clutch

Why would anyone think that a 2nd wave was not coming? (when lockdowns are lifted)

Take a cruise instead. ;D

The US is clearly not Sweden, though, right? I think this is a fair point as the people's behavior might be the single most important factor in containing the virus. It probably explains why many Asian countries were able to contain the outbreak. Having said, what now for the US? We see that as soon as the measures are lifted, people quickly go back to their normal behaviors, e.g., what happened on California beaches.

It seems plausible that Sweden will have a similar economic downturn as that is largely tied to people's behaviors and trades. If you listen to their top epidemiologist, Johan Giesecke, his main argument is that you will have a similar number of deaths at the end regardless, whether you are in a FORCED lockdown vs a voluntary one. And that there is no need to take such a draconian and authoritarian measure -- which could become a threat to free democracy. His interview: I don't think he mentions economy even once...

"WHO emergency expert says Sweden could be ‘future model’ for coronavirus policy" https://www.nydailynews.com/coronavirus/ny-coronavirus-who-emergency-expert-20200430-rsa3s3lm6bfk3fjofw3oezzrxu-story.html

The flaw with that thinking is that we're learning and working on things that could be here before the vaccine, and the timeline for the vaccine is unknown (could be sooner than we think too), and there's limited healthcare capacity. So if in 2-3 months we have some more therapies/drugs and best practices (proning?) to helps save people who get sick, it's better to be infected later rather than sooner and to keep the curve flat rather than have a high peak early on. Vaccine -- I think it'd be the same as relying on a miracle when every expert says it would take at least 18 months. Healthcare capacity -- Good point, but it seems Sweden has avoided overflows. At least I haven't seen any news regarding this. This was obviously a problem in NYC or Italy but might have been overestimated in many countries. As you may know, it's quite the opposite in Ontario where cardiac patients are dying due to delayed surgeries while hospital beds are empty. So a lockdown can directly cause deaths, too. Treatment -- I think the Swedish thinking is that reaching the herd immunity quickly is the best "treatment". This is how a pandemic was overcome throughout our history. It does sound cruel but seems like that's what they believe in. What I'm saying is you can't judge their action unless this pandemic has played out. Especially it was their plan to intentionally go through the peak. You can judge that from a moral/ethical standpoint, but you can't judge whether it's working or not -- yet.

It seems a bit harsh to constantly review Sweden on the number of deaths compared to their neighbours as their policy was never aimed at less corona death in the first place and they were upfront about this. If someone wants to compare, you have to look at the broader picture (economic growth, quality of life), which you cannot do until much later. Despite what many predicted, their IC capacity seems to be holding. I think it's useful to look at what this approach does vs different approach. I don't see anything harsh or unfair here. I also saw some numbers somewhere that it's not because things arent officially closed that they aren't basically closed.. saw numbers on Swedish restaurants and theaters being basically zero, but don't remember where. Probably same for any big events, travel, etc. Regarding Sweden -- here is an answer from their former state epidemiologist. "I think we should wait a year when comparing the deaths in different countries." Why not wait 10 years and then we'll really have perspective? This is about real-time decision-making under uncertainty to try to balance various pros and cons to do as well as possible through a crisis.. I have answered this before but the 1 year - 18 months timeline is what a lot of modeling work is based on -- when they anticipate that a vaccine will be available. The Swedish argument is that you can't keep the lockdown for 18 months and as soon as any country lifts the lockdown, the number of cases/deaths will peak again -- as the modeling work also predicts. Therefore, if you sum up all the deaths over that period most countries would have suffered a similar number of deaths.

^^^ Long term care / nursing home deaths seem to be a significant problem in almost every country where there is significant community transmission. And it seems to be irrespective of whether the country imposed a severe lockdown or not. It's just the perfect combination of density + old age, the condition at which this virus is most lethal. In hindsight, not having foreseen this problem could be the most serious mistake made by the governments / health officials around the world.

It seems a bit harsh to constantly review Sweden on the number of deaths compared to their neighbours as their policy was never aimed at less corona death in the first place and they were upfront about this. If someone wants to compare, you have to look at the broader picture (economic growth, quality of life), which you cannot do until much later. Despite what many predicted, their IC capacity seems to be holding. I think it's useful to look at what this approach does vs different approach. I don't see anything harsh or unfair here. I also saw some numbers somewhere that it's not because things arent officially closed that they aren't basically closed.. saw numbers on Swedish restaurants and theaters being basically zero, but don't remember where. Probably same for any big events, travel, etc. Regarding Sweden -- here is an answer from their former state epidemiologist. "I think we should wait a year when comparing the deaths in different countries."

"More people will die of economic fall out then will die of coronavirus: CEO World Food Program"

Golf! Can't find any safer activity than that in terms of catching the virus.

Maybe people expect their sanitizer sales will sky rocket... https://www.cnbc.com/2020/04/24/coronavirus-kegs-are-going-bad-boston-beer-has-a-solution.html

You seem to have left out one of the other principal reasons for flattening the curve in the first wave, which is simply to buy time. The hope is that we will have more tools available than simply hand washing and physical distancing, the same tools we we had hundreds of years ago. A good analogy is to think of it as putting a patient in to a medically induced coma briefly in hopes that treatment will improve in the interim. The number of interventions large and small that can be developed in three months is often also underestimated buy those who oppose flattening the first wave. Those are all fair points. I'm just not sure if the public is aware of this as the main reason. Perhaps the message would be too grim if they were told, "we are just buying time, hoping to find a cure...and it could take over a year".

https://jamanetwork.com/journals/jama/fullarticle/2763667 I think you could infer from the case fatality rates for the working age groups, which seem to be very low considering the infected fatality rate is probably is an order of magnitude lower than that.

Glad to see that more people are recognizing what the "flatten the curve" exactly entails. It's not to eliminate/control the virus, but to stretch out the number of cases/deaths over time. There is always a danger of 2nd or 3rd spike even if you control it now (e.g., look at Singapore). Hence, the modeling papers such as the Imperial College's work recommend doing the intervention measures for 18 months or more, until the vaccine is found. I'm not sure those who religiously support the "flatten the curve" approach understands this! And I don't understand why some people would like to consider discovering a vaccine as a "black swan" event that could happen in the short term. All the EXPERTS agree that it will take about 18 months. Shouldn't we take their words? Anyways, the problem I see is that the general public does not understand what the strategy entails. They are mostly left in the blind having to trust the government and their experts. Only after you read the actual modeling papers or run simulation yourself, you really understand the consequences and what's ahead of us with this strategy. And it's not just Trump in the US who is not communicating this, but the same in other countries as well. I honestly don't know which measure will work out the best in the end...The future is impossible to predict. I'm not sure why many value investors suddenly believe anyone can model and predict the future... We used to laugh at so-called financial or economic "experts" who try to model and predict the market... It's not much different in the epidemiology world where the system you are trying to model is extremely complex and dynamic.

For those who argue that more people could die because of "overflow" in hospitals: At least in Canada, its quite the opposite. Operating rooms are empty while cancer patients' surgeries are getting delayed: https://www.google.com/amp/s/beta.ctvnews.ca/national/coronavirus/2020/4/24/1_4910699.html Who knows how many of such patients would die because of delayed surgeries... And no, CTV news ain't Fox.

APRIL 2 WHO report: "There are few reports of laboratory-confirmed cases who are truly asymptomatic, and to date, there has been no documented asymptomatic transmission." https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200402-sitrep-73-covid-19.pdf Why is WHO so wrong on everything? How does WHO think the virus is spreading so fast? They think lot of people are going around sneezing and coughing? Its beyond stupidity to say no asymptomatic transmission. I'm far from approving WHO but I can tell you why. It's because they need significant scientific evidence to make any particular claim. Things like asymptomatic transmission, immunity for those infected, the benefit of wearing masks, etc., are all very hard to scientifically validate (i.e., with significant enough sample size), especially with a new virus. The problem is that many of the governments are relying on WHO because they want to act based on scientific evidence. In some sense, they have became slave to the process, while perhaps they just need to act fast and safe. Science might be the best thing the mankind has created, but it shouldn't constrain us from taking the most reasonable action.

Really? Flattening the curve strategies do not incorporate in their projections a positive black swan emerging: a vaccine, effective treatment, or heat/humidity reducing spread/severity/mortality (positive black swans) because this is impossible to predict. They also do not necessarily incorporate extra deaths from healthcare overload (which would be very hard to estimate). Hence our nonsense peddlers seize on this as "proof" that flattening has no real benefit. They are left out of models because it is impossible to model black swans (even positive ones) and extra deaths that result from overload. Just because they are left out does not mean these are not very real benefits of flattening (they are). As the bank example I used--if everyone goes to the bank to ask for their deposits all at once vs over time, you will see a real, nonlinear difference as the bank will fail in the fmr scenario. Again, I am not going back to square one (arguing about benefits of curve flattening which should have been settled 6 weeks ago) and coming down to the level of our great nonsense dwellers here... So you are now arguing that we should make decisions based on the potential events that are left out of the model. Why make/use any models then? (sarcasm)

Also, from the Imperial College paper -- this is the prediction model in the full picture: Once you lift the intervention in September (as in the picture), you get the same spike in the fall. Hence, the paper recommends putting in the intervention in place for 18 months. Are we all ready for that? I actually applaud them for this recommendation -- this means they are really thinking like health professionals and not as a blend of health pros + politicians/economists. Their very last paragraph in the paper can be a bit chilling: "... However, we emphasise that is not at all certain that suppression will succeed long term; no public health intervention with such disruptive effects on society has been previously attempted for such a long duration of time. How populations and societies will respond remains unclear."

"On recovery from infection, individuals are assumed to be immune to re-infection in the short term. Evidence from the Flu Watch cohort study suggests that re-infection with the same strain of seasonal circulating coronavirus is highly unlikely in the same or following season (Prof Andrew Hayward, personal communication)." I think they simply assume that the people who were infected won't get infected again. As this group size increases, the rate of infection slows down and we see the curve tail off. Your last point is an important one. The Imperial College model takes age into consideration to predict the percentage of people requiring hospitalization/ICU/fatality rate. It's in Table 1. You will see that they have underestimated the infected fatally rate for the older population. (on the other hand, they have overestimated the hospitalization rate across the entire age groups, likely indicating that they were relying on the numbers from Wuhan/Italy at that time.)

Dalal.Holdings, I'm trying to show that I can use scientific evidence and reasoning to counter many of the arguments you are making. That is how science works. None is absolute and things should be critiqued. I think you are just too used to the "deplorables" arguing with you simply based on their ideology. And maybe you are one of them too, just on the other side.

Lol. This somehow proves models are useless? Reminder to self: refrain from responding to nonsense peddlers. It shows (not "proves" -- none of these models are provable) that over a longer period time, the model could turn out to be incorrect.

There goes that lone example from the “do nothing” crowd. But what do you expect from people who lack any sense of objectivity and scientific literacy? Often wrong, never in doubt. I'd revisit the deaths/mil number in 16 months and it should be similar across most of the countries. The area under the flattened and peaked curves are about the same... No one is arguing the area of the curve is different. The area under the curve will be approximately the same, but flattening and delaying peak prevents healthcare overload (which would lead to more deaths and more area under the curve), allows to buy time for positive black swan (treatment, vaccine, warm/humid weather) to emerge. If a vaccine or treatment emerges, the flatter curve is better and ends up with a much smaller AUC. That’s one thing you are discounting (in addition to consequences of ICU/vent/healthcare overload). That's why I say revisit in 16 months, when all those factors would have played out, instead of them being model assumptions. I'm sure Sweden has many qualified health experts too and a prediction model. For some reason, they concluded that their approach is the best course of action. Only time will tell. Why 16 months? Let’s revisit in 10b years during the heat death of the universe. /arguing nonsense Because that's the timeline these intervention measures are based on, at least in this paper. https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf "The major challenge of suppression is that this type of intensive intervention package – or something equivalently effective at reducing transmission – will need to be maintained until a vaccine becomes available (potentially 18 months or more) – given that we predict that transmission will quickly rebound if interventions are relaxed."

I haven't seen any news yet that hospitals in Sweden are overwhelmed. Maybe the experts there knew that was going to be the case. Also, the experts knew that that vaccine won't be available for another 18 months, or the probability is so low. They probably took these into account, and understanding "flattening the curve" is simply prolonging the damage, and decided to roll the dice. They are the experts, too.

There goes that lone example from the “do nothing” crowd. But what do you expect from people who lack any sense of objectivity and scientific literacy? Often wrong, never in doubt. I'd revisit the deaths/mil number in 16 months and it should be similar across most of the countries. The area under the flattened and peaked curves are about the same... No one is arguing the area of the curve is different. The area under the curve will be approximately the same, but flattening and delaying peak prevents healthcare overload (which would lead to more deaths and more area under the curve), allows to buy time for positive black swan (treatment, vaccine, warm/humid weather) to emerge. If a vaccine or treatment emerges, the flatter curve is better and ends up with a much smaller AUC. That’s one thing you are discounting (in addition to consequences of ICU/vent/healthcare overload). That's why I say revisit in 16 months, when all those factors would have played out, instead of them being model assumptions. I'm sure Sweden has many qualified health experts too and a prediction model. For some reason, they concluded that their approach is the best course of action. Only time will tell.