Peregrine

Good to hear you're feeling better. Were there any differences between how you felt with this versus previous experiences with the cold or flu?

Vaccines will go to med staff first, but regardless remember two doses per person. I know that's the plan to prioritize the med staff, but I'm not in agreement that it's the right approach. If one were to take the 70+ age group out of the equation, what would be the load on the hospitals today? That's how the pressure comes off the hospitals, and the rational for the curfews and shutdowns is that the spread of the virus is risking our hospitals being overrun. Anyways... The thinking I think is that front-line workers are vectors of spread to the elderly. Though I agree with you that the elderly should be vaccinated first.

The flu mutates frequently. All viruses mutate.

Thanks. I'm guessing the last number is the estimate for your IFR?

It is not objecting to masks Frank. But pro-maskers were saying if only every one wears masks Covid disappears. Even CDC director said that - masks are more important than vaccine. CDC director said "masks are our best defence". If masks are our best defence and are better than vaccine, we are doomed. Because mask mandates have been tried in many places and masks are worn by above 90% people and yet there are big spikes in infections. The best defense is not working. Coming back to whether masks are better than not wearing, not everyone agrees on this. For example as per this article Reduction of Self-Reinoculation It is well-recognized that COVID-19 exists outside the human body in a bioaerosol of airborne particles and droplets. Because exhaled air in an infected person is considered to be “loaded” with inoculum, each exhalation and inhalation is effectively reinoculation..... We propose that fresh air could reduce reinoculation and potentially reduce the severity of illness and possibly reduce household spread during quarantine. This calls for open windows, fans for aeration, or spending long periods of time outdoors away from others with no face covering to disperse and not reinhale the viral bioaerosol. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7410805/ This article is written by some of the top doctors including Baylor, Johns Hopkins, Emory, Yale....and many more.... There is one randomized study that is cited by anti-maskers which is https://bmjopen.bmj.com/content/5/4/e006577.short This study does not have an arm of not wearing mask and it is not with Covid 19. It compares "Hospital wards were randomised to: medical masks, cloth masks or a control group (usual practice, which included mask wearing). Participants used the mask on every shift for 4 consecutive weeks." What we need are proper studies which are lacking. That is why I keep asking what is your evidence? There is no evidence. Only arguments and pronouncements. Now I am not going to tell you whether CDC director is correct (Masks are our best defence in which case we already lost because our best defence has been tried many places) or all these doctors are correct that re-innoculation of virus is bad and will lead to more severe disease. What we should demand from CDC is evidence, not pronouncements. Yes, I'm aware that the clinical evidence of mask effectiveness has not been particularly strong yet. But practically speaking, it's a minor inconvenience with low trade-offs - which is one reason why I think the public health messaging has shifted from lockdowns to masking. I don't think it's particularly helpful to get into the righteousness of all this stuff when people's lives have been upended to such a degree - we should be focusing on practicality.

I think anti-masking has become ideological just like how much of this debate has evolved. I think it's rather silly to object too much - it's a fairly small inconvenience with some possible benefits (if not reducing transmission then maybe reducing viral load) and none of the massive collateral damage that comes with lockdowns. I think the consensus gradually focusing on masking and moving away from lockdowns is a good thing on balance.

Have you considered the possibility that the difference between a)spontaneous individual actions, b)how people react to recommendations and c)how people react to rules may not be different in the extreme? Also, do you think that 'measures' (whatever the origin) improved, had not effect or worsened virus-related health outcomes (let's forget about the costs for this part of the argument)? Also, how do you explain the divergent evolution between the US and Sweden after the first phase (percent positive rates, excess mortality)? Do you actually think that 'extreme measures' are explaining the wide and persistent difference? BTW, i agree that costs have been (and will be) significant. But i wonder if you can help clarify the benefits, if any. Good point on the voluntary measures. But Sweden's google mobility data are fairly close to 2019 baseline levels now. The US is a much bigger country and the outbreaks right now are concentrated in the places that were spared in the spring. My guess is that higher level of population immunity is a big reason for the current more benign experiences in places that were hit hard in the spring.

I don't think there has been much trading of VIX futures to move it right now. It's mainly used as a hedge for SPX exposure and apparently there's a lot of money on the sidelines at the moment.

Oh, and more on Sweden's economy: https://www.bloomberg.com/news/articles/2020-10-06/swedish-gdp-set-to-trounce-euro-zone-u-s-and-even-top-nordics?sref=79DyzZ1p

Of course it's real, just not nearly as bad as many make it out to be and certainly not worth the collateral damage of the extreme measures taken so far in an attempt to counteract it.

About Sweden....

So across Europe where cases have been rising, positivity rates among the old have remained low whereas those of younger age groups have shot up which in my view shows that the more vulnerable are shielding themselves while the less vulnerable are going back to more normal lives. Despite the vitriolic mainstream reaction to the Great Barrington Declaration, society is more or less going that route anyway.

It appears that the increased infections are taking place in areas in the country that weren't hit hard in the first place. For example, the increased infections in the UK are taking place in northern UK and not in London and the South. Similar trends happening in other places seeing "second waves".

I think the reason is because this is difficult to implement. First, what is the cutoff? 30 years old let's say? Sounds reasonable, maybe +/- 5 or so years. Now even with a threshold, not many aspects of society are so cleanly segmented by age. Schools would be the most obvious one, but even those are filled with teachers and administrators. In theory it makes sense but I think implementation is the challenge. I'm glad that a discussion can be reasonable, and why should it not be? As for practicality, should it be more difficult to implement than striving to suppress the virus among the entire population? I don't think it should necessarily be that difficult. We can start with the elderly homes - increase funding and staffing, which has been a chronic problem with elderly homes that finally blew up in the open. In schools, those who are older or with pre-existing conditions may teach virtually or assist in other aspects, such as grading and marking papers or helping to plan lessons for teachers in class. Allot specific times for businesses to open specifically for the elderly. Older people living in multi-generational households can be given the option for temporary stays in the many hotels that are sitting empty right now (what's ironic is that the lockdown strategy has actually increased multi-generational mixing). These are all things that can be practically done, especially considering the immense resources being devoted to this.

Though I disagree with the policy prescription, I think that's fair. See and that's also my own bias. I live a comfortable life and I am young in the context of COVID. I can afford social distancing. There's an old line from that Dirty Jobs show, where the host (Mike Rowe) questions the whole, "safety first" attitude. Sometimes, he argues, it's "safety second, or third". And that was in the context of the working class / paycheck-to-paycheck individuals. To say nothing of age ranges for which this virus has disparate impacts. So how do we both protect people and allow people to work and live? Well first, what do we know? There was a violent initial spike, a somewhat extended but less-deadly second wave, and now we are entering flu season. OK - so then what is the optimal response here? I think it is reasonable to plan for something closer to the "second wave". This is a compromise between both extremes: the initial violent spike on one end, and a situation where COVID has essentially run its course on the other end. So then I would argue the optimal response would be continued mask wearing, some social distancing in high-exposure cities and events, and statewide-tailored responses with federal support for things like medical resources, unemployment resources, if needed. Thanks for being objective. I agree with much of what you said. I think anti-masking is silly - I think even anti-maskers can concede that it is a minor inconvenience for most with little drawback. I also think that people are naturally social distancing and that the enormous resources deployed so far could find far better uses (i.e. more funding to elderly homes). Where we may differ a bit is in the question of whether younger people should live more normal lives. I think that there has been enough evidence that shows that the risk to the young is similar to or even below that of the flu. And compounded with the fact that the young recover faster and are thus infectious for shorter windows of time, chains of transmission are broken quicker, thereby reducing the possibility of increased transmission in more vulnerable groups. I think given the immense age-stratification in the risk of this disease we should be deploying an age-stratified strategy, unfortunately, we haven't yet been using this well-established knowledge to our advantage.

Though I disagree with the policy prescription, I think that's fair.

How is that having it both ways? Read what you quoted again. The first statement is true - that is how epidemics have historically ended. Spanish Flu (H1N1) never disappeared but it reached a balanced state where it became endemic in the population. This will happen with SARS-COV-2 as well - the only question is when. I think we can all agree that at some point the epidemic will end, it's just a question of when. I'm of the belief that the hardest hit areas are a lot further along on that timeline.

I think that you're misinterpreting what I mean. I do think that it's a possibility that COVID is seasonal, although there are arguments against just how seasonal it is. There is evidence within states that counties that were hit hard in the spring have thus far been spared while neighboring counties have seen spikes (see Blaine, Idaho and the New Orleans parishes in Louisiana - both were hit hard in the spring but have not seen spikes since even as the rest of the state has). Why are you so insistent on getting a definitive statement? So that perhaps it can be used as a "gotcha" in the future? I don't feel that's constructive nor do I feel it's constructive to gloat if a prediction does come to pass. It is foolish to make definitive statements about the future. I lean toward the idea that endemicity is a lot closer in the hardest hit areas thus explaining their recent benign experience but I'm not so closed-minded to not think that future waves are out of the realm of possibility in those areas as well. The fact that so many refuse to even acknowledge either possibility makes a balanced discussion difficult.

I didn't realize you could see the future! With such a gift, can you confirm if there will be a "third wave" as we emerge flu season, or if COVID has run its course? Please, be definitive. Nothing is definitive. But we can draw inferences from the data that we see and from what we know about past epidemics. I don't think it's useful to draw causation when there's ample direct evidence refuting it and a more sensible answer is apparent. Another thing: we don't have the luxury of waiting until we know things for certain. Policy-making is never done with a crystal ball. The stakes today are never higher because of the immense trade-offs that society has seemingly willfully accepted as a necessary evil to apply the consensus-favored policy of today.

AKA "herd immunity" 1. Arizona never had a state wide mask mandate. 2. A lot of the restrictions were soft, not well-enforced and unlikely to have had significant effect in reducing interaction. Google mobility data in the state was fairly consistent over the summer and in some counties are now even above 2019 baseline levels. I mean, forget Arizona - look at what's happened in Florida. Even less mitigation and their hospitalizations are down nearly 80% from peak levels. I don't understand why people refuse to acknowledge the basic pattern of how epidemics unfold and eventually recede. Why don't we just call it endemicity threshold (ET) rather than herd immunity threshold? Since HIT has become so toxic and politicized.

Yes, we do call that an epidemic. We have seasonal flu epidemics every single year. CDC defines the threshold for an epidemic as 7.2% of total deaths, so no we don't get flu epidemics every year. But yes, some years the flu can get quite bad.

Hmm. It's almost like the "immunity" in herd immunity means something... Exactly. Which is why the herd immunity term in the general lexicon has become a complete misnomer. This virus will be around long after a vaccine is widely available but at some point (and a lot sooner than many think), it will no longer be an epidemic. Instead, it will become endemic in the population just like all the other respiratory viruses that circulate regularly. This is how previous pandemics ended - viral infections were never eliminated.

Oh, this is ironic. If Rt is perpetually below 1, that means perpetual decline in the number of infections with the end state being 0. This has never happened with respiratory viruses. The Spanish flu (H1N1) still circulates today as do the thousands of other coronaviruses and influenza.

The literal definition of HIT is Rt<1. No it isn't. Rt for the seasonal flu can be above 1 during the winter but do we still call that an epidemic? For Rt to be perpetually below 1 would mean the elimination of the disease, for which is not possible. I don't think you understand the implications of this math all that well.

Doubt Cuomo will allow a full second wave. But increasing positivity and Rt > 1 despite heavy restrictions are clear indicators that herd immunity threshold hasn’t been reached. Edit to add: schools and restaurants haven’t even been open a full incubation period, so too early to detect a second wave. There's a big misconception about what the herd immunity threshold even is. For many, it seems to mean the point at which 1) the virus disappears or 2) that the virus no longer spreads. But that's not possible given the thousands of different respiratory viruses that circulate normally. Rather, the herd immunity threshold is better described as the point in which the virus crosses over from epidemic to endemic. Under that definition, HIT being reached and Rt>1 is not incompatible. The virus will still be around long after the epidemic has ended. So it's because of Cuomo's excellent leadership that a second wave will be avoided? Florida's rt has been estimated as below 1 since late June, even below that of NY's...by your thinking, was it DeSantis's doing as well?