what they say at the end of that clip. IF we simply follow a herd immunity strategy, it would mean a 70 % infection rate - 28 million Californians - and 800,000 deaths. I assume he meant that is why we are living abnormally, and wearing masks, and putting in all these restrictions - to avoid 800,000 deaths. It's the Bill Gates strategy. Muddle through together and plan to win the war with a vaccine. I buy it. The interesting thing is that Newsom is using an implied death rate of 3 % - if you based 800,000 on 28 million infected Californians. I'm still guessing that Fauci's 1 % is a realistic number, once we really have the full picture. But whether you use 280,000 or 800,000 it is a scary number. For all his geekiness, I do think Newsom has done a good job of conveying the fact that, like it or not, we are all in this very scary horror movie together.

Nope. 100,000 to 200,000 is way too low. Not the way we are doing this.

That idea is almost certainly not true. Brazil is off the charts with infection and death. It is in the Southern hemisphere. This is a theory, but I actually believe there is so much evidence that is almost a proven fact. You have to have a plan. And you have to choose to be either Sweden, or South Korea. It's not quite that black and white. But either you essentially go for natural herd immunity, or you go for "test, trace, treat". The latter is a strategy to mostly contain the virus until the vaccine itself confers injected herd immunity. Just like with many other diseases we have mostly conquered. Both strategies are based on certain unproven assumptions about antibodies and vaccines. One article I read said that the weather was partly what worked in Florida. But not because warmer weather kept the virus at bay. I think the consensus, or near consensus, is that this virus seems to thrive in all weather conditions, as long as it has lungs to feed on. The theory with Florida is that weather helped because it got people outside. Walking on a beach is almost certainly safer than being surrounded in a bar by hundreds of people who are exhaling the virus. I believe in Florida there are cops on the beach making sure that people keep moving, and don't congregate in groups. One of the articles I read suggested that after the initial novelty of being at the beach again wore off, a lot of people just said it was more trouble than it is worth. Mostly, I think the beaches are not packed. So that's a recent picture from Newport Beach in California. Newsom's reaction was to say, "We can't have that." I think it's probably common sense to say that the odds of getting COVID-19 at the beach, in the sun, are lower than the odds of getting it in a packed cinema, or sports stadium, of restaurant. The Sweden versus South Korea choice to me is at some level very simple. In South Korea, the public seems to be united in saying we want it to be so that only 20 people or so get this virus every day. Period. Just tell us what that means, and we'll do it. So far, it is working. It is not unlike saying that we will fly in planes if only a few of them crash every year. But if 50 planes crash every day, sorry. Figure it out, and until then we just won't fly. The pretty much apples to apples equivalent to South Korea in Florida is this. We'll go to Disneyland, as long as it does not sicken, hospitalize, or kill us. But until you figure that out, Disneyland is going to have a huge problem on the demand side - whether it is open or not. And if it opens and people get sick, or hospitalized, or die, Disney knows they have a huge image problem all of a sudden. Sweden is saying we'll let 5,000 or 50,000 people a day get infected. We'll just try to make sure they are not nursing home residents, or highly vulnerable. And we'll hope that the survivors have immunity to the virus for as long as it takes - which they may or may not. And some part of that does depend on having a centralized government-run health care system that can be reorganized more quickly than the US could do it. There is no evidence in the real world that countries benefit by doing it like Sweden does. There is evidence that all the countries employing "test, trace, treat" so far have been more successful than unsuccessful in lowering deaths and containing the virus. I don't think we will get the benefit of a Spring break and Summer vacation from this virus. There is at least no evidence of that so far.

Here's one additional factoid that speaks to the complexity of how to reopen without just killing both hundreds of thousands of people and the economy. South Dakota has the 13th highest per capita infection rate of all US states. And yet they have the lowest fatality rate of all - 0.49 % of confirmed cases. They are the only state with a death rate below 1 % of all cases. I think we now all realize that the number of confirmed cases is way lower than the number of actual infections, of course. Meanwhile, Utah has the second lowest death rate, at 1.04 %. I think I can guess why this is. Utah has the youngest population of any US state, by far. Rep. Ben McAdams is a poster child. He got so sick that he had to be in a hospital for a week. Thankfully, he survived. So even for the relatively young and healthy, this virus is no picnic. Even for the young, it strains hospital capacity. Even for the young, strokes happen, and young people die. In South Dakota, a huge chunk of those confirmed cases were a meat packing plant in Sioux Falls, which had to be closed. So, again, it is magical thinking to believe that people can work through a pandemic. The people who work at that plant DO NOT want to work if it means getting sick, being hospitalized, and maybe dying. Would any of us choose to work there? So it just seems like magical thinking to believe this isn't going to be happening a lot - all over the US - unless we have really aggressive testing and contacting tracing in place. The good news, such as it is, is that only a few people in the meat packing plant died. We can't have grocery stores open if the message to the employees is: "Hey, good news! Only a few of you will die." That won't work. But I'm hoping what the low death rate in SD means is that even when an outbreak does happen in a major job center (about 4000 jobs), it can be quickly contained and contact traced without spreading further. That, at a minimum, is what we need to figure out if we DO NOT want an economy built on fear and death.

Again, there just seems to be a lot of magical thinking going on. This debate between lives and economic livelihood is just a fake argument. At least some people seem to think the problem is the lock down, not the virus. It seems like the magical thinking is that if the lock downs go away, the virus will go away with it. It's also just not true to say that the numbers of new cases are going down in the US. They are at best flat, and probably going to go up with "reopening". We'll know soon enough. But when the lock down goes away, the virus will likely get worse. As a result, the economy will probably get worse. Tell me if this article make sense: That article makes sense to me. It's anecdotal, but I was stunned to learn from the owner of my local small business take-out-only pizza place that business was down 50 % to 75 %. This is a place that I thought would be booming. Many people are simply choosing NOT to take out pizza - even though the business is wide open, and has no lock down restrictions whatsoever. The article above makes one of the best cases of everything I have read about why our economic livelihoods depend on our lives. That's certainly the lesson of 1918. When a pandemic runs wild, social life and the economy collapse - completely. That's not a theory. That is the fact of what happened all over the US in 1918. That said, cities across the US that had a plan cut the death rate by a half or or even two-thirds, and made things less terrifying. Presumably, given our better technology, we should be able to do at last as well in 2020. I agree completely with @LivingnLA that there is no "right idea" here. The opposite. This is probably the biggest human crisis of my lifetime. There are no easy answers. That said, to simplify it, there is a choice to be made: do we want to be South Korea, or do we want to be Sweden? We at least now know we have to have a plan. And you really can't be both South Korea AND Sweden. You have to choose. So here's an interesting perspective on the US and our choice: Guess who said that? Anders Tegnell, architect of Sweden's strategy, in an interview in USA Today. I agree with everything Tegnell said above. It reinforces what @LivingnLA said. That's a good overview of the pluses and minuses of what Sweden is doing. I will give Tegnell credit for this. There is a plan, which is better than the total mess in the US, as he describes it. And he is aware of the real and potential failings. They learned that protecting people in nursing homes is easier said than done. They do have a much higher death rate than their neighbors - so far. It is simply a gamble that "herd immunity" is actually being achieved. Nobody knows. The death is real. The herd immunity is a theory. Most important, Tegnell's theory is built on the idea that China, South Korea, Taiwan, Hong Kong, New Zealand, Australia, Austria, Thailand, and others are just wrong. Those countries believe they can "essentially eradicate" the virus, as New Zealand's PM just said. Tegnell believes that is not a sustainable strategy. At this point, nobody can say for certain whether it is sustainable or not. We can say that if you exclude China from that list I just named, every other country COMBINED had way fewer deaths than Sweden. So there is a good argument that the best way to contain the virus is to do what most countries are doing - contain the virus, through testing, tracing, and treating. One factor that is different in the US is that we let it get completely out of control. So starting from a peak of 30,000 cases is just different than having 1,000 or co cases as a peak, like South Korea or Australia did. Plus, they got their shit together much more quickly then we are on "test, trace, treat". On any given day, the US is still confused about whether we want to be Sweden, or South Korea. 20 % or so want to be Sweden, and 80 % want to be South Korea. Here's another thing about the science and numbers of this. If a herd of cows could vote, and 80 % of the herd voted not to be slaughtered, then presumably the herd would not be slaughtered. But if 20 % of the herd walks into the slaughterhouse, they are probably going to be slaughtered, anyway. So if 20 % of the US population wants to do what they want to do, that changes the science and the numbers. It basically means that, by default, we can't be South Korea. It's ironic, I think. South Korea has exactly what we say we want. They have open businesses, open offices, open restaurants. We say that is what we want. We say, Why can't offices be open? Why can't small businesses be open? Why can't restaurants be open? Somehow, in South Korea, they actually are! And yet the country has had 695 deaths, total - which is 1 % of what the US now says is the "goal" we will try to keep deaths to. So South Korea gets the mostly functioning economy, and the US gets death and lock downs. Can you explain that to me, @Unicorn? How is this possible? Again, it is magical thinking to say that anyone thinks we should just hibernate for a year or two. I think it is also magical thinking to believe we can just "bubble wrap" seniors and vulnerable populations for a year or two. So it actually does make sense to me to say that, as difficult as it will be, maybe millions of tests a day and an army of 300,000 or so contract tracers is a better idea than millions of deaths. Here's a take on how we are handling it in the US. I'm posting this article not based on any political perspective, but simply because it does a good job of laying out the numbers and the facts: Bennett & Leibsohn: Coronavirus response — compare Florida with New York, and look at the results so far I said we can't be both South Korea and Sweden. As a nation, that is correct. But we are kind of trying to have it both ways. Florida is basically trying to be like Sweden, but in an organized way. So far, both Florida and California have COVID-19 deaths that are way lower than their annual flu deaths. By objective measures, California is doing somewhat better than Florida. But both are doing way better than average. Both are certainly doing way better than NY, where the virus had already spread like wildfire before anyone realized what was happening. New York has now had 7 times the number of deaths they do annually from the flu. And the almost 23,000 deaths there don't account for a huge spike in unaccounted for deaths, at home and in nursing homes, beyond what is normal for New York at this time of the year. So 23,000 is probably an undercount, not an overcount. I think that tells us that if we just let this run out of control in an overwhelmed medical system, it will easily be at least 10 times as deadly as the flu.

Are you saying that in any state the death rate could not be 10 to 20 times worse than the flu? It is already over 5 times more deadly than the flu in both New York and New Jersey. It is about 3 times more deadly than the flu in Michigan and Massachusetts. And note that I am comparing less than two month's of COVID-19 deaths, AFTER an extraordinary lock down, to twelve months of flu deaths. Are you saying the same thing will not happen in Wyoming, or California, or Texas, unless we take measures to prevent it? Because the scientists seem to be saying the virus does not discriminate between Americans, or recognize state or regional borders or variations. To be clear, this forum is a place to talk about the science of it, not the politics of it. So I am just trying to focus on the science and the numbers. So the only point of view I will argue from is that of the virus. All the virus wants is lungs to feed on. That's all. So I'm just trying to think about what science tells us the virus needs. The virus could give a shit about politics or religion or even whether you like to cross dress. It's pretty much all about lungs. Period. That is what the scientists are saying. You can go down the list. Dr. Fauci. Dr. Redfield. Dr. Birx. I love Dr. Birx's line. When asked why a state like Idaho should have to sacrifice because New York has about 300,000 cases, her response was simple: New York had 10 cases not that long ago. In fact, New York's first case was March 1. Not even two months ago. Meanwhile, Sun Valley, Idaho has had more confirmed cases than NYC, relative to population. Her point, of course, is that Idaho should not sacrifice to save lives in New York. Idaho should sacrifice to save lives, and the economy, in Idaho. People don't spend top dollar in Sun Valley to get sick and die. I think what I said is that states need to develop testing, tracing, and treating programs that are driven by the Feds. That is pretty much what all the states are saying, as far as I can tell. No one thinks that forcing states and cities and hospitals to outbid each other makes any sense at all. So that is one example where we need national leadership. Another one. If Las Vegas wants to use their casinos as a petri dish for the virus, what happens when those people drive back to California and spread the virus again? The virus is not going to notice that the lungs it is feeding on just crossed a state border, or got on a plane. It makes no sense to argue the virus will jump out of the car at the California border. Meanwhile, almost all the existing public health testing and tracing know how is in state and county health departments. That needs to be expanded dramatically, unless we just want to let the virus go wherever it chooses to. And within individual states, as Idaho has proven, Blaine County can be every bit as toxic as New York City, while other counties have no infections at all. So those are examples of parts that are best left to states who are dealing the best they can with different local circumstances. That said, probably every county in America has a public health department. Which is why Dr. Birx is fundamentally right to promote a county by county infrastructure. I go back to Sious Falls, South Dakota. If a meat packing plant with about 4000 employees can very quickly have about 25 % of their work force sick, some of whom are in hospitals, and several of whom died, that's not good work force development. You are going to have major meat suppliers forced to shut down. Do that enough times and you create food supply problems all over the nation. So these laws of science and the math of exponential infection growth work as well in South Dakota as they do in Manhattan. At the 30,000 foot level, Australia has a roughly similar structure of levels of national and regional control. Even China, which is essentially a dictatorship, used very different methods in Hubei than it did in other provinces. Both countries are big countries with complex economies. Both countries figured it out. Pragmatism pretty much dictates that some things should be top down, and others bottom up, I think. I'm not a scientist. But like most Americans, I think what Fauci and Birx are saying makes a hell of a lot of sense. Get the number of new infections down for at least a few weeks. And then be ready for very aggressive testing, tracing, and treatment (meaning usually isolation). Fauci keeps saying this is very difficult when you have as many as 30,000 cases, which is why the numbers need to come down. Everything they are saying is based on the best practices in a number of other countries. What is magical thinking is to say that because some place has only 10 cases, it is not a problem,or it will stay that way. So, for example, I can recall when Riverside County, CA, where I live, had only 10 cases. That was last month. Now it has about 3000 cases. It has 118 deaths. I'm assuming that Dr. Fauci is right, and that the real death right is about 1 %. That would suggest that those 118 deaths point to 11,800 cases. Meaning even now in Riverside County, 3 out of 4 cases are undiagnosed. The good news is they are undiagnosed because the infected people are not getting really sick. The bad news is they are infecting other people. Which is why the level of sickness, hospitalization, and death is still rising in California, despite the lock down. It will keep rising, until an aggressive "test, treat, trace" program is put into place. Where I agree with you about different things happening in different places is that the best time to intervene in Riverside County would have been when we had only 10 confirmed cases. Even then, it could have meant we really had 100 infections or more, probably. But if we could have magically manufactured 300,000 robotic contact tracers and put them to work all over the US overnight, the Riverside County cases would NOT have grown from 10 to 3000. If we had kept it at 10 or 20 or 50, maybe we could be looking to gradually reopen now. I'm not arguing for a one size fits all strategy. I think I made clear that states and counties need to respond to what is actually happening on the ground. That said, the science of exponential growth does not change. And it is unforgiving. Newsom said several months ago that if we did nothing to prevent it, up to 20 million Americans could be infected by this Spring. We'll never know for sure if he was right. But I am glad that Californians proved that worst case scenario was not inevitable. It is baked into the cake now that California and Florida are going to do things very differently. In a way, that's a good thing. As I said above, relative to population, both states have roughly the same number of deaths, which is way below the national average. It's also way below the number of flu deaths they have annually. Two months ago neither state even had a confirmed case of COVID-19. So I think we'll know better a few months from now what is working and not working among states in the US. There is one other thing that is just science, and that is not a regional thing. My guess is 10 to 20 % of Americans simply are convinced that they want to push the limits of science regarding the rules of infection, death, and exponential growth. So this has nothing to do with politics, or sociology, or public opinion. This is just hard science and exponential math. If you take a virus that is this contagious and you offer it 30 million lungs or so, the virus is going to have a feeding frenzy. That's just science. So science tell me the virus will have a very good run in every region of the US, given that 10 % or so of people are wanting to liberate the virus and feed it. The virus will make no distinctions about the race or region of who those lungs belong to. It will just be a race between a virus and an immune system. In most cases, the immune system will win with minimal or no damages. In other cases, the results to the human whose lungs are infected will be deadly. Again, that's just science in every region of the US. I'm still missing how we make an economy and workforce function when you have maybe 10 % of workers with a viral infection. In theory, that means all 10 % of them are off work on sick pay. In reality, it means maybe 6 % are working thinking they are fine and spreading the disease, and 2 % are coughing and think they have the flu or allergies, and 1 % are home sick, and 1 % are in a hospital or seriously ill. That's really not a good work force strategy. To use the Disneyland example, if this played out over a few months, like it played out in Ohio prisons, customers would not flock to Disneyland. They would not see Disneyland as a fun place to go. They would probably see Disneyland as worse than a prison. They would see it as a death camp. That is, as I said, why I think Disneyland will not reopen until they feel confident that people will not be afraid to shake Mickey Mouse's hand again.

Thanks for posting that. And I agree. Hindsight is always 20/20. It is amazing that was just a little more than three months ago. We live in a different world.

Absolutely. There are basically two choices: 1) Reopen when an unprecedented testing, tracing, and treatment protocol is in place in each state, driven by the Feds. That is what Fauci and Birx and pretty much all the scientists are saying; or 2) Just reopen. Georgia is clearly choosing number two. There seems to be a lot of magical thinking in the US. Magical thinking doesn't usually work as a principle of science, though. There's no evidence yet that the virus is seasonal. Brazil and Australia are both in the Southern hemisphere. Brazil has 10 times as many cases as Australia. And 50 times as many deaths: 4,286 in Brazil, and speeding up, versus 83 in Australia, and slowing down. The difference is likely what each country is doing to prevent disease, as opposed to the weather. So you can say IF the number of cases go down, then ............... "x". So IF the number of new cases in South Korea go down from a peak of 851 on March 3rd to 10 on April 25th, you could take "x" steps. In fact, South Korea never closed the economy down - like offices, and restaurants. They are one of the poster children for how you win the war by "test, treat, trace". Another example: IF the number of new cases in Australia go down from a peak of 537 cases on March 22rd to 21 on April 26th, you could take "x" steps. In fact, the country is now starting to gradually reopen while keeping the virus in check. Road to Recovery: Australia Eases Restrictions as Coronavirus Spread Slows Some of this will be trial and error. So in one area beaches that were reopened were closed again two days later. Instead of just exercising, crowds were forming again. Arguably, having schools open and letting people work is more important than going to the beach. More on beaches later. Now, another example: IF the number of cases in the US went down from 0 confirmed on March 3rd to 9,422 on March 22nd to 38,958 on April 24th, you could take "x" steps. So you can see there is a big logical problem here. I used the dates cases peaked in South Korea, March 3rd, and Australia, March 22nd. So in those countries, cases did go down to a handful a day. In the US, they went up. Way up. The US is now the global outlier. We are watching tens of thousands of people get infected and thousands die every day. Our response is to talk about reopening. Right now, in April 2020, any statement that starts with "If the numbers continue to come down" is just magical thinking. We hit a new HIGH of 38,958 new cases a few days ago. At best, the number of cases are plateauing in the ballpark of 30,000 cases a day. I'm not an epidemiologist. But that makes testing and contacting tracing unworkable, if not impossible. Florida’s No-Rules Vibe Gets a Coronavirus Reality Check Florida’s governor is desperate to get the state back to work. But the tourism industry is moving much more cautiously. I will be curious to see how things in Florida work. Florida has slightly more deaths per million than California. (50 versus 43). The number of deaths in both states is about one half to one third of the number who die of the flu every year. So that is not a horrible number. Meanwhile, in New York, the 22,275 who died are about 6.5 times the 3400 or so who die of the flu in NY every year. No one knows why Florida is doing better than some expected. One theory is that Florida has a lot of seniors, and older people are wiser. Lock down or not, they have voluntarily complied because they don't want to die on a ventilator. That article above is more speculative than factual. But I do think it makes sense that Disney may not reopen until 2021. They don't want the distinction of being viewed as a death camp, as opposed to an amusement park. Meanwhile, there is no evidence that being in a small group on a beach in Florida is more lethal than being in a bar or gym in Manhattan. So I am ambivalent about Florida beaches. People need a way to get outside without ending up in hospitals. Being on a beach may be safer, and healthier. The biggest problem the economy faces is death, and fear of death. Having thousands of deaths a day does not solve that problem. If reopening leads to more death and more fear, it makes the problem worse. Yes, it will be interesting. Sweden's rate of death per million is actually higher than the US's death rate: 217 per million in Sweden versus 167 per million in the US. So that extra 50 deaths per million would mean 16,500 more dead Americans. We'd be well over 70,000 dead, as opposed to just pushing over 50,000 dead Americans. I personally don't see Sweden as a reason to feel encouraged. I'd go with the South Korea or Australia model, myself. Why not have 100 to 1000 or so deaths, instead of 50,000, and have an economy that can still mostly function? If we can agree and make it work. Georgia is # 16 on the list of deadliest states, if you count it by deaths per million. The number of deaths is probably the most real number. Even if we are massively under counting infections, it is somewhat harder to under count dead bodies. Georgia's death rate - 86.3 per million - is just about double California's death rate. It is about half the US average of 166 deaths per million. That's in part because the death rate in New York alone is 1,145 per million. The real question we don't know is whether every state could get as bad as New York. I think the logical answer, coming from most scientists, is YES. And if New York is at 22,000+ dead and still only has 14 % of residents with antibodies (assuming that actually gives them immunity), they still need maybe 60,000 more deaths in New York alone, just to get the spread of the virus to slow. Nothing magical about that. Again, my point is there just seems to be a whole lot of magical thinking in the US. If there are outbreaks in prisons in Ohio and meat packing plants in South Dakota, I just don't see why there won't be outbreaks in gyms in Georgia, and hair salons in Atlanta. The way China or South Korea and Australia deal with this is to at least try to keep the number of infections so low that it FEELS safe, and it IS actually very safe. It's like driving and flying, knowing that your odds of a car crash or plane crash are extremely low. We're doing something very different in the US. My guess is that when the number of cases go up, and gyms or hair salons are closed because some outbreak will happen somewhere - especially without testing and contact tracing - it will just reinforce all the fear of death. I'll be looking at Georgia as an example of how to do it wrong. Florida is I think a better example of how to at least try to open up using common sense. The main point I take away from that article is that a state that relies on tourism for its bread and butter knows that the worst thing you can do is get a reputation for inviting people to come to Florida to get sick, or die. My best guess of where this goes is what that epidemiologist above said: "only" 800,000 dead Americans, if we are lucky. We won't do what other countries are doing to at least try to contain the virus. So the best hope is we get to 50 % of the population infected slowly, in a way that does not crush the medical system and kill lots of doctors and nurses who don't have adequate PPE. There is nothing magical or miraculous about that. Again, if I am missing something, please tell me. If anyone can explain how you run a workforce and an economy with coronavirus numbers like this, please explain. Other than magical thinking. And ignoring the fact that the number of infections is NOT going down, and may actually be trending up still.

Did you have a specific reaction to that video? Like where you saying the CDC was doing the right thing, or the wrong thing? I think the video makes the case for two extreme positions: 1) It's useless to try to find a needle in a haystack; or 2) We have to find needles in haystacks to avoid mass death. Both positions are logical enough. And that video shows while finding a needle in a haystack is either futile, if you believe 1, or very difficult, of you believe 2. What's obviously wrong with the approach in that video is that the CDC was looking for symptoms. That's not bad. But by February we knew that maybe 1 in 4 cases remain asymptomatic. Now it looks like it could be over half of cases - but we still don't know for sure. The CDC protocol was based on what worked for SARS and MERS. The assumption was that you'll know when you get sick, and you're mostly contagious during the period you know you're sick. It worked to keep diseases like SARS and MERS and Ebola for spreading in ths US. Hindsight being 20/20, we now know that several things could have happened differently. The first thing is there could have been an immediate decision to get private drug companies to mass produce tests. The assumption could have been we need massive testing and contact tracing. That certainly fits better, now that we know there are many people who will never be symptomatic walking around, spreading the virus. The need for mass testing and contact tracing was South Korea's first very big and key assumption. Three months later, we can look back and see how those assumptions played out. South Korea had 10 new cases yesterday. The US had 35,419 new cases yesterday. I'd say South Korea made the better call. Other countries that have prioritized mass testing and contact tracing - Hong Kong, Taiwan, Australia, New Zealand, Austria - among others, have had similarly successful results to South Korea. Where it has gone bad, like Singapore, which had 618 cases yesterday, it was because they missed cluster outbreaks, like among immigrant workers living in dorms. That is not unlike what happened in South Korea, when they missed 4000 cases that developed in a religious sect. South Korea did prove they could get that under control, and keep it under control. So far. While Germany has had 6000 deaths, it stands out compared to other European nations. The German per capita death rate is 70 per million citizens. In France, it is five times higher: 350 dead per million citizens, or a total of about 23,000 French deaths. Some of that is that the average age of German cases is about a decade younger. So more people who get the disease survive. But Germany is also far more aggressive at testing. They've tested over 2 million people, whereas France is under 500,000. I think that has helped them to at least control the spread of the outbreak. That should matter to the US. South Korea proved that even if one horse gets outs out of the barn, you can get it back in. In the US, all the horses got out of the barn. So, realistically, I think the best hope for the US is what Germany is doing. They went from a peak of about 7000 cases a day in late March to about 15000 a day today. So they would meet the US standard of 14 days of steady decline in cases. Meanwhile, the US does not meet the US standard. The US went from a peak of about 33,000 cases a day in late March to a new high of 38,958 cases two days ago. With this "reopening", without adequate testing or contact tracing in place in any US state, according to people like Dr. Fauci, the number of new cases is likely to increase, not decrease. The US, even more than Sweden, is clearly going to be the poster child for implicitly saying, "Let's let this just run its course, and see what happens." That's not where a majority of the public is at, based on every poll. But majorities don't matter. All it takes is one person to spread the disease. The US has millions who appear to be willing to take whatever risk is involved in spreading it. So whether they are a majority or a minority, the virus could care less about democracy. The virus is mostly just interested in finding good lungs to feed on. The sobering analysis is that this virus just can't be controlled. That's what Sweden's version of Dr. Fauci is basically saying. So if you buy that, here's a US epidemiologist that says we will have at least 800,000 deaths. Infectious disease expert: We're only in the second inning of the pandemic He's saying the virus will just keep coming, relentlessly, in wave after wave. And he assumes it will take 50 % of US citizens being infected, or 160 million people, to really slow the spread. He assumes a death rate of 0.5 % to 1 %. But his 800,000 dead Americans is based on the smaller number. I think we know in places like New York, where the virus has been allowed to spread the most, the real death rate is probably closer to 1 %. That's partly because when the hospital system is crushed, and thousands of sick people are dying at home, you do get a higher death rate. The unstated assumption, which some actually do state, is that it's really futile to try to find needles in haystacks, anyway. So let's just let some version of that play out all over America. Nothing like this is happening in South Korea, or Australia, or Hong Kong, or even Germany, which has it pretty bad. They are making a very different set of assumptions. And they are massively building out testing and tracing based on the assumption that they can find enough needles in enough haystacks to keep this under control. Back to that video, this gives reason for both hope and hopelessness: Newly confirmed coronavirus deaths might not be nation’s first, California officials say So what we now know is that a woman in California died of COVID-19 on Feb. 6, as compared to what we thought was the first death on Feb. 29 in Washington. She was one of at least a handful of Californians who died of COVID-19 in February. So there is a good chance that by the time that CDC airport screening was occurring on Jan. 17th, the virus was already inside the US, at least in California. Someone who died in early February was probably infected by the middle of January. So pessimists could take this as a basis for saying there's just no point to this exercise. The CDC was screening at airports in January. And the virus got in, anyway. So why not just let the virus rip, and just see what happens? At best, we just have to try to keep hospital systems from being completely overwhelmed, like they were in NY and several countries in Europe. The fact that we now know this was starting to spread in California in January also provides reason for optimism, though: https://public.tableau.com/views/COVID-19PublicDashboard/Covid-19Public?:embed=y&:display_count=no&:showVizHome=no That's a summary of caseloads, hospitalizations, and deaths in California. What is simply a fact is the the Bay Area is NOT an epicenter of this crisis. In fact, the Bay Area - if it were a state - would have one of the lowest infection and death rates in the US. Some part of this could just be luck. NYC kept getting boatloads of travel from both Europe and China. But some part of it also has to be that the Bay Area was the first part of the country to slam the breaks on hard. So if you look at mid-March, when the Bay Area lock downs started, California was still at a a handful of deaths a day. That's probably two months AFTER the first infections in California came from China. I do think during this period the CDC was doing testing and contact tracing. But only of people who'd been to China, or had contact with people who were infected and came from China, I believe. That testing and tracing and isolation may have actually bought California some time. I'm assuming the real death rate is between 0.5 % and 1 % of everyone actually infected. In other words, 5 times to 10 times more deadly than the flu. So that would mean that when California was having 3 or 4 or 13 or 24 deaths a day in late March, it probably meant there were hundreds of cases in the state. Those death rates are in the ballpark of what South Korea had. The worst day for them was 9 deaths in one day. So, at least so far, South Korea and other countries has shown you can control infections at that level, and still have people riding subways and going to work. I do think this is either/or. And the minority in the US gets to choose in this case. It really doesn't matter what 90 % of America thinks. 10 % is more than adequate for the virus to spread. Dr. Fauci keeps saying we have to get the absolute numbers down. You can't have enough tests and tracing when you have 30,000 new cases a day. As far as I can tell, we are implicitly choosing contagion, and mass death. And it isn't even so much a choice. Some of it is that, realistically, it may be too late. Too many horses are out of the barn. But the other part of it is that a minority is saying, "No. We don't agree to play by these rules." They are voluntarily giving their lungs to the virus, who will gladly take them.

Well, some of that is not so bad. As everyone here knows, I don't do subtlety and nuance. Ha ha. Funny you mention him. He's one of the few Twitter accounts I look at, to see what interesting charts he has posted. Speaking of numbers, and how you can present the same data to reveal trends in two very different ways, here's his latest: The hopeful: The horrific: [MEDIA=twitter]1254461533880496128[/MEDIA]

This just adds more verbosity to the posts above. So if you are not interested in facts or details or analysis, stop reading and go read Twitter, please. One thing that is clear, and understandable, is that most reporters don't think like epidemiologists. Nor do most people. Now all of a sudden we have to pretend we are experts, when we are in fact largely ignorant, just because we don''t want to get sick. It's hard to make sense of what is actually going on in these prisons, based on the data we know. That one article mostly fuels two ideas: 1) Lots of people get this disease and show no symptoms; 2) Maybe this isn't as deadly as we think. The first statement is true. The models from China and South Korea suggested that maybe 25 % or 30 % of people were asymptomatic through the course of their infection. It could be way higher than that. The Reuters article is mostly NOT helpful because it only offers a snapshot. I think we know that if you tested 1000 people 24 to 48 hours after they were infected, almost none would test positive or show symptoms. Several days later most would test positive, and many would start to show symptoms. Weeks later some would be in hospitals, and some would die. So the article doesn't shine any light on the question of whether COVID-19 is as deadly as people think. Here's a few more articles that do: DRC Confirms Positive COVID-19 Test Result of Correctional Staff Member at Marion Correctional Institution March 29, 2020 As far as I can tell, that was the first death associated with Marion. It makes sense that it could be a staff member, since someone had to bring the virus in from outside. Let me suggest that everyone think of Marion and Ohio prisons this way. Think of them as Amazon fulfillment centers, or cinemas, or factories, or meat packing plants, or shopping malls. These are all places where many people congregate together, in enclosed spaces. Some of them, like Amazon fulfillment centers and factories and meat packing plants, are "essential" work places that we can't shut down. So the best way to think of this issue is a workforce issue, I think. Somehow, we have to have the ability to work. Yet, somehow, this disease makes it so that when people come together to work, you get fear and sickness and hospitalization and death. That's not the kind of work environment people want. 17 Ohio prisoners now dead of coronavirus; 4 at Marion Correctional April 24, 2020 So now we have another snapshot, close to a month after the first death. So at Marion, we know the disease has had plenty of time to progress through various phases, ending in death for the unlucky ones. This article only tells us about cases and deaths. We don't know how many people developed symptoms, how many are in hospitals, etc. And here is the most complete picture we have, from the State of Ohio: COVID-19 Inmate Testing | UPDATED: 4/25/2020 We still know almost nothing about how many people are symptomatic, or hospitalized. What we do know from this chart is that, if allowed, the disease will likely spread like wildfire. We can hope that in other Ohio prisons, isolation of those that tested positive will stop the spread. Again, I would encourage everyone to think of that prison chart as a list of every Amazon fulfillment center in the state, or every Walmart in the state, or every shopping mall in the state. Prisoners have no choice about being in prison. People have a choice about whether to work at Amazon or Walmart, or shop at Walmart or a shopping mall. So if we want to prevent an economy from being able to function, what we very much want to add to the picture is virus, sickness, hospitalization, and death. This is certainly how Gov. DeWine is looking at it. That's not a political statement. That's just a fact. So what we know is we have 17 certain COVID-19 prisoner deaths, plus two other suspected COVID-19 prisoner deaths, plus one staff member death at Marion. I think we also know more of these infected people will eventually die. But let's look at 20 people statewide, and 5 people at Marion. And this is out of a base of 3,845 inmates and 240 staff with confirmed infections, or about 4100 people. Statewide, 20 out of 4100 is obviously just shy of a 0.5 % death rate. At Marion, 5 people (including the staff member) out of 2028 have died, so it is closer to 0.25 %. At Pickaway, it's 12 deaths (including 2 suspected) out of 1563 inmates and 79 staff. That's a 0.73 % death rate - very close to what New York's statewide death rate is, if the antibody tests are correct and 14 % of the state population is infected. There's a lot we don't know. How many prisoners eventually got sick? How sick? How many were hospitalized? But I think we are getting more and more data that suggest that while a 0.2 % death rate might be possible, it's a stretch. 1 % might be too high. But especially if we factor in "herd slaughter", and the idea that we want mass sickness and lots of death, it's quite doable. Add collapsed hospitals, where doctors and nurses also get sick and die because they lack PPE, and you can probably get over a 1 % death rate. Especially if we make sure we have lots of dead bodies in houses that people want to get out of the home because they stink. That could give you a 1 % death rate. And some really high quality stench and fear and sickness and sadness and terror and misery. Oh, yeah, and a whole fucking boatload of death. My point is that this is creating an uproar in the Ohio prison system, where people don't get to choose to be prisoners. Does anyone really think this could work in a meat packing plant, or a Walmart, or a shopping mall, or an Amazon distribution center? Once you add fear and choice, people would not want to work there, eat there, or shop there. And it won't take one-third of the employees getting sick. Once a couple employees get sick, probably the whole place gets shut down. I don't think we have any choice but to focus on test, trace, treat. The experts say millions of tests a day, and maybe something like 300,000 contact tracers. This is where I become a huge fan of Abbott, and corporate America. If Big Pharma can figure out mass production and profitability, please let them do it. The public health contact tracing is, and needs to be, a government function. It's that, or have every shopping mall and factory and Walmart and Amazon fulfillment center in America be like those Ohio prisons. If people take this prison analysis to mean that most people who get infected don't develop symptoms, or don't get very sick, they are just missing the point. Most people don't die from smoking or drunk driving or speeding. That's because we have tons of laws governing those things, and lots of enforcement mechanisms. 0.2 % of America is 650,000 dead Americans. 1 % of America is 3.25 million Americans. You can argue about whether we really need 25 % or 50 % or 75 % of Americans infected to complete our fun and interesting herd slaughter experiment. In New York, if we go with the 14 % estimate, we know their terror is basically just getting started, if we go for completely effective herd slaughter. Only about 20,000 New Yorkers have died. Even to get to 60 % herd slaughter, we need 60,000 more dead New Yorkers. Whatever numbers you pick, it is simply going to be mass fear and mass death. If anyone can explain how you run a workforce and an economy with coronavirus numbers like this, please explain.

Thanks. Funny you say that. I thought I was being verbose. As an aside, I have always hated Twitter. The last several years have given me reason to despise Twitter. Twitter is great, as long as you mostly don't give a shit about facts, thoughts, arguments, or details. Maybe what I am about to say in unfair to hospitals. But I think what you pointed to is another reason why herd slaughter is a horrible idea. It just doesn't make sense to combine a stressed out or collapsed medical system with a brand new disease that nobody understands. Even when people survive, there are going to be many permanent bad outcomes. My point is not that hospitals are to blame. It's that are at the front end of a learning curve. And this is one where it's simply better not to even toss the coin and see what happens. The good news is that with AIDS it took years of poisoning people with overdoses to realize that if we use less of this drug and combine it what that drug it works better. And AIDS of course was a death sentence in a way COVID-19 is not. But the bad news in that is it changes the ethics. You could, in effect, use Gay men who were dying anyway as guinea pigs. Because even bad treatment might let them live a bit longer. The same does not apply with COVID-19. That right there has to put even more stress on doctors and nurses that know that, unlike with better known diseases, they are at least partially flying blind. Nick Cordero's wife says he is 'recovering well' after doctors inserted temporary pacemaker That's the human face for your point. And I get that the same thing perhaps could have happened if he had the flu. Or if he got hit by a car while crossing the street after leaving a Broadway theater. Part of the fear factor is that everybody is looking at things under a microscope, even though we usually just live the risk. But as you are suggesting, I think that's because the risk is actually way higher. For survivors of severe COVID-19, beating the virus is just the beginning I read a story about a German doctor who specifically said, after being diagnosed with COVID-19, that there was a particular hospital he wanted to be treated in. And it was because they don't use ventilators, or only use them as a last resort if they know you are about to die. This doctor was not ventilated, although he was on an oxygen mask I think. He said for a few days he thought he was going to die, and kind of wanted to die. It was very difficult for him to breathe. But his point is that the ventilators can screw your lungs up, as well. One statistic, which I think exaggerated the point, was that over 80 % of people on ventilators die. One of the earliest reports from China in the NEJM suggested it was at least over 50 % on ventilators die. Again, the issue is not that hospitals should not use ventilators. It's that this disease is so deadly that once you get to an ICU bed, the number of good options starts to rapidly decline. Cordero himself has been on dialysis, pace makers, etc. They are obviously throwing everything they can at him. And he is missing a leg. His Broadway career, if not his life, is over. This is not meant as a dig at doctors, or nurses, or hospitals. The exact opposite. They are putting their own lives at risk to fight a disease nobody really understands. We have let our caregivers down, by not making sure they have the protective equipment they deserve. If they save Cordero's life, that is a victory. But he will have lifelong medical problems. Meanwhile, the hospitals in the middle of this are being crushed financially, as well. In 1918, given what we knew about viruses (pretty much nothing) we didn't have much choice. Even then, we could reduce the death rate by twofold or threefold by taking measures to prevent the spread. The results so far in those countries above strongly suggest that we are now able to actually stop this thing from spreading, if we choose to.

I actually think the numbers are getting clearer and clearer with these antibody tests. If I had to guess, The Lancet studied that estimated a death rate of 0.66 % - if everybody in the whole world could be tested at once - is in the ballpark of correct. That said, if you include the CA and NY antibody studies, it could be anywhere from 0.2 % to 1 %. In other words, COVID-19 could be two to ten times more deadly than the flu. I think we know for a fact that this is more deadly than the flu. The flu does not kill 22,000 New Yorkers in less than a few months. The flu does not lead to refrigerated trucks being turned into morgues. So the question now is: how much more deadly is it, and how do we protect the people it is deadly to? I put this post in the politics section although 99 % of it is apolitical test data. All the data does hold together, and creates a relatively sensible hypothesis, at least, of what is going on. So if you take the NY data, which is the most extensive, we know that 2 % of all NYC residents have confirmed cases. And the antibody tests suggests a 20 % infection rate. In NY state, we know that 1.44 % of state residents have confirmed cases (287,000 out of 19.5 million people). The antibody tests suggest a 14 % infection rate. So in both cases it works out to about a 10 to one ratio between confirmed cases and actual cases. We've known all along that these high death rates - 7.56 % in New York right now - are so high because the people being tested are only the sickest subset of victims. So right on the face of it, you can divide 7.56 % by 10 and get a hypothetical 0.756 % death rate. That's in line with what The Lancet and Fauci have been saying all along. You can get to similar results by taking these presumed infection rates, based on the antibody tests, and work back to a presumed death rate. So in NYC there's a presumed infection rate of 21 %, which would be 1.76 million New York City residents out of 8.4 million. There are 16,388 reported deaths as of yesterday. That's a 0.93 % death rate. In NY State there's a presumed infection rate of 14 %, which would be 2.73 million state residents out of 19.5 million. There are 20,861 deaths as of yesterday. That's a 0.76 % death rate. The CA data from LA County and Santa Clara County suggest a somewhat more optimistic picture - perhaps a death rate as low as 0.2 %, and perhaps anywhere from 20 to 50 actual cases for every confirmed case. LA's antibody tests suggested an actual infection rate of 4 % of the population. That would be 400,000 infected of a 10 million population. There are 797 deaths. That's a 0.2 % death rate. In their findings, Santa Clara County estimated a 0.2 % death rate. There's three good reasons I can think of for why CA would suggest a 0.2 % death rate, and NYC would suggest anywhere from 0.6 % to up to 1 %. First, testing errors. We really have no clue whether these tests measure anything valid. The more studies that come out, the more likely it is that they do paint a picture of a disease that does not kill MOST people, and that has many asymptomatic infections. We knew that already. But false positives can make a difference, especially when you are talking about tests that measure numbers like 4 %, rather than 50 %, testing positive for something. Concepts like testing sensitivity and specificity are above my pay grade. But I tend to think NY would be the most accurate. We can compare a hypothesis based on antibody tests to actual cases and actual mass death. So if the question is: how will this likely play out in the entire US, or world, if let it, I think what happened in NY tells us what we could expect. To simplify, I'd go with Dr. Fauci and a 1 % death rate. Anybody over 50 is potentially in trouble. Anybody over 65 is in big trouble. Anybody over 75 better have a will or trust written up. Meaning your chance of getting really sick, or being in a hospital, or dying is serious. A second reason could be that NYC in particular did experience a relatively complete hospital meltdown. They think 5000 people died of COVID-19 at home, because they were very sick and the hospitals were full. So that right there could potentially double or triple the NY death rate. I think we know now from both 1918 and 2020 that quality of care is a big factor in whether people live or die. It is the whole concept behind "flatten the curve". So you could take NY and CA actual death rates as proof that "flatten the curve" saves many, many lives. A third reason is that if only 4 % of your population is infected, it is probably easier to shelter the vulnerable people. Mainly, they can stay inside. Or you can keep people out of nursing homes. I did check, and the age distribution of cases in NY and CA is very similar. Roughly 1 in 4 cases in both states were seniors. So if that's true, that would not explain the difference between a 0.2 versus 1 % death rate. The timing of cases could be a factor. The number of cases in LA is going way up, in part due to the added testing. Since death lags with COVID-19, the LA death rate may twice as high a month from now. I think one huge problem with the "herd slaughter" concept is that no one who advocates it has come within a million miles of explaining how you bubble wrap 30 % of your population for a year or two. If the idea is that 70 % get infected, the first question is: which 70 %? Some of that 70 % is Black women with diabetes, or young men with heart or lung conditions. But even if you magically solve that problem, who actually works in nursing homes? Who goes into the homes of seniors to clean, or repair things? We can't even get testing and tracing ramped up to what we need to prevent people from getting infected. So now we are suddenly going to reorganize our entire society to protect the 30 % or so that is most vulnerable? Give me a fucking break. One final piece of data. If you look at what is happening on Navy ships, it is very anecdotal. But I think the little we do know confirms the picture I painted above. On the Roosevelt there were about 800 cases. I think 7 ended up being in a hospital, or about 1 %. One sailor died, which would give you a death rate of about 0.1 %. There are two broad data sets that suggest that for adults under 50 or so, the hospitalization rate is 10 to 15 % of all cases. One is a CDC study of about 2500 US patients published in March, and the other is all the NYC data. So, again, it seems like in the real life experiment where we tested 100 % of a young population on a ship, you can divide by about 10. The 10 % hospitalization rate in the CDC study and in real life in NYC probably reflects a small segment of the sickest population of young adults. The 1 % hospitalization rate FOR YOUNG ADULTS is likely more accurate. These numbers may sound low. But they are way higher than flu hospitalization and death rates for young adults. So even if they are that low, our economy is still fucked. We'd have mass death all over the US, like in NYC. And 1 % of all young adults in hospitals is a big number - millions of hospitalizations. And by the way, how do you like the idea of 20 % or 50 % of your workforce out of work sick? In NYC, at one point 20 % of the NYPD was out sick. And a bunch of cops died. So the economic problem is not just all the fear caused, that keeps a huge chunk of people from wanting to go shop or eat in a restaurant. The other huge problem is if we just let this rip through our economy unchecked, you would have 20 % of the workforce sick, all at once. How does an employer manage that? Anybody who is still advocating herd slaughter hasn't thought it through. You can't have 20 % of a workforce that is sick, and another 30 % of vulnerable adults that is bubble wrapped for a year or more. I think pretty much the whole world is moving in the direction of test, trace, treat. Here's the number of actual deaths in a bunch of countries that seem to have gotten a handle on test, trace, treat: Australia - 80 deaths Austria - 536 deaths Hong Kong - 4 deaths New Zealand - 18 deaths South Korea - 240 deaths Taiwan - 6 deaths Thailand - 51 deaths Combined, those nations have over half the population of the US. They all used some variation of a prompt lock down to flatten the number of cases, and then a move to test, trace, and treat to keep it low. It is early days in terms of whether they can sustain this. But it is working so far. It does create an environment where people can shop and eat and work, albeit with a new and enforced set of restrictions to keep the number of new cases a day in the single or double digits. Meanwhile, the US has had 30,000 new cases a day for three weeks running. Sorry, but this is not politics. This is tragedy. Anybody who is a patriot should be deeply embarrassed by the mass death and the mass stupidity.

Wow. Let me see if I understand what you are saying. You mean that creating calm and certainty based on evaluation of data is actually a strategy some people use? Wow. Who would have known? I guess you must not be from around here.