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Friday, May 22. 2020
Yesterday, a post by a fellow commentator addressed whether anyone would listen to epidemiologists again. This, in itself, is not a controversial question. There is a range of opinions, even among epidemiologists, on how to deal with viral outbreaks. That said, most posts are designed to create a discussion. None are likely to ever come to any complete answer, though hopefully some shared ground can be hammered out. It seems this did not occur and considerable animus was shared in the comments section.
I will begin by saying I have not lost anyone to Covid, but I can list about 15 people in my family who are at risk. They have all been isolating, as they should. They know isolation won't prevent them from getting ill, as we know there are many other problems with isolation. But it is a safety feature. There are no guarantees for any of us.
The questions which remain are whether we 'flattened the curve', actually 'saved lives', and even if we could do these things.
There is no way, literally none, to answer whether we 'flattened the curve' or 'saved lives'. Saying we did will only be based on what you presume may have happened otherwise. That's not science, that's an opinion. My opinion is we didn't and can't do either, but my opinion is no better informed than yours. I base my reasoning on logic. Isolation has happened, and people are still getting sick despite isolation. The virus spreads more easily in confined spaces, and shutting up a family with one asymptomatic member may well doom the entire family. Multi-generational homes in Italy, where that kind of living is more common than in the US, certainly played a role in the Italian situation.
On a personal note, having had Covid, and taken the antibody test, we know that my wife (despite sharing, as couples do, food, utensils, etc.) does not have the antibodies. My son (24) and I (58) both have them. He was clearly asymptomatic. My wife believes she's a Viking. Perhaps she is. It did raise the question for her, though, 'how is the most contagious virus, as we're told this is, not infecting me when you've been so sick and he was asymptomatic?' It's anecdotal, but I can rattle off 20 such anecdotes from friends and family. Studies are good, and real science is useful, but anecdotes should also inform, because they are personal experience. So this is contagious, yes. But how contagious? We simply don't know, and neither do 'experts'. So both sides can be 'correct' and 'informed'.
Based on my personal experiences here in New Jersey...I'm afraid I just don't see the danger others do. Even if I did see it, many others don't, and their views matter.
Speaking of personal experience, I can point out someone very close to me also had it, and had it very badly. They are diabetic, and where my symptoms lasted 2 weeks with 4 bad days, theirs was 3 horrible weeks. We have come out of our experiences with completely different views of the virus. They are angry, blame Trump, and feel we should be locked down until it goes away or there is a vaccine. They are so angry, I have stopped speaking with them about Covid. That didn't stop them from asking me to not speak at all ever again, though I doubt this will happen. I hope.
It seems personal views have led to extreme outcomes, reactions and policy opinions.
Taking personal experience and crafting policy from it is a strange thing. How can there be a one-size-fits-all response when my own story (remember, anecdotes inform) show that even a severely contagious disease is not always as contagious as you think? The spread in NYC was, but shouldn't have been, unexpected. A crowded city with millions arriving and leaving every day with billions and trillions of points of contact? It's shocking something like this hasn't happened before. Now that it has, New York's experience cannot, and should not be, the same as South Dakota's or Minneapolis', let alone Podunk's. We are finding that it isn't, and it doesn't have to be. The lockdown where I grew up, in rural areas of Pennsylvania, has literally devastated some families. Even here in NJ, we drop off food at the food bank every week because it is literally empty. People may be trying to avoid the risk of Covid, but the risk of hunger and deprivation is growing faster.
This avoidance of Covid risk is clearly (to me) misguided. We'll learn more over the next 2 to 4 weeks, as the main issue is whether reopening to any degree will cause a 'spike'. I don't mean one day increases like Florida's on May 21 (due to a massive influx of test results, practically double the normal), but sustained, multi-day increases of 25% or more from average levels. That has not happened, so far, in any reopening.
It seems to me, the only important numbers should be the number of new cases reported prorated to testing levels, and the number of hospitalizations for Covid cases. Deaths are also important, but should be listed as a lagging indicator. Remember, the two main reasons for the lockdown are 'flatten the curve' to avoid overburdening hospitals and/or 'save lives'.
Your opinions will drive what you think is reasonable and rational, and what you think is logically useful. If you've lost a loved one, or have someone struggling with the virus or on a ventilator, you will think it's more serious than it may really be. The news has tried to make it seem that way.
On the other hand, if you had a mild case or none at all, you may take a walk down the street as I do each day since my recovery. You'll see it's not really as frightening as the media makes it out to be. 95% of the people are simply not sick. Some percentage of them are recovered, a larger percentage are asymptomatic, and even more may be like my wife and just not getting infected. Of the 5% who are sick, most are not hospitalized and are dealing with their symptoms at home, as I did and all my friends did.
If you thumb through the pages of history and look at previous pandemics and plagues, you'll see this is not as deadly as most pandemics have been. Many killed larger percentages of the world's population. Prior to the 1900s, most of those deaths were due to lack of good health care and lack of knowledge and understanding - but people still went about their lives. Oddly, we're in a better place today, knowing more, but still knowing little about this particular virus, and yet we're scared. Why?
I'm certainly not willing to expose myself to a deadly disease, yet I was somehow exposed. I seriously doubt isolating would have 'saved' me. We don't know if my son got it from me, or from his travels in and out of New York or at his office. Maybe he gave it to me. Isolating may be what got me sick. But I was never scared. The day they sent us home from the office, I said I didn't want to work from home full time. They said I didn't have a choice. Fine. I'll save some money on the commute and meals. The damage to my psyche, on the other hand, has been significant. Isolation has costs. I'm dealing with some of these as best I can, and they are not enjoyable, let me tell you. I guess I fall into the lucky group of having to suffer from Covid, but also suffer from the other debilitating mental issues that come along with isolation.
As a result, after reading all the comments on the epidemiology post, I came to a conclusion. If you're getting emotional over this, you've given up on thinking reasonably about our situation. You're personalizing it, which is certainly your right. But personalizing a disease doesn't make your policy view scientific or more informed. Listening to 'authorities' claiming to have 'science on their side' doesn't make any view scientific. It's just a view.
I get to share my views here, so I do. In addition, it helps to share our thoughts, that's why I like the comments section. Issues and disagreement arise when we're sharing an emotional response, a personal response, or rational thought. My posts are personal, and as rational as I can make them. I try to drop the emotion.
We're all going to be fine. 99.1% of us, or so, will survive Covid. These numbers will increase as treatments improve. Isolation is unlikely to be helping, only extending the period of infection. Even if isolation was reducing infections, it's causing a multitude of other unintended consequences.
If you're angry that you have a loved one that died due to Covid, I'm truly sorry and understand your point of view. If you're angry because others don't take it as seriously as you do because of your loss, I'm sorry too. However, I can respect those feelings, and the points of view associated with them without agreeing that the policy you support is correct or 'best'.
There is, clearly and obviously, no way to make everyone safe. This is a literal impossibility. Some people will die and, sadly, that's unavoidable. Some close to of us will die. That's how viral outbreaks work. Personalizing these facts are what we will do, but personalizing them and trying to force others to agree on policy is useless. We can mourn the losses, and we can hope our medical professionals continue to improve treatments and find cures or vaccines. We shouldn't be angry with each other because we choose to support different policies. The goal is to protect yourself and your loved ones - not to force others to provide that protection.
Each day I drive my car I worry about the bad driver, the reckless driver, and the drunk driver. I drive defensively to avoid a bad outcome. As a result, with the virus, I live defensively. Laws can punish the reckless and drunk driver - but the law won't make these drivers go away. That doesn't mean the law is 'bad', but it does mean we need to keep in mind the value of laws are extremely limited. The true problem, the one you can't pass a law to punish, is the bad driver and unseen circumstance. The bad driver is the one thing you can't account for. You also can't account for the good driver who is momentarily distracted. You can't account for the dog in the road, the deer leaping from the woods. These are useful analogies for managing myself in this new reality. We all have a lot going on in our lives, even without a virus. But the virus hasn't changed how we should live our lives. It has only shifted how we should think about managing ourselves around others and in public.
For some reason, though, it's driving a wedge between people. I hope my close friend doesn't stop talking to me as the result of a virus. That would be silly and childish. I'll avoid the topic, if they are willing to, as well. If the topic comes up, though, I will discuss it rationally. I won't get emotional, if they reference their experience, I'll reference mine. If they reference science, I'll reference science that supports my view. We can disagree, that's fine - there is literally no correct science on this topic yet. My different point of view doesn't put you at risk, no matter how much you think it does. It's fear that is making the difference, and that fear is irrational when you look at the numbers. Even though there may be personal losses to consider, the numbers still matter more on a societal level, than the individual sense of loss. "If we save one life" is not a good mantra for a safety policy - as we here at Maggie's have pointed out.
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Thanks, Bulldog. That was excellent. You wrote about "the numbers". The way the health departments publish those really makes me angry. We're supposed to be "flattening the curve", but they only publish cumulative numbers so the curve always goes up. They publish cumulative hospitalizations rather than current hospitalizations; They never show the admission dates or discharge dates so the result is that we don't know if there's a current problem or whether the problem was over months ago. Neither do we know if the hospitals were overwhelmed on any given day. I have to conclude that the data are presented this way intentionally simply to create fear. Am I wrong?
You're not wrong. I've had the same thoughts - they ARE putting this in cumulative numbers, so as to scare the (sadly, most of the people) innumerate.
I've also noticed that they NEVER publish the number recovered. NEVER. They occasionally show a discharged person (usually young, naturally, as that is mostly who does recover). But, not out of the wheelchair. Not on camera.
I've come to the conclusion that the enstupidizing of the American people was deliberate. That way, they have to accept the most ridiculous statistical reasoning, without protest. They simply don't understand well enough to follow the argument, and pick holes in the rationale.
The truly sad part is that you don't need a high level of math skills to see the naked emperor - addition, subtraction, multiplication, division. Basic fractions and decimals, and the ability to calculate percentage. What we USED to learn in elementary school, or, at least, by junior high.
The number of Fatal and new cases* clearly shows the curve was flattened in NY & NJ and those numbers, unlike some others, are independent of testing.
The question will always be "flattened as compared to what, exactly?"
I'm not saying it didn't happen. I'm saying you can look at the numbers now and say anything you want. I'm not a believer that it was flattened at all. There is no point of comparison to know that.
As you alluded in your conversations with your friend, there is an emotional element intertwined with Coronavirus outbreak. My belief is that people that, for whatever reason, have a strong emotional reaction to the illness tend to be irrational over how to deal with sickness.
Take my wife's daughter for example. She has a giant intellect. Ivy League grad, has tutored physics and advanced mathematics, and is now a surgeon. And yet, with all that STEM training, she is absolutely convinced if her mother travels to see her, her mother will contract the Coronavirus and DIE!!! It's a mind-boggling miscalculation of risk, but there it is.
There is absolutely no arguing with people that have staked out an emotional position on The Virus. They seem to gravitate to an imagined worst case scenario. The numbers don't matter.
>but sustained, multi-day increases of 25% or more from average levels.
I think the correct measure is relative to hospital usage, not average levels. We want people to catch the disease over the summer.
To explain, my conservative assumption is won't be any miracle cures/vaccines. If true, this means we'll all get sick eventually. The worse plan under that scenario is to push cases from the May-October into November-March, when the flu is also competing for hospital resources. Not only are we wasting hospital-days now, we'll are more likely to 'overwhelm the health system' when it also needs to treat flu patients.
That these measures would be effective and without them we would be worse off is a classic “ unfalsifiable hypothesis”. Probably built knowingly.
The original intent was to try to buy some time for the hospitals to get ready. A couple of weeks maybe three. They called it flattening the curve and that was as good a name for it as any. After the PPE's were available and the hospitals were generally ready we should have opened up the country with care for those most at risk. That's where it all went off the rails. Now it is political. It is also a fear thing such that those who are afraid are now asserting authority that they do not have. This "pandemic" has now become a disaster. We need to pull back the reins on our elected "leaders" and maybe even knock them off their high horse. If we don't do something soon it will be too late.
Instapundit linked to a report of a study related to infection rates
My brief summary of the study's conclusion is that, similar SARS and MERS that are also coronaviruses, most people don't transmit the disease to others. That's balanced out, though, because some people transmit it to lots of other people. I don't know if a specific reason for the difference is identified. I've heard speculation that forceful exhalation, like singing, aerosolizes the virus and gives it greater dispersion.
As to the belief that NY and NJ flattened the curve, well, see Bulldog's comments above.
In 1918, in 1957, in 1969, all epidemic years, we accepted that disease can kill. Now, it seems society, pundits and leaders largely seem to think that if we just follow the rules, we can control this virus, even though we can't realistically do so.
Thank you kindly, Bulldog. Three friends have had it, two on the moderate end of severe. Two friends have lost relatives, one of whom was a nurse in the thick of it in New York. A distant neighbour, a nurse on the other side of town, has also fallen to it. Epidemics happen, and the results can be fatal to some. My grandparents, all four of them, used to talk about the epidemics of early in the last century, and they were very grim. One of my grandfathers survived rheumatic fever twice, and lived to pass his seventy-fifth birthday.
I'm at significantly elevated risk compared to my peers. This is due to a therapy that saved me from a disease that should have killed me nearly a quarter century ago. I know what risks are acceptable and what aren't, and have sequestered my self from the unacceptable ones weeks before some hack politician decided to needlessly and arbitrarily restrict my life.
What nobody has explained to me is why my neighbours and local businesses should be subject to extreme and costly restrictions on the pretext that they might endanger me. I doubt anybody would dare try: when something becomes a political issue, the political calculation is always the first, and often the only consideration. I can take care of myself, thanks. Pretty much anything the nags, cranks, government, do-gooders, control-freaks etcera have ever done for me is make things more difficult and significantly more costly.
The worst of this situation is largely confined to one region and a couple of vulnerable populations. Factor them out and the risk is a great deal lower than the gross data, incomplete as it [still] is, would tend to indicate. There are areas in which elevated caution is probably appropriate. In the meantime, as Zhivago's said to his apparatchik brother, Yevgrav, "... some of us have to keep the patient alive by living."
The Spanish Flu infected about a third of the world's population, so it's by no means certain that "everyone will be infected" by the coronavirus.
I guess it's chic now to say no vaccine is possible and everyone will get it as a way of resisting public health measure.
This means that prophylactic measures like social distancing were effective, note the difference between the infamous Liberty Loan parade in Philadelphia and St. Louis. "Public health officials attributed the lower death rate [in St. Louis compared to other major US cities
] to the early and rigorous ban on public gatherings."
The Spanish Influenza of 1918 in St. Louis, Missouri
Far more deadly and infectious viruses have been eradicated, and, more relevant, the Spanish Flu apparently mutated itself out of existence by the end of 1920 without a vaccine.
Curious who said 'everyone will be infected'? I did a search, but didn't find that in my post or in any comments. So that's an interesting statement that is apropos of nothing.
The comparison to the Spanish Flu and your assessment of effectiveness of social distancing is based entirely on a few opinions, not any proved case studies.
Yes, other viruses have been eradicated. They were not RNA viruses, so did not mutate as rapidly.
It's not chic to say no vaccine is possible. But even the professionals have said there is no guarantee. So without appealing to authority, the best comparison is the flu - for which we have many vaccines and yet we still get it, year after year after year.
My guess? This will wind up being more like SARS and MERS and simply mutate itself out of existence or into less lethal forms. After all...it is a SARS virus. But that's just a SWAG.
I wasn't referring to any of your posts. Apologies for the confusion.
My assessment on social distancing was based on the article found in the National Library of Medicine published in 2006, not anecdotal evidence. It was linked above, Here is the Abstract in full:
In view of current concern about a possible pandemic of virulent avian influenza, it is timely to revisit the public health response to the "Spanish" influenza of 1918. St. Louis, Missouri, was the most successful of nine largest cities in limiting the death toll from influenza and pneumonia through the use of public health measures during the first 8 weeks of the epidemic. A second wave of cases increased the final death rate, but it remained below that of other major cities. Public health officials attributed the lower death rate to the early and rigorous ban on public gatherings.
The large war bond parade in Philadelphia causing thousands of infections is fairly well known, here's a CDC article on this:
I can't say any more than you can whether and when there will be a vaccine of some sort (and 100% effectiveness is not necessary), but big pharma thinks there will be and whoever develops one will make billions. Given that profit motive, I'll trust big pharma's assessment of their chances. As one of the other posters points out, "the effort to create a SARS vaccine was dropped when it faded as a problem." The unstated corollary is that the financial incentive vanished when it faded as a problem.
Major league sports and their players associations are betting on social distancing as they plan to resume or start seasons; they are among many businesses very sensitive to making a mistake on reopening. Again, I'll follow the money.
I suspect it will end more or less as you suggest.
Your No. 11:
Curious who said 'everyone will be infected'? I did a search, but didn't find that in my post or in any comments. So that's an interesting statement that is apropos of nothing.
No. 4, six hours earlier:
To explain, my conservative assumption is won't be any miracle cures/vaccines. If true, this means we'll all get sick eventually.
To my knowledge, smallpox is the only disease affecting humans that has ever been eradicated. That took sustained effort over decades with a vaccine that had been available for over 100 years. We have greatly reduced the incidence of many childhood diseases in areas that practice widespread inoculation but the reason that every generation of children continues to be vaccinated is because those diseases have not been eradicated.
It is not merely chic to believe that a vaccine may not be developed. An effective vaccine for a corona type virus has never been developed (the effort to create a SARS vaccine was dropped when it faded as a problem). There are multiple issues to be addressed. Coronaviruses and other viruses mutate and render vaccines ineffective after period of time. Immunization protection fades in our bodies over time. One reason why a vaccine for the common cold (also a coronavirus) has never been developed is because our body's immune reaction to the stimulation fades in a matter of months. While there are promising reports of C19 vaccine production the testing of those vaccines is not complete, and the production arrangements have not been completed so we have no idea how many doses may be available.
Extreme social distancing has been a good strategy for providing time to assess the problem but is not a long term solution.
We've been hit hard but the equivalent of a 1918-1920 event would cause approximately 1 million fatalities in a year.
Eradication of smallpox took a concerted push by world health authorities but to be honest, I don't think there was the same sense of urgency there is now, since it had been eradicated in North America and Europe before the last wild case in Somalia (there were accidental lab infections since).
Smallpox is the only viral disease to be eradicated, but polio is next, within a few years, since the only cases are now in Africa with the infection rate plummeting.
There are a lot of viral diseases that could be eradicated but for the anti-vaxxers and exceptions to vaccination laws: measles, mumps, diptheria, rubella. There are others.
Social distancing as a stopgap measure works, and, note that hardly anyone is volunteering to contribute to herd immunity.
> since the only cases are now in Africa with the infection rate plummeting.
Africa and Pakistan:
Yes, smallpox was eradicated, but any virus that also lives in a reservoir of infected animals, especially when those animals are in contact with humans, will be impossible to eradicate, short of innoculating every individual wild animal that belongs to the reservoir species. What reservoirs are there for corona virii? We don't know if it's only bats, or if perhaps mosquitoes are also carriers. How do we innoculate mosquitoes???
Seasonal influenza passes between swine and birds until it jumps into humans. This happens in large part because of the unsanitary conditions of agricultural practices where pigs and fowl are raised in close proximity, as is done in China. Changing some of these practices seems like a good place to start. William McNeill makes this point in Plagues and Peoples.
The source of SARS-CoV-2 virus isn't known yet, but similar viruses come from bats through an intermediate vector, civet cats or dromedaries. Newsweak has just reported that Chinese authorities have have announced a comprehensive ban on eating wild animals and the hunting and trading of wildlife. So this is a start.
BD, here's a potential issue for your consideration. In the last paragraph you write, "There is no way, literally none, to answer whether we 'flattened the curve' or 'saved lives'. Saying we did will only be based on what you presume may have happened otherwise. That's not science, that's an opinion. My opinion is we didn't and can't do either, but my opinion is no better informed than yours." The first sentence of the last paragraph is your opinion but you state it as nonconvertible fact. You frequently present your opinion as fact IMHO and it makes you come off as a bit of a pompous know it all IMO.
After the pandemic is done, it is my opinion that there will be some very good after-the-fact analyses conducted that will definitely inform all of us about what worked well, what did not work well, even what helped minimize hospital utilization.
When fortune telling, it is helpful to humbly note your fortune is your opinion right up front...
I think we will learn from this illness and our actions. However I do believe that politics and political correctness will sway the results to fit specific biases. We may well be more ignorant of what is the right thing to do after this has all been studied.
I live near Hartford and run a critical infrastructure business so we stayed open and work nationwide. So I was very attentive to regional variations in COVID risk. I took the daily case and death numbers produced by the state health department by Connecticut town and did some quick analysis. On a daily case and death basis the leading hot spot in Stamford has just started to level off nearly three months into the lockdown. Hartford is still almost a linear rise with no indication of any benefit of lockdown. My upper income suburb has only a minimal amount with essential no trend with time at all, but then next suburb closer to Hartford has a constant increase! My conclusion is the same as Bulldogs. The virus has a pretty low infectivity except for very close contact in somewhat unknown conditions. I also think there is a fair level of immunity from having related Coronavirus types (colds) in the past. This would explain some of the lack of family infections. There also appears to be a genetic factor that could explain many of the Hispanic and Black areas of higher infection. The original lockdowns if a very tight quarantine for 14 days had a chance of working, but the extended loose lockdowns only frightened the public but destroyed the economy.