Coronavirus

[Liberty]

People make it more complicated than it needs to be.

 

We can see what works elsewhere.

 

The way to keep the economic AND human suffering to a minimum is to keep R0 below 1 and as low as possible.

 

The way to do this is first with the hammer (lockdown), which we've done in many places, and then have everybody wear masks, have hand washing stations everywhere in public spaces, try to have as much social distancing as possible in public spaces, have contact tracing, heck, recommend that everyone take vitamin D supplements. All this is basically free compared to letting things blow up again (well, much better than free.. huge positive value)... All no-brainers that have worked elsewhere. Anyone sane would be pushing hard on this. If even Italy can get things under control, anyone can...

[Peregrine]

Anyone sane would be pushing hard on this. If even Italy can get things under control, anyone can...

 

Comparing new case counts in Italy to that of the US is disingenuous. For one, Italy is a far smaller country while the US is much more spread out. And two, the worst hit places in Italy likely already have a sufficient degree of immunity such that their numbers continue to fall even with limited mitigation. New York's numbers looks a lot like Italy's for instance - and this despite having widespread crowded protests daily for more than two weeks already.

[Liberty]

Anyone sane would be pushing hard on this. If even Italy can get things under control, anyone can...

 

Comparing new case counts in Italy to that of the US is disingenuous. For one, Italy is a far smaller country while the US is much more spread out. And two, the worst hit places in Italy likely already have a sufficient degree of immunity such that their numbers continue to fall even with limited mitigation. New York's numbers looks a lot like Italy's for instance - and this despite having widespread crowded protests daily for more than two weeks already.

 

It's not what I'm doing.

[Peregrine]

You're not? Sorry I may have been mistaken since you put this chart up a few posts ago.

 

When Italy is better run than the US...

 

[ERICOPOLY]

Comparing new case counts in Italy to that of the US is disingenuous.

 

Saying he is 'disingenuous' is a bit harsh and there are other explanations for his remarks:

disingenuous: not candid or sincere, typically by pretending that one knows less about something than one really does:

 

Such as not first considering your points made here, and doing so because you had not yet made these points:

 

For one, Italy is a far smaller country while the US is much more spread out. And two, the worst hit places in Italy likely already have a sufficient degree of immunity such that their numbers continue to fall even with limited mitigation. New York's numbers looks a lot like Italy's for instance - and this despite having widespread crowded protests daily for more than two weeks already.

[Peregrine]

Comparing new case counts in Italy to that of the US is disingenuous.

 

Saying he is 'disingenuous' is a bit harsh and there are other explanations for his remarks:

disingenuous: not candid or sincere, typically by pretending that one knows less about something than one really does:

 

Such as not first considering your points made here, and doing so because you had not yet made these points:

 

For one, Italy is a far smaller country while the US is much more spread out. And two, the worst hit places in Italy likely already have a sufficient degree of immunity such that their numbers continue to fall even with limited mitigation. New York's numbers looks a lot like Italy's for instance - and this despite having widespread crowded protests daily for more than two weeks already.

 

Agreed - poor choice of words. What I meant was that the comparison wasn't properly contextualized.

[Liberty]

You're not? Sorry I may have been mistaken since you put this chart up a few posts ago.

 

Yeah, it's not about the nominal number of cases. Italy has 60m people, so talks of herd immunity after 35k deaths doesn't make sense. A country known for chaos and bad management has been able to totally crush its curve while the US has one of the worst curves in the world (which isn't surprising when you look at how bungled almost everything has been from leadership). 4.3% of world population with over 27% of deaths so far.

[Peregrine]

You're not? Sorry I may have been mistaken since you put this chart up a few posts ago.

 

Yeah, it's not about the nominal number of cases. Italy has 60m people, so talks of herd immunity after 35k deaths doesn't make sense. A country known for chaos and bad management has been able to totally crush its curve while the US has one of the worst curves in the world (which isn't surprising when you look at how bungled almost everything has been from leadership). 4.3% of world population with over 27% of deaths so far.

 

The data coming out of the hardest hit places have been quite positive IMO: case counts, hospitalizations and positive test rates have been dropping steepest in the places that have seen the worst outbreaks yet serology testing in those places suggests 20-30% infection rates in those populations. This suggests that we might not need anywhere near the arbitrary but oft-cited 70% infection rate level to see sharp declines in the virus's prevalence.

 

As far as deaths per 1mm pop, US is at 351 vs Italy's 566.

[Liberty]

You're not? Sorry I may have been mistaken since you put this chart up a few posts ago.

 

Yeah, it's not about the nominal number of cases. Italy has 60m people, so talks of herd immunity after 35k deaths doesn't make sense. A country known for chaos and bad management has been able to totally crush its curve while the US has one of the worst curves in the world (which isn't surprising when you look at how bungled almost everything has been from leadership). 4.3% of world population with over 27% of deaths so far.

 

The data coming out of the hardest hit places have been quite positive IMO: case counts, hospitalizations and positive test rates have been dropping steepest in the places that have seen the worst outbreaks yet serology testing in those places suggests 20-30% infection rates in those populations. This suggests that we might not need anywhere near the arbitrary but oft-cited 70% infection rate level to see sharp declines in the virus's prevalence.

 

Has the very high false-positive rates in serum tests been addressed? I don't put much weight on those.

 

Trying to spin things to say that the US hasn't made things much worse than they had to be isn't realistic. Weeks and weeks were wasted, opportunities to push masks were wasted, the federal government mostly hindered states and did little at crucial times, everything was politicized and made confusing to citizens, etc.

 

 

As far as deaths per 1mm pop, US is at 351 vs Italy's 566.

 

Not a good time to compare both when one country has almost no new cases for a while while the others a bunch more coming in, since it can take weeks for deaths after infection.  Italy's median age of 46 (vs US at 39) and multi-generational homes certainly didn't help it there too, but that just shows how much worse the US would be if it also had those demographics and cultural traditions.

[Peregrine]

You're not? Sorry I may have been mistaken since you put this chart up a few posts ago.

 

Yeah, it's not about the nominal number of cases. Italy has 60m people, so talks of herd immunity after 35k deaths doesn't make sense. A country known for chaos and bad management has been able to totally crush its curve while the US has one of the worst curves in the world (which isn't surprising when you look at how bungled almost everything has been from leadership). 4.3% of world population with over 27% of deaths so far.

 

The data coming out of the hardest hit places have been quite positive IMO: case counts, hospitalizations and positive test rates have been dropping steepest in the places that have seen the worst outbreaks yet serology testing in those places suggests 20-30% infection rates in those populations. This suggests that we might not need anywhere near the arbitrary but oft-cited 70% infection rate level to see sharp declines in the virus's prevalence.

 

Has the very high false-positive rates in serum tests been addressed? I don't put much weight on those.

 

Trying to spin things to say that the US hasn't made things much worse than they had to be isn't realistic. Weeks and weeks were wasted, opportunities to push masks were wasted, the federal government mostly hindered states and did little at crucial times, everything was politicized and made confusing to citizens, etc.

 

 

Not it hasn't which is why serology tests for those with limited outbreaks (i.e. the Santa Clara study) or for individuals aren't useful. Serology tests in places with far more widespread outbreaks provide a much better gauge of the population's exposure level and it may well even understate the level of exposure at the time the tests were taken given the weeks it takes for antibodies to appear + sampling bias that favors a less susceptible population (i.e. healthy people going into grocery stores). Either way, it's the hardest hit places that are seeing their numbers decline fastest.

 

Not trying to put a spin on anything just providing data points that show that the transmissibility of the virus may be far less potent than what many originally thought.

[ERICOPOLY]

case counts, hospitalizations and positive test rates have been dropping steepest in the places that have seen the worst outbreaks yet serology testing in those places suggests 20-30% infection rates in those populations. This suggests that we might not need anywhere near the arbitrary but oft-cited 70% infection rate level to see sharp declines in the virus's prevalence.

 

This may be due to people of certain lifestyles, such as that of the bus driver or the hair dresser, who are most at risk to contract the virus in the first place, and while they have the virus are likely to spread it to the greatest number of people. 

 

Such people probably test at higher than 20%-30%.  If they don't, throw all common sense out the window.

[Liberty]

You're not? Sorry I may have been mistaken since you put this chart up a few posts ago.

 

Yeah, it's not about the nominal number of cases. Italy has 60m people, so talks of herd immunity after 35k deaths doesn't make sense. A country known for chaos and bad management has been able to totally crush its curve while the US has one of the worst curves in the world (which isn't surprising when you look at how bungled almost everything has been from leadership). 4.3% of world population with over 27% of deaths so far.

 

The data coming out of the hardest hit places have been quite positive IMO: case counts, hospitalizations and positive test rates have been dropping steepest in the places that have seen the worst outbreaks yet serology testing in those places suggests 20-30% infection rates in those populations. This suggests that we might not need anywhere near the arbitrary but oft-cited 70% infection rate level to see sharp declines in the virus's prevalence.

 

Has the very high false-positive rates in serum tests been addressed? I don't put much weight on those.

 

Trying to spin things to say that the US hasn't made things much worse than they had to be isn't realistic. Weeks and weeks were wasted, opportunities to push masks were wasted, the federal government mostly hindered states and did little at crucial times, everything was politicized and made confusing to citizens, etc.

 

 

Not it hasn't which is why serology tests for those with limited outbreaks (i.e. the Santa Clara study) or for individuals aren't useful. Serology tests in places with far more widespread outbreaks provide a much better gauge of the population's exposure level and it may well even understate the level of exposure at the time the tests were taken given the weeks it takes for antibodies to appear + sampling bias that favors a less susceptible population (i.e. healthy people going into grocery stores). Either way, it's the hardest hit places that are seeing their numbers decline fastest.

 

Not trying to put a spin on anything just providing data points that show that the transmissibility of the virus may be far less potent than what many originally thought.

 

I agree the virus is probably less dangerous than initially thought, though still pretty bad (115k deaths in the US after a few months, far from the end of the crisis), but you don't gamble on that during the initial confusion and panic, you take precautions and do the things that you know work, as they more than pay for themselves early on in an exponential process. If those had been taken well, we'd be in much better shape now, like SK/NZ/Taiwan/HK/etc, but that was bungled.

 

I was looking at the high-level trends for whole countries (ie. Italy vs US, but you can look at lots of other countries that were hit hard but crushed their curve*). I agree serum can provide some info for specific highly-infected areas, but I wasn't looking at areas there so I'm not sure what it has to do with it.

 

*

[Peregrine]

case counts, hospitalizations and positive test rates have been dropping steepest in the places that have seen the worst outbreaks yet serology testing in those places suggests 20-30% infection rates in those populations. This suggests that we might not need anywhere near the arbitrary but oft-cited 70% infection rate level to see sharp declines in the virus's prevalence.

 

This may be due to people of certain lifestyles, such as that of the bus driver or the hair dresser, who are most at risk to contract the virus in the first place, and while they have the virus are likely to spread it to the greatest number of people. 

 

Such people probably test at higher than 20%-30%.  If they don't, throw all common sense out the window.

 

Could be - there's been strong evidence of the 80/20 rule - superspreaders accounting for the lion's share of transmission.

 

There's also strong evidence that susceptibility varies highly across the population - that some people are just a lot more susceptible to being infected when exposed to the virus, namely the old.

 

Either way, both data points suggest that we likely don't need 70% of the population infected to see R0 fall sufficiently under 1 to see large case declines. Hell, New York State's estimated R0 has fallen to the 0.7 level and serology tests show 13% of the population have tested positive for antibodies.

[KCLarkin]

Not trying to put a spin on anything just providing data points that show that the transmissibility of the virus may be far less potent than what many originally thought.

 

Seems to be a very high correlation between countries that believe this and deaths/million.

[Jurgis]

Hell, New York State's estimated R0 has fallen to the 0.7 level and serology tests show 13% of the population have tested positive for antibodies.

 

And you are sure thie R0 decline is because of the 13% population testing positive and not because of the lockdown/social-distancing/masks?  ::)

[Peregrine]

Hell, New York State's estimated R0 has fallen to the 0.7 level and serology tests show 13% of the population have tested positive for antibodies.

 

And you are sure thie R0 decline is because of the 13% population testing positive and not because of the lockdown/social-distancing/masks?  ::)

 

I think a whole host of factors are at play. But the speed of the decline in New York City vis-a-vis other cities (that have also instituted lockdowns and changed their behaviors) suggests that the relatively higher levels of infection already in place have a strong deterence on the virus's transmissibility.

 

Btw, New Yorkers haven't really abided by social distancing for the last few weeks and positivity rates are at 1.7% versus the rest of the country at 5-6%.

[John Hjorth]

... I think a whole host of factors are at play. But the speed of the decline in New York City vis-a-vis other cities (that have also instituted lockdowns and changed their behaviors) suggests that the relatively higher levels of infection already in place have a strong deterence on the virus's transmissibility. ...

 

Personally, for me, there is no way for me to pursue this line of thinking. Personally, I consider it a line of "sleeping pillow" thinking. I hope my quoting is not considered unfair.

[Peregrine]

Interesting. Maybe just wearing masks is enough to halt the spread - two COVID-positive symptomatic hairstylists who wore masks saw 140 customers over 8 days and none of them have tested positive since.

 

https://www.cnn.com/2020/06/11/us/missouri-hairstylists-coronavirus-clients-trnd/index.html

 

 

[maxthetrade]

A recent study from Germany comes to the same conclusion:

 

"After the city of Jena became an early adopter of masks in public transport and shops on April 6, new infections in the municipality of 108,000 almost disappeared. Most of the surrounding state of Thuringia and elsewhere in Germany only adopted mask policies days or weeks later and the outbreak in many of those areas continued to spread, according to a paper from the Institute of Labor Economics in Bonn."

 

https://www.bloomberg.com/news/articles/2020-06-12/masks-can-reduce-covid-spread-by-40-german-study-suggests

 

Masks are a no brainer, it's silly that people still refuse to use them. With masks we could probably pursue 90% of normal economic activities with very low risk of infection. 

[Peregrine]

A recent study from Germany comes to the same conclusion:

 

"After the city of Jena became an early adopter of masks in public transport and shops on April 6, new infections in the municipality of 108,000 almost disappeared. Most of the surrounding state of Thuringia and elsewhere in Germany only adopted mask policies days or weeks later and the outbreak in many of those areas continued to spread, according to a paper from the Institute of Labor Economics in Bonn."

 

https://www.bloomberg.com/news/articles/2020-06-12/masks-can-reduce-covid-spread-by-40-german-study-suggests

 

Masks are a no brainer, it's silly that people still refuse to use them. With masks we could probably pursue 90% of normal economic activities with very low risk of infection.

 

I'm guessing even 100%. Japan has virtually been unaffected despite having one of the oldest populations in the world and some of the densest cities in the world. Tokyo's subways remain as crammed as ever and yet few COVID deaths - think it has to be tied to widespread mask use in crowded indoor settings.

[Cigarbutt]

This post is about potential optimization of the hammer and dance concept. It’s a very powerful concept but, to a hammer, many things will look like a nail. So it’s about a relatively anecdotal experience that supports flexible adaptation in relation to re-opening, other waves and potential investment implications.

 

My area (Montreal) has been hit similar to the worst places in the world. There are many reasons for that but (whatever the circumstances that led to these results) this outcome provided an opportunity to test adaptation measures. Roses can grow on manure. One of the two main hospitals in Montreal was designed as the epicenter for treatments of COVID-19 cases and it tried to maintain services for all. The concern was to continue to provide services to the population as much as possible under the circumstances while reducing the risk of COVID-19 transmission to the minimum. This was a very dynamic process (up to 36 iterations for procedures in high risk sectors). Simplified, they mostly came up with a risk stratification (risk of transmission) with three categories (low, medium and high risk) with correlated levels of precautions, adapted procedures, level of protective equipment etc. The high risk category required extensive measures (with a very high impact on ‘productivity’). Interestingly, using their evolving guidelines, 90% belonged in the low risk, 8.5% in the medium risk and 1,5% in the high risk. This risk-management episode resulted in, despite being exposed to one of the highest hospital COVID-19 prevalence in the world and despite the indication to do frequent potentially at-risk procedures, the performance of at least 60% of the typical case load. What about security and risk of transmission? Using the rate of seroconversion of health care personnel working in the hospital as a proxy for nosocomial spread (CV- patient comes in the hospital and becomes CV+) and as a potential proxy for community spread, out of 13 000 hospital workers, three persons became CV+ as result of hospital exposure.

 

This data shows that we can become potentially more selective in risk stratification with the aim of minimizing the impact on output while keeping the risk of transmission to very adequate levels.

 

If anybody is interested in the ETTO principle (Efficiency-Thoroughness Trade-Off):

https://erikhollnagel.com/onewebmedia/ETTO.pdf

 

[Liberty]

Taleb on masks: https://medium.com/incerto/the-masks-masquerade-7de897b517b7

[Investor20]

Japan had not just masks.  They had 3Cs to avoid.

 

That is to avoid Closed spaces, Crowded places, Close contact settings

 

They reasoned, for example for Tuberculosis, ventilation has reduced TB transmission, another respiratory infection.

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3716713/

Natural ventilation reduces high TB transmission risk in traditional homes in rural KwaZulu-Natal, South Africa

 

So they had several guidelines with reference to increasing ventilation including office area HVAC settings to increase fresh air, car AC (recycle or fresh air), keeping windows, doors open, simply not to talk in certain circumstances, etc.

 

http://japan.kantei.go.jp/ongoingtopics/COVID19CASFlyer/PROffice3CGuide_en.pdf

 

 

 

[Viking]

Taleb on masks: https://medium.com/incerto/the-masks-masquerade-7de897b517b7

 

You look at all the economic devastation caused by the virus. Of all the things individual people can do to get the economy back to normal, wearing a mask when out is the most simple and most effective. Given our need to get the economy back to normal as quickly as possible wearing masks when out should be a requirement. But governments in US and Canada would look stupid (given previous communication on wearing masks) so this will likely not happen. So most people will continue to not wear masks when out; and many of these same people will bitch and complain about the need for the government to end restrictions and get the economy back to normal. Crazy times :-)

 

Taleb has 6 reasons why masks help. Here is one of them:

 

Third Error: Mistaking Absence of Evidence for Evidence of Absence

 

“There is no evidence that masks work”, I kept hearing repeated to me by the usual idiots calling themselves “evidence based” scientists. The point is that there is no evidence that locking the door tonight will prevent me from being burglarized. But everything that may block transmission could help. Unlike school, real life is not about certainties. When in doubt, use what protection you can. Some invoked the flawed rationalization that masks induce false confidence: in fact there is a strong argument that masks makes one more alert to the risks and more conservative in behavior.

[Liberty]

A surgeon on masks: https://www.howardluksmd.com/sports-medicine/wear-a-mask-save-a-life-today-maybe-your-own-maybe-someone-elses/