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1.3% of NYC "corona deaths" reported with no underlying conditions. https://twitter.com/adamscrabble/status/1245378516721549322/photo/1

 

we are fighting this virus ass-backwards.  we should be focusing all of our mitigation efforts on elderly and health-compromised. everyone else should be going to work.  why are we so wrong-headed?  we are listening to epidemiologists, who are half-baked statisticians.

 

Any post-lockdown plans will surely involve mass serological testing of those who are vulnerable and isolating those who test negative, while the rest of us will take care of herd immunity.  there's no other way.

 

agreed.  but this should have been the "lockdown" plan as well. establish "health census"

for underlying conditions and elderly and confine the mitigation resources to them.  all of these epidemiologists are using stupid assumptions as to what our health objective should be.  it should NOT be reducing infections among the entire population. it should be reducing infections of a targeted population.  you need someone with common sense to tell the epidemiologists what to model.

 

Specifically what assumption/parameter do you believe is being widely used and incorrect? Again, your entire assumption is dependent on everyone non-elderly getting CV such that we have herd immunity. Herd immunity generally starts at ~80% of the population. Further, it's not been shown that immunity is long lasting or prevents repeat illness. Many epidemiologists have cautioned that this may not be the case.

 

29% of the US population is >55 years old.

https://www.kff.org/other/state-indicator/distribution-by-age/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

~5% of kids are raised by grandparents (this ignores all kids raised by older parents)

 

20% of the households in the US are multigenerational. Unless one wants to cull the herd, Herd immunity isn’t going to work in such a setting.

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Guest cherzeca

it sure as hell would work in the setting if masks were given to these families on a priority basis.

 

what is hard to understand about common sense?

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it sure as hell would work in the setting if masks were given to these families on a priority basis.

 

what is hard to understand about common sense?

 

Masks don't work 100%, especially if you live daily with someone who might be infected (and people won't wear masks inside their house 100% of the time anyway).

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Evidence supporting the "it's impossible to isolate the vulnerable" theory is BC long-term care facilities.  They're trying really hard to avoid it in long-term care facilities including shutting down against visitors, stopping staff from moving between facilities, doing remote diagnostics when possible, and taking the temperature of everyone who enters the building. Yet 21 facilities have it.  (The lower mainland--an area with about 55% of BC's population--has about 55 facilities.)

 

And overall, BC has been fantastic at dealing with the virus, cutting off exponential growth very early (see the yellow line, and note that the Y-axis is linear, not logarithmic, unlike almost every other chart like this you'll see).

 

 

In Quebec they have had to go one more step and hire security guards to monitor the fire doors.  Visitors have been banned from seniors homes for a few weeks now.  However, family members were just showing up at the old folks homes and when they were not allowed in through the main door to visit their family member, some of the residents just sneaked their visitors in by opening the fire doors. 

 

What can you do when a portion of the most vulnerable population doesn't agree with the pandemic control measures?  I went to the grocery store on Tuesday, and it was packed with geezers.  People who are in the 80+ age range should know better than to leave their home to go shopping or to visit family, but some seem to have different risk preferences than the epidemiologists!

 

 

SJ

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Guest cherzeca

it sure as hell would work in the setting if masks were given to these families on a priority basis.

 

what is hard to understand about common sense?

 

Masks don't work 100%, especially if you live daily with someone who might be infected (and people won't wear masks inside their house 100% of the time anyway).

 

well, shit, let's ignore common sense because it wont work 100%!  as if what we are doing now is working 100%....actually close to 100% effective in shutting down economy, so there is your plan!

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New post by Tomas Pueyo, author of the Hammer and the Dance post:

 

https://medium.com/@tomaspueyo/coronavirus-out-of-many-one-36b886af37e9

 

The coronavirus is growing everywhere in the US.

Some states are on their way to controlling it.

Others have massive outbreaks that make China’s outbreak pale in comparison.

Many are unprepared, and will suffer some of the worst outbreaks.

All voters care about this, Democrats and Republicans.

Democrats were hit first.

But Republicans have more to lose.

They’re older and more likely to die.

Most hesitation comes from the perceived cost of suppressing the virus.

Fortunately, it’s cheaper to suppress it than to let it run loose.

We should do it.

But right now, states are left fending for themselves. It’s a mess.

They are competing against each other instead of collaborating.

They might be forced to seal their borders with each other.

There is a role for states and a role for the federal government. The federal government coordinates, the states execute.

If both step up, we will save lives and increase the GDP.

 

If you haven't read the previous post, you should:

 

https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-the-dance-be9337092b56

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1.3% of NYC "corona deaths" reported with no underlying conditions. https://twitter.com/adamscrabble/status/1245378516721549322/photo/1

 

we are fighting this virus ass-backwards.  we should be focusing all of our mitigation efforts on elderly and health-compromised. everyone else should be going to work.  why are we so wrong-headed?  we are listening to epidemiologists, who are half-baked statisticians.

 

Any post-lockdown plans will surely involve mass serological testing of those who are vulnerable and isolating those who test negative, while the rest of us will take care of herd immunity.  there's no other way.

 

You all post some interesting counter-points as to why this solution is sub-optimal. Of course it is sub-optimal.  But imo, it is the only way. Any other way will involve very, very long lockdowns with questionable expected success and much much more quality life years being lost over the cure than over the illness.

 

And of course, we should listen to the advice of epidemologists, but we should also balance that with the advice of economists.  an epidemologist will only care and know about the epidemic, not about the economic aftermath.

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Guest cherzeca

Evidence supporting the "it's impossible to isolate the vulnerable" theory is BC long-term care facilities.  They're trying really hard to avoid it in long-term care facilities including shutting down against visitors, stopping staff from moving between facilities, doing remote diagnostics when possible, and taking the temperature of everyone who enters the building. Yet 21 facilities have it.  (The lower mainland--an area with about 55% of BC's population--has about 55 facilities.)

 

And overall, BC has been fantastic at dealing with the virus, cutting off exponential growth very early (see the yellow line, and note that the Y-axis is linear, not logarithmic, unlike almost every other chart like this you'll see).

 

 

In Quebec they have had to go one more step and hire security guards to monitor the fire doors.  Visitors have been banned from seniors homes for a few weeks now.  However, family members were just showing up at the old folks homes and when they were not allowed in through the main door to visit their family member, some of the residents just sneaked their visitors in by opening the fire doors. 

 

What can you do when a portion of the most vulnerable population doesn't agree with the pandemic control measures?  I went to the grocery store on Tuesday, and it was packed with geezers.  People who are in the 80+ age range should know better than to leave their home to go shopping or to visit family, but some seem to have different risk preferences than the epidemiologists!

 

 

SJ

 

survival of the fittest operates on the mental fitness domain as well...

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it sure as hell would work in the setting if masks were given to these families on a priority basis.

 

what is hard to understand about common sense?

 

Masks don't work 100%, especially if you live daily with someone who might be infected (and people won't wear masks inside their house 100% of the time anyway).

 

well, shit, let's ignore common sense because it wont work 100%!  as if what we are doing now is working 100%....actually close to 100% effective in shutting down economy, so there is your plan!

 

I assumed you were replying to the previous post about multi-generational homes. Masks are useful in public spaces because they reduce R0 if enough people wear them. But they're not real protection for more vulnerable people living with people who go out every day in the population.

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it sure as hell would work in the setting if masks were given to these families on a priority basis.

 

what is hard to understand about common sense?

 

Are you suggesting hospitals (who are running out) give their masks to multigenerational families? This is common sense?

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Not listening to experts, recently and for years past, is what brought us to this point.

How to qualify an expert?

What if different experts come to different conclusions with the same data?

How to deal with fallibility and biases of experts, especially in uncertain situations?

What if if policy conclusions are based on values and a subjective aggregation of experts' opinions rather then pure epidemiological data?

 

Disclosure and an example:

i'm in the process of getting ready to approach the front line on this thing. As part of the preparation, one of the questions that has come up is: Will there be other waves?

The three defining criteria for this question are:

1-social distancing methods

2-the mutagenic potential of the virus and the directionality of that potential

3-herd immunity

2- is unknown and is independent. 1- and 3- are clearly in conflict in the process of policy setting. How do you deal with that? I could provide my own answers but submit that the answers are far from clear, especially at this point.

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But, what if you live in a liberal democracy rather than a society led by an all-powerful social administrator?  How would a liberal democracy effectively impose isolation on the aged and otherwise vulnerable population, while allowing the young and healthy to continue to freely live?  Do you simply find some legal framework through which medical care is denied to anyone over, say, age 70 who catches Covid?  So, the governors/premiers would all go on television and announce that starting in 14 days (the covid incubation time), any person over 70 who catches the virus will be ineligible for medical services and therefore the onus is on the aged and vulnerable population to self-isolate indefinitely?  Effectively, the decision to self-isolate would be made at their own risk and peril?  It's a pretty ugly solution for a liberal democracy, and I am not sure that I know of any constitution of any serious country that would permit such a strategy.

 

if an 80 year old refuses to isolate, it's his/her own choice. It's the same now: if someone goes out anyway, it's on them. You can't let your policy be dictated by the notion some might not listen. At least, for that 80 year old you have the leverage there's an actual health threat to that person, while most 20 year olds have a bigger chance of getting hit by a bus on their once-a-day walk to the supermarket than actually dying of this virus.

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Evidence supporting the "it's impossible to isolate the vulnerable" theory is BC long-term care facilities.  They're trying really hard to avoid it in long-term care facilities including shutting down against visitors, stopping staff from moving between facilities, doing remote diagnostics when possible, and taking the temperature of everyone who enters the building. Yet 21 facilities have it.  (The lower mainland--an area with about 55% of BC's population--has about 55 facilities.)

 

And overall, BC has been fantastic at dealing with the virus, cutting off exponential growth very early (see the yellow line, and note that the Y-axis is linear, not logarithmic, unlike almost every other chart like this you'll see).

 

 

In Quebec they have had to go one more step and hire security guards to monitor the fire doors.  Visitors have been banned from seniors homes for a few weeks now.  However, family members were just showing up at the old folks homes and when they were not allowed in through the main door to visit their family member, some of the residents just sneaked their visitors in by opening the fire doors. 

 

What can you do when a portion of the most vulnerable population doesn't agree with the pandemic control measures?  I went to the grocery store on Tuesday, and it was packed with geezers.  People who are in the 80+ age range should know better than to leave their home to go shopping or to visit family, but some seem to have different risk preferences than the epidemiologists!

 

 

SJ

 

survival of the fittest operates on the mental fitness domain as well...

 

Great example of lack of education. Reinforces the importance of leadership and the message they communicate. And the importance of trust in government and media.

 

When these conditions are present (South Korea, Singapore, Taiwan) a crisis can be successfully managed. If not, a crisis can morph into a catastrophe.

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Not listening to experts, recently and for years past, is what brought us to this point.

How to qualify an expert?

What if different experts come to different conclusions with the same data?

How to deal with fallibility and biases of experts, especially in uncertain situations?

What if if policy conclusions are based on values and a subjective aggregation of experts' opinions rather then pure epidemiological data?

 

Disclosure and an example:

i'm in the process of getting ready to approach the front line on this thing. As part of the preparation, one of the questions that has come up is: Will there be other waves?

The three defining criteria for this question are:

1-social distancing methods

2-the mutagenic potential of the virus and the directionality of that potential

3-herd immunity

2- is unknown and is independent. 1- and 3- are clearly in conflict in the process of policy setting. How do you deal with that? I could provide my own answers but submit that the answers are far from clear, especially at this point.

 

Experts don't know the future, don''t have all the answers, and make mistakes. But they at least know what they're talking about and know what the data means better than laymen and have studied past epidemics (don't have to make all the first-timer mistakes when the stakes are this high, like saying ahead of time you're thinking about quarantining an area, making everybody flee from it and infect other places), and epidemiologists have recommended all kinds of measures forever that were never put in place except in places like Singapore and Taiwan (where epidemiologists are actually now in high offices). They should also be put in charge of the response and best practices should be followed (clear chains of commands and such), rather than have the politicians play reality-TV stars for hours on TV muddling up the message and contradicting them and giving bad advice to populations (it's a hoax, it'll go away on its own, go to restaurants, etc), not coordinating states, not using power to produce equipment fast enough, closing down pandemic groups and offices, making false promises (where are the 5 million tests and fancy websites and drive-through at CVSes etc), no doing statistically significant random testing of the population, etc.

 

If I was going to have brain surgery, I'd certainly rather that a brain surgeon was in charge rather than a TV personality that had never thought about brain surgery until a few weeks ago, or his son in law. Politicians need to get out of the way, every day matters.

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But, what if you live in a liberal democracy rather than a society led by an all-powerful social administrator?  How would a liberal democracy effectively impose isolation on the aged and otherwise vulnerable population, while allowing the young and healthy to continue to freely live?  Do you simply find some legal framework through which medical care is denied to anyone over, say, age 70 who catches Covid?  So, the governors/premiers would all go on television and announce that starting in 14 days (the covid incubation time), any person over 70 who catches the virus will be ineligible for medical services and therefore the onus is on the aged and vulnerable population to self-isolate indefinitely?  Effectively, the decision to self-isolate would be made at their own risk and peril?  It's a pretty ugly solution for a liberal democracy, and I am not sure that I know of any constitution of any serious country that would permit such a strategy.

 

if an 80 year old refuses to isolate, it's his/her own choice. It's the same now: if someone goes out anyway, it's on them. You can't let your policy be dictated by the notion some might not listen. At least, for that 80 year old you have the leverage there's an actual health threat to that person, while most 20 year olds have a bigger chance of getting hit by a bus on their once-a-day walk to the supermarket than actually dying of this virus.

 

 

Well the problem is not that the 80 year-old might die.  I can agree fully that he pays his money and takes his chances, which is exactly what we are generally allowed to do in a free society.

 

The problem is that before the 80 year-old gets around to dying, his family takes him to the hospital where he occupies an ICU bed and a ventilator for a couple of weeks.  When you have enough 80 year-olds behaving like this, there are no ICU beds remaining for your young healthy person who does get hit by a bus.  In other words, there are externalities associated with the decisions being made by the 80 year-olds.  One way to internalize those externalities could be to deny healthcare services to them, but as I suggested, that's a bit of a toughie in a free society.

 

 

 

SJ

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Guest Schwab711

it sure as hell would work in the setting if masks were given to these families on a priority basis.

 

what is hard to understand about common sense?

 

Masks don't work 100%, especially if you live daily with someone who might be infected (and people won't wear masks inside their house 100% of the time anyway).

 

well, shit, let's ignore common sense because it wont work 100%!  as if what we are doing now is working 100%....actually close to 100% effective in shutting down economy, so there is your plan!

 

Masks are a great idea. What I'm aiming at is what has been pointed out already. Blaming scientists/experts/whatever for Trump/governors shutting down large parts of the economy lacks common sense. Economic activity would've sharply fallen either way. Every country around the world has suspended 'non-essential' activity. You can't restock chachkies even if you convinced everyone to continue to go to TGT to buy them. Even in the south, economic activity is far lower than normal despite not having official orders not to go out. If you don't shut down while the rest of the world is shut down (such that infection is as widely identified and traced as possible, globally) we will just return to uncontrolled infection all over and the economic decline will be greater in total. It's not the experts that lack common sense. I think it's you that can't see that a greater short term pain will result in lower cumulative economic damage.

 

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But, what if you live in a liberal democracy rather than a society led by an all-powerful social administrator?  How would a liberal democracy effectively impose isolation on the aged and otherwise vulnerable population, while allowing the young and healthy to continue to freely live?  Do you simply find some legal framework through which medical care is denied to anyone over, say, age 70 who catches Covid?  So, the governors/premiers would all go on television and announce that starting in 14 days (the covid incubation time), any person over 70 who catches the virus will be ineligible for medical services and therefore the onus is on the aged and vulnerable population to self-isolate indefinitely?  Effectively, the decision to self-isolate would be made at their own risk and peril?  It's a pretty ugly solution for a liberal democracy, and I am not sure that I know of any constitution of any serious country that would permit such a strategy.

 

if an 80 year old refuses to isolate, it's his/her own choice. It's the same now: if someone goes out anyway, it's on them. You can't let your policy be dictated by the notion some might not listen. At least, for that 80 year old you have the leverage there's an actual health threat to that person, while most 20 year olds have a bigger chance of getting hit by a bus on their once-a-day walk to the supermarket than actually dying of this virus.

 

minten,

 

No, it's not. Here in Denmark, this kind of reckless behavior [perhaps inverted compared to the actual context here discussed] is countered by the Danish Epedimic Act, which has been activated about a couple of weeks ago, latest Tuesday last week it was strengthened further, to use force related to reckless behavior. Reporters here have asked for insight in the cases where this has happened [there are a few cases [ less than 5, I think] already here], but insight has not been granted by the authorities. Elder people getting interviewed to the local paper saying "The death has to have a cause" and something like that. People who have been asked to quarantine, but refuse to do so [with proof of that] goes into some kind of box, locked from outside - somehow. Period.

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But, what if you live in a liberal democracy rather than a society led by an all-powerful social administrator?  How would a liberal democracy effectively impose isolation on the aged and otherwise vulnerable population, while allowing the young and healthy to continue to freely live?  Do you simply find some legal framework through which medical care is denied to anyone over, say, age 70 who catches Covid?  So, the governors/premiers would all go on television and announce that starting in 14 days (the covid incubation time), any person over 70 who catches the virus will be ineligible for medical services and therefore the onus is on the aged and vulnerable population to self-isolate indefinitely?  Effectively, the decision to self-isolate would be made at their own risk and peril?  It's a pretty ugly solution for a liberal democracy, and I am not sure that I know of any constitution of any serious country that would permit such a strategy.

 

if an 80 year old refuses to isolate, it's his/her own choice. It's the same now: if someone goes out anyway, it's on them. You can't let your policy be dictated by the notion some might not listen. At least, for that 80 year old you have the leverage there's an actual health threat to that person, while most 20 year olds have a bigger chance of getting hit by a bus on their once-a-day walk to the supermarket than actually dying of this virus.

 

 

Well the problem is not that the 80 year-old might die.  I can agree fully that he pays his money and takes his chances, which is exactly what we are generally allowed to do in a free society.

 

The problem is that before the 80 year-old gets around to dying, his family takes him to the hospital where he occupies an ICU bed and a ventilator for a couple of weeks.  When you have enough 80 year-olds behaving like this, there are no ICU beds remaining for your young healthy person who does get hit by a bus.  In other words, there are externalities associated with the decisions being made by the 80 year-olds.  One way to internalize those externalities could be to deny healthcare services to them, but as I suggested, that's a bit of a toughie in a free society.

 

 

Well, not sure how things are in the US at the moment, but I'm pretty sure in Italy right now the 80 year-old is taken off of the ventilator the moment the 20 year old comes in.

 

As a side note, a doctor said on my national television yesterday the survival percentage of any IC-patient with corona in Italy is 5% (while 50% in my country, elder people are strongly advised not to choose the IC at all). I doubt if that's correct, but if even remotely so, a ventilator appears to be overrated anyway for the very sick and very old.

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But, what if you live in a liberal democracy rather than a society led by an all-powerful social administrator?  How would a liberal democracy effectively impose isolation on the aged and otherwise vulnerable population, while allowing the young and healthy to continue to freely live?  Do you simply find some legal framework through which medical care is denied to anyone over, say, age 70 who catches Covid?  So, the governors/premiers would all go on television and announce that starting in 14 days (the covid incubation time), any person over 70 who catches the virus will be ineligible for medical services and therefore the onus is on the aged and vulnerable population to self-isolate indefinitely?  Effectively, the decision to self-isolate would be made at their own risk and peril?  It's a pretty ugly solution for a liberal democracy, and I am not sure that I know of any constitution of any serious country that would permit such a strategy.

 

if an 80 year old refuses to isolate, it's his/her own choice. It's the same now: if someone goes out anyway, it's on them. You can't let your policy be dictated by the notion some might not listen. At least, for that 80 year old you have the leverage there's an actual health threat to that person, while most 20 year olds have a bigger chance of getting hit by a bus on their once-a-day walk to the supermarket than actually dying of this virus.

 

minten,

 

No, it's not. Here in Denmark, this kind of reckless behavior [perhaps inverted compared to the actual context here discussed] is countered by the Danish Epedimic Act, which has been activated about a couple of weeks ago, latest Tuesday last week it was strengthened further, to use force related to reckless behavior. Reporters here have asked for insight in the cases where this has happened [there are a few cases [ less than 5, I think] already here], but insight has not been granted by the authorities. Elder people getting interviewed to the local paper saying "The death has to have a cause" and something like that. People who have been asked to quarantine, but refuse to do so [with proof of that] goes into some kind of box, locked from outside - somehow. Period.

 

Wow.. in that respect Denmark must be way ahead of the rest of the world.

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Not listening to experts, recently and for years past, is what brought us to this point.

How to qualify an expert?

What if different experts come to different conclusions with the same data?

How to deal with fallibility and biases of experts, especially in uncertain situations?

What if if policy conclusions are based on values and a subjective aggregation of experts' opinions rather then pure epidemiological data?

 

Disclosure and an example:

i'm in the process of getting ready to approach the front line on this thing. As part of the preparation, one of the questions that has come up is: Will there be other waves?

The three defining criteria for this question are:

1-social distancing methods

2-the mutagenic potential of the virus and the directionality of that potential

3-herd immunity

2- is unknown and is independent. 1- and 3- are clearly in conflict in the process of policy setting. How do you deal with that? I could provide my own answers but submit that the answers are far from clear, especially at this point.

Experts don't know the future, don''t have all the answers, and make mistakes. But they at least know what they're talking about and know what the data means better than laymen and have studied past epidemics (don't have to make all the first-timer mistakes when the stakes are this high, like saying ahead of time you're thinking about quarantining an area, making everybody flee from it and infect other places), and epidemiologists have recommended all kinds of measures forever that were never put in place except in places like Singapore and Taiwan (where epidemiologists are actually now in high offices). They should also be put in charge of the response and best practices should be followed (clear chains of commands and such), rather than have the politicians play reality-TV stars for hours on TV muddling up the message and contradicting them and giving bad advice to populations (it's a hoax, it'll go away on its own, go to restaurants, etc), not coordinating states, not using power to produce equipment fast enough, closing down pandemic groups and offices, making false promises (where are the 5 million tests and fancy websites and drive-through at CVSes etc), no doing statistically significant random testing of the population, etc.

 

If I was going to have brain surgery, I'd certainly rather that a brain surgeon was in charge rather than a TV personality that had never thought about brain surgery until a few weeks ago, or his son in law. Politicians need to get out of the way, every day matters.

That's a fair answer. These days, people (in higher offices and on the ground) have to make tough decisions based on incomplete information, with both short-term and long-term consequences. Given challenging conditions, I wonder if less energy should be spent pointing fingers and sunk costs. i was part of an international virtual meeting (listening mostly) yesterday and was impressed by comments made by MDs working around Ground Zero in New York. I would say people are doing their best under the circumstances which, to some degree, are related to bad luck and very resistant historical path dependency. They keep making mistakes while adjusting but remain hopeful about the outcome. BTW, if you were expecting brain surgery in NY (and in most places), you'd be on a waiting list as Covid patients have taken center stage.

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https://www.dropbox.com/s/6ua7j979dbqb045/masks_final_n_HF_NA.pdf?dl=0

 

"The Case for Universal Cloth Mask Adoption & Policies to Increase the Supply of Medical Masks for Health Workers" (April 1 2020)

 

Source:

 

We have two principal recommendations: 1) everyone should immediately begin wearing cloth masks in public, 2) The govt. should immediately use all available means to increase the supply of medical masks, especially by heavily rewarding producers.

 

The basis for our recommendation is simple: anything that combats the spread of the virus is absurdly valuable due to the resulting reduction in mortality risk (not to mention accelerating resumption of normal economic activity).

 

How large are the benefits? Even if masks reduce transmission probabilities by only 10% (and as you'll see, that is likely very conservative), the value of *each cloth mask* is between $3,000 and $6,000. Our best estimate is that their protective value is closer to 40-50%.

 

These estimates are of course sensitive to the assumptions made in the underlying epidemiological models. But even if those models overstate mortality risk by a factor of TEN, each cloth mask *conservatively* generates $300 in value!

 

The same economic argument that says that masks for the average person are worth thousands of dollars suggests that each N95 respirator for a healthcare worker could be worth *millions* of dollars (report says why).

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Guest cherzeca

"But they [epidemiologists] at least know what they're talking about and know what the data means better than laymen...."

 

so lets get beyond the stupid media reporting and try to understand epidemiologists.  epidemiologists are second rate statisticians plain and simple.  here is their advice.  based upon their assumptions (which have no resemblance to common sense), their models predict with a purported 95% accuracy rate that US deaths will range from 30,000-160,000.

 

feel smarter now?

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