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How to cope with coronavirus

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Old Monday 23rd March 2020, 18:08   #126
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Originally Posted by tenex;3973835. . .More importantly, the really vital questions here [I
are not technical matters of epidemiology[/i], but of public policy, in which everyone can and should have a voice.
Indeed, particularly at the state level given the vacuum at the center. Oregon’s taking a fairly hard line. How about Colorado?

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Old Monday 23rd March 2020, 18:12   #127
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Boris Johnson is to speak at 8.30pm tonight.
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Old Monday 23rd March 2020, 20:12   #128
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Aviation is a professional business, not a democracy, and so ought to be countering a viral epidemic.
Poor logic, all too common just now. Flying a plane is a matter for aviation professionals. Running a society actually is democracy! (What's going on with the virus is only one part of the picture. Tunnel vision...)

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Indeed, particularly at the state level given the vacuum at the center. Oregon’s taking a fairly hard line. How about Colorado?
Muddled for the moment: recommendations on distancing, closure of "inessential" businesses (as if anyone really knows how to make that distinction)... drifting stupidly toward something more like lockdown, as if that was the only possible thing to do and it was just a question of at what point to do it. Of course if that was true (which it's not) it should already have been done some time ago, which only contributes to the stupidity and confusion.

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Old Wednesday 25th March 2020, 07:59   #129
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Interesting new academic take on COVID-19 in the UK from researchers/modellers at Oxford University. If they're right, this might not take so long after all (spring still a write-off though). They're obviously not impressed with the Imperial College modelling!

I'm betting Oxford may well be right: my brother went to Queen Mary College so I have a familial disrespect for anything that comes out of Imperial....

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Old Wednesday 25th March 2020, 08:06   #130
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Interesting new academic take on COVID-19 in the UK from researchers/modellers at Oxford University. If they're right, this might not take so long after all (spring still a write-off though).

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?
https://nymag.com/intelligencer/2020...lf-of-u-k.html
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Old Wednesday 25th March 2020, 09:48   #131
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[quote=Deb Burhinus;3974665]?
https://nymag.com/intelligencer/2020...lf-of-u-k.html[/QUOTE

Yes, that's it. Worth reading one or two British articles as well though.

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Old Wednesday 25th March 2020, 16:25   #132
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Interesting new academic take on COVID-19 in the UK from researchers/modellers at Oxford University. If they're right, this might not take so long after all (spring still a write-off though). They're obviously not impressed with the Imperial College modelling!
[link]
Untested, widespread asymptomatic (or mild) infection has been obvious for some time now, and herd immunity the only real hope of averting disaster. This must be happening here in the US also, and gives hope that there may be only one critical "wave" of hospitalization to deal with.
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Old Wednesday 25th March 2020, 20:34   #133
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I had a closer look at the Dutch numbers till today. Testing for the virus is wholly inadequate, but assuming that people who get ill get tested, the following trend emerges:
Men are twice as likely to be hospitalised and die than women, although positive tests are equally distributed.
Over 65, half of those who are tested positive are so ill that they end up hospitalised.
Between 75 and 80, 25% of hospitalised patients has died; of the patients over 80, 50% has died. People over 95 aren't hospitalised anymore (explaining the over 100% mortality), although numbers are small (9 deaths thusfar).
Deaths under 60 are really rare, but the chance to get hospitalised is significant from 45 upwards (20% of positive tests).

It's interesting how the 35-45 age bracket seems to be faring a bit better than the 25-35s: 35-45 will typically be the group of people with children in daycare centres and primary school.

Anyway - not long until the intensive care units run out though. 644 people on IC units, 925 beds available (of which 350 were newly created). With almost 100 new cases today, it's get ill in the next three days or ... plead for one of Germany's 25000 beds?
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Old Thursday 26th March 2020, 15:10   #134
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Interesting, good news story. I think.

https://www.bbc.co.uk/news/uk-52052880
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Old Thursday 26th March 2020, 16:16   #135
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Interesting, good news story. I think.

https://www.bbc.co.uk/news/uk-52052880
Amazing what some people see as 'good news'.......
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Old Thursday 26th March 2020, 17:09   #136
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Hi there Andy, nice to hear from you I thought I was on your ignore list?


It's good news that the idiots will be given the sentences they deserve.
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Old Thursday 26th March 2020, 19:33   #137
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It's good news that the idiots will be given the sentences they deserve.

Speaking of (but not quite), is anyone else seeing the news images tonight - people have come out of their houses and are packing onto the pavements in this clapping homage to the NHS. Probably the sight of the Chancellor and Bojo standing in Drowning St, in the hope of inspiring a nation.

Don’t they realise the Italians and everyone else have been doing this from their windows and balconies in the ‘safety’ of their homes, not crowded onto the pavement outside ..?
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Old Thursday 26th March 2020, 23:36   #138
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I've been wondering whether the level of initial exposure to the virus could be the key. Get a light dose, and your immune system has time to deal with it in the upper respiratory tract and you get over it. Get a massive dose, and it goes straight to your lungs and/or overwhelms the immune system, and does serious damage. Is this medically plausible?
Those details may not all be quite right, but I've just read a new article by Siddhartha Mukherjee at The New Yorker. Some relevant passages:

"Nearly all the SARS patients who came in initially with a low or undetectable level of virus in the nasopharynx were found at a two-month follow-up to be still alive. Those with the highest level had a twenty- to forty-per-cent mortality rate. This pattern held true regardless of a patient’s age, underlying conditions, and the like. Research into another acute viral illness, Crimean-Congo hemorrhagic fever, reached a similar conclusion: the more virus you had at the start, the more likely you were to die.

Perhaps the strongest association between the intensity of exposure and the intensity of subsequent disease is seen in measles research. “I want to emphasize that measles and COVID-19 are different diseases caused by very different viruses with different behaviors,” Rik de Swart, a virologist at Erasmus University, in Rotterdam, cautioned when we spoke, “but in measles there are several clear indications that the severity of illness relates to the dose of exposure. And it makes immunological sense, because the interaction between the virus and the immune system is a race in time. It’s a race between the virus finding enough target cells to replicate and the antiviral response aiming to eliminate the virus. If you give the virus a head start with a large dose, you get higher viremia, more dissemination, higher infection, and worse disease.”"

...“If you acquire measles through household contacts, where the density and dose of exposure is the highest—you might be sharing a bed with an infected child—then you typically have a higher risk of developing more severe illness,” he said. “If a child contracts the disease through playground or casual contact, the disease is usually less severe.”


These are different viruses of course, but there seems also to be good reason for concern with the initial viral dose of COVID-19, not only for healthcare workers but in the home. (The implication of course would also be that light exposures may be less dangerous except for high-risk individuals.)

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Old Thursday 26th March 2020, 23:55   #139
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Those details may not all be quite right, but I've just read a new article by Siddhartha Mukherjee at The New Yorker. Some relevant passages:

"Nearly all the SARS patients who came in initially with a low or undetectable level of virus in the nasopharynx were found at a two-month follow-up to be still alive. Those with the highest level had a twenty- to forty-per-cent mortality rate. This pattern held true regardless of a patient’s age, underlying conditions, and the like. Research into another acute viral illness, Crimean-Congo hemorrhagic fever, reached a similar conclusion: the more virus you had at the start, the more likely you were to die.

Perhaps the strongest association between the intensity of exposure and the intensity of subsequent disease is seen in measles research. “I want to emphasize that measles and COVID-19 are different diseases caused by very different viruses with different behaviors,” Rik de Swart, a virologist at Erasmus University, in Rotterdam, cautioned when we spoke, “but in measles there are several clear indications that the severity of illness relates to the dose of exposure. And it makes immunological sense, because the interaction between the virus and the immune system is a race in time. It’s a race between the virus finding enough target cells to replicate and the antiviral response aiming to eliminate the virus. If you give the virus a head start with a large dose, you get higher viremia, more dissemination, higher infection, and worse disease.”"

...“If you acquire measles through household contacts, where the density and dose of exposure is the highest—you might be sharing a bed with an infected child—then you typically have a higher risk of developing more severe illness,” he said. “If a child contracts the disease through playground or casual contact, the disease is usually less severe.”


These are different viruses of course, but there seems also to be good reason for concern with the initial viral dose of COVID-19, not only for healthcare workers but in the home.
Very interesting, indeed, thanks for the excerpts. What do you/he see as the public policy implications of all this?
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Old Friday 27th March 2020, 01:32   #140
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Those details may not all be quite right, but I've just read a new article by Siddhartha Mukherjee at The New Yorker. Some relevant passages:

"Nearly all the SARS patients who came in initially with a low or undetectable level of virus in the nasopharynx were found at a two-month follow-up to be still alive. Those with the highest level had a twenty- to forty-per-cent mortality rate. This pattern held true regardless of a patient’s age, underlying conditions, and the like. Research into another acute viral illness, Crimean-Congo hemorrhagic fever, reached a similar conclusion: the more virus you had at the start, the more likely you were to die.

Perhaps the strongest association between the intensity of exposure and the intensity of subsequent disease is seen in measles research. “I want to emphasize that measles and COVID-19 are different diseases caused by very different viruses with different behaviors,” Rik de Swart, a virologist at Erasmus University, in Rotterdam, cautioned when we spoke, “but in measles there are several clear indications that the severity of illness relates to the dose of exposure. And it makes immunological sense, because the interaction between the virus and the immune system is a race in time. It’s a race between the virus finding enough target cells to replicate and the antiviral response aiming to eliminate the virus. If you give the virus a head start with a large dose, you get higher viremia, more dissemination, higher infection, and worse disease.”"

...“If you acquire measles through household contacts, where the density and dose of exposure is the highest—you might be sharing a bed with an infected child—then you typically have a higher risk of developing more severe illness,” he said. “If a child contracts the disease through playground or casual contact, the disease is usually less severe.”


These are different viruses of course, but there seems also to be good reason for concern with the initial viral dose of COVID-19, not only for healthcare workers but in the home. (The implication of course would also be that light exposures may be less dangerous except for high-risk individuals.)
That sounds like the rationale for a variant of the 'lets develop herd immunity' policy, infect everybody just a little bit.
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Old Friday 27th March 2020, 03:40   #141
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That sounds like the rationale for a variant of the 'lets develop herd immunity' policy, infect everybody just a little bit.
I can't help but think that perhaps a 'middle way' would have been best in terms of protecting life overall, not overwhelming the health system capacity, and avoiding the real impacts and misery of a shutting down and in some segments, destroyed economy.

The debate thusfar seems to have been polarized into (i) draconian shutdown and isolation to 'flatten the curve' , and the polar opposite - (ii) the let 'er rip philosophy to gain herd immunity as quickly as possible and let the cards fall where they may.

The world seems to be largely following strategy (i) which at least attempts not to overwhelm the health system capacity, preserve life, though while 'infecting' many with financial hardship and poverty. Why has the suspension of Capitalism not been enacted? Why are financiers still collecting (or accruing) debt payments during this time?

Whether economic stimulus is fiscal, monetary, or even includes quantitative easing too (and that is not even considering the equity of distribution vis a vis employees vs business owners) - these 'packages' must be paid for down the track. Largely this will be born by the ordinary honest citizen while globally corporate and elite tax minimization and avoidance will continue.

This is one of the greatest transfers ('theft') of wealth that we have seen. Happening right under our noses while people are paralyzed with fear bombarded 24/7 through the media, and isolated from normal social communication and support networks.

I don't think (ii) is the best course of action - the impacts on our health system (including the mortality of many dedicated selfless personnel) and death rates and totals among elderly and vulnerable populations of the world would be tragically unacceptable, even if it is a quick way to 'herd immunity'. I can't help but think that some of the rank incompetence we have seen from politicians and various 'leaders' has let this cat out of the bag to some degree anyway - certainly I think we have suffered more deaths even so far than necessary.

I checked the latest data this morning, and the US has now streaked ahead to have the highest number of cases in the world. Occasionally I will catch a snippet uttered by DJT and can hardly believe my ears - it does not inspire confidence ....

The other statistic that seems to holding true thus far is that people under 50 are not dying anywhere near the rates of people in their 60's, 70's, and 80's - with each passing decade seeming to double the death rate. Also, so far post virus recovery immunity seems to be holding - estimates of the time that protection holds for vary and seem largely uncertain, though I have read of figures of at least a year.

Given that, I think a third or 'middle way' would have been far better all round. This would have been (and possibly still could be) - (iii) Immediate lock down isolation for anyone say ~50-55 years or older (and those immuno-compromised or otherwise vulnerable) with strict hygiene standards and procedures in dealing with the 'outside' world (including one's own families) and services (including financial) focused in supporting that.

The rest of the world would be left to carry on normally (though hopefully with more care towards the environment and our fellow man). This would offer minimal risk of death (though infection would be rife) and rapidly achieve 'herd immunity'. Even cash seems an excellent way to transmit the virus - certain segments constantly exposed such as shopkeepers would need to take additional hygiene precautions (from what I have observed here this is already happening way ahead of official advice). I think this course of action would be better on all fronts.

I saw an older bloke (60's) yesterday who was about to catch the same lift as me. He was wearing some material gardening type gloves, and as we are to observe 4sqm personal spacing in this country I said to him - here mate I'll get all the buttons - I'm not worried about any of this stuff. He said I am - I don't want to die yet ! and proceeded to tell me how long the virus lived on half a dozen different surfaces. After we got out of the lift and went our different ways, I saw him grab a public handle to open a door and then proceed to unknowingly scratch his nose with that very same gloved hand !





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Old Friday 27th March 2020, 04:42   #142
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‘We’re Flying Blind’: Why Testing for Coronavirus Antibodies Will Matter

https://nymag.com/intelligencer/2020...ll-matter.html


Interesting - particularly how under-resourced the WHO is ....
Soooo much work to be done around all sorts of 'better' testing etc.







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Old Friday 27th March 2020, 05:46   #143
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That sounds like the rationale for a variant of the 'lets develop herd immunity' policy, infect everybody just a little bit.
Perhaps, though not sure how to best implement such a policy. Let children and healthy young and middle-aged adults run free, quarantine everybody else?

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Old Friday 27th March 2020, 07:55   #144
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I have bought into the idea that accidental exposure is better than household one, it seems well supported. That's why I am doing the once-weekly shopping, not my wife, despite me being a higher risk group. We live on 17 sq. meters, there is no way to prevent transmission between us. it's geometrically impossible for us to stay 2 meters from each other and both have access to the toilet...

The "lock up all the vulnerable" scenario is insane, as I have already explained. You would have to lock them up for months, it's an enormous amount of people and for old people it may as well be just an alternative form of a death sentence. I know it's hard to comprehend for many people, but if you are on a timer (old or with a progressive disease) waiting things out is not exactly an easy thing to do.
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Old Friday 27th March 2020, 08:49   #145
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The "lock up all the vulnerable" scenario is insane, as I have already explained. You would have to lock them up for months, it's an enormous amount of people and for old people it may as well be just an alternative form of a death sentence. I know it's hard to comprehend for many people, but if you are on a timer (old or with a progressive disease) waiting things out is not exactly an easy thing to do.
Describing an idea/viewpoint that you don't agree with as 'insane' isn't particularly helpful in rational discussion.

Any ideas of 'shielding' or similar vulnerable persons would have to take into account a whole range of things, and mental health and other issues would have to be considered as a high priority, and plenty of scope for dealing with.

We are moving into summer ...
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Old Friday 27th March 2020, 09:13   #146
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I have bought into the idea that accidental exposure is better than household one, it seems well supported. That's why I am doing the once-weekly shopping, not my wife, despite me being a higher risk group. We live on 17 sq. meters, there is no way to prevent transmission between us. it's geometrically impossible for us to stay 2 meters from each other and both have access to the toilet...

The "lock up all the vulnerable" scenario is insane, as I have already explained. You would have to lock them up for months, it's an enormous amount of people and for old people it may as well be just an alternative form of a death sentence. I know it's hard to comprehend for many people, but if you are on a timer (old or with a progressive disease) waiting things out is not exactly an easy thing to do.
So what do you propose, let them all do as they wish, catch the disease, overwhelm the health service and then die? Modern society is not used to giving things up in the public interest, we've become spoiled and selfish.

I'm yet to see any viable alternatives.
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Old Friday 27th March 2020, 09:46   #147
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So what do you propose, let them all do as they wish, catch the disease, overwhelm the health service and then die? Modern society is not used to giving things up in the public interest, we've become spoiled and selfish.

I'm yet to see any viable alternatives.
South Korea is the obvious example of a viable alternative. They were able to get the transmission to very low levels and sustain that basically purely through testing and tracing. But it requires significant investments in the process and some discomfort to everyone. But it's a solution that doesn't throw a third of the population into a possible indefinite home arrest.

I keep wondering why, in the presence of such a glaring example, do so many people and governments insist on inventing their own "solutions". Yes, it costs a lot of money but is it really more expensive than the alternatives?

You speak about selfishness, but that's what I consider the "lock up the elderly" scenario to be the most extreme scenario of. It's a cop out, a way to try to avoid fighting it the hard way, and it's a cop out of possibly apocalyptic consequences - be it either through it not working outright, through it not being able to provide enough care for the vulnerable or simply though the psychological damage inflicted.

Instead of looking where to lock up the elderly, we should be constructing a huge worldwide testing and tracing industry, even at the cost of reducing many other industries meant to provide us with various dispensable luxuries.
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Old Friday 27th March 2020, 09:51   #148
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South Korea is the obvious example of a viable alternative. They were able to get the transmission to very low levels and sustain that basically purely through testing and tracing. But it requires significant investments in the process and some discomfort to everyone. But it's a solution that doesn't throw a third of the population into a possible indefinite home arrest.

I keep wondering why, in the presence of such a glaring example, do so many people and governments insist on inventing their own "solutions". Yes, it costs a lot of money but is it really more expensive than the alternatives?

You speak about selfishness, but that's what I consider the "lock up the elderly" scenario to be the most extreme scenario of. It's a cop out, a way to try to avoid fighting it the hard way, and it's a cop out of possibly apocalyptic consequences - be it either through it not working outright, through it not being able to provide enough care for the vulnerable or simply though the psychological damage inflicted.

Instead of looking where to lock up the elderly, we should be constructing a huge worldwide testing and tracing industry, even at the cost of reducing many other industries meant to provide us with various dispensable luxuries.
There's a lot of things our woeful governments should have been doing - including massive testing, agreed.

Restricting international travel at a much earlier stage and a 'police state' app following people's movements as in S Korea wouldn't have been tolerated as an infringement on civil liberties in the west. You can't directly compare ...
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Old Friday 27th March 2020, 10:09   #149
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There's a lot of things our woeful governments should have been doing - including massive testing, agreed.

Restricting international travel at a much earlier stage and a 'police state' app following people's movements as in S Korea wouldn't have been tolerated as an infringement on civil liberties in the west. You can't directly compare ...
But we are the West. It's the core of the discussion, what we, as the West, should do now. And I am saying that proposing that we put our desire to not be infringed on our civil rights ahead of the future of the elderly is immoral, that's really all.
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Old Friday 27th March 2020, 10:27   #150
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But we are the West. It's the core of the discussion, what we, as the West, should do now. And I am saying that proposing that we put our desire to not be infringed on our civil rights ahead of the future of the elderly is immoral, that's really all.
If you let them wander around unchecked, they'll probably have no future and no one, is locking them up, it's an advisory in both their own and the public good.

I have a neighbour who's in an 'at risk' group and he's happily self isolating for three months with the support of neighbours.
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