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Gordo

Just curious, anyone have a plan, or preps for global pandemic?

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Singapore open sources their contact tracing phone app, which uses bluetooth to track other app users you have been near in the past. Would you install something like this on your phone, and allow it to upload data to authorities should you become infected?

 

https://www.straitstimes.com/singapore/coronavirus-spore-government-to-make-its-contact-tracing-app-freely-available-to

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32 minutes ago, Ron Put said:

Yep, my hat off to Sweden and its health officials, who are apparently uniquely isolated from political pressure:

22 dead today at a 2% fatality rate suggests 1100 new infections on the day roughly 20 days prior.  They reported 227 new infections today but I'd bet it was between 8800 and 17600 as there ought to have been 3 or 4 doublings in spread rate from the 1100 per day 20 days ago.    My guess is they will chicken out and attempt to slow it down within the next 2 or 3 weeks as bodies continue piling up at ever faster rates.  After locking down hard they will still have another 2 to 3 weeks of growth in death rates. 

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6 hours ago, Ron Put said:

[....]my hat off to Sweden and its health officials, who are apparently uniquely isolated from political pressure:

[...]the thrust of your post was not clear to me.

Ron,  one point was that it's not only political pressure involved.  I.e.,

Quote

Ron Put:  Imposing the toughest restrictions possible is suddenly the safest way for politicians in the world's democracies, otherwise they will be painted by the opposition with the blood of every death. Thus, here we are. 

However, that may be true,  there is also the role of the "expert" community.  To give one example,  from  my quote about Sweden:

Quote

More than 350 public health academics and practitioners in Sweden ranging from full professors to post-doc researchers have signed a petition calling on the government to change its coronavirus strategy.

That's why I asked: "Where  are the health experts, economists,  social scientists et al. opposing these extreme measures-- authorities that  might  lend legitimacy and credibility to politicians who might be inclined to do the same? "   Of course, there are such experts (as in Sweden's Folkhalsomyndigheten),  but across Europe and the U.S.,  in the WHO etc.,  they seem to be a distinct minority.

(Is there really a correlation between  countries' degree of democratic populism and the degree of restrictiveness imposed to combat Covid-19?)

In any case,  as I wrote previously,  it's not an either/or choice:  there is a whole range of options between  the extremes of  do absolutely nothing and total lockdown for months.  Each country/region has to consider how much to  "flatten the curve" via restrictions, and devise a reasonable strategy based on its individual circumstances, including and especially,  the ability of  its health care system  to withstand a huge surge in patients.

Edited by Sibiriak

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13 hours ago, Dean Pomerleau said:

How much is travel restricted in Italy, particularly to/from the Lombardy region? If there are travel restrictions, are people following them and how are they enforced?

Dean, as far as I remember, all the restriction have been applied in successive stages:

  1. First lockdowns in about 10 small towns of Lombardy and neighbouring Veneto (Codogno, Vò Euganeo.....). In the meanwhile, all other areas where free
  2. First restrictions in business openings: from example, in Milan bars and other eateries could be open only until 6:30 PM
  3. First closures of schools and some businesses, forbidden public gatherings.
  4. Restrictions on movements from Lombardy. Now, the news leaked on the CNN channel and the social media the evening before it was officially issued and this caused a massive flow of people during the night from the most infected areas to the relatively safer areas.
  5. Presently, there is a severe restriction enforced by police and military patrols everywhere, along roads, bus and railway stations, airports. In particular, you can only leave Lombardy  (and every other place) if you are working on a necessary business or have some other verifiable authorizations. You must carry a signed sheet in the format released from the government, where you declare all the route and the reasons. This even if you go out to buy some necessities walking.

In the beginning, people were not following the restrictions much, until the police started fining. Now you can see very few people around, even walking dogs must be done within a narrow radius from the residence. But of course, someone manages to escape, although the probability of being caught now is substantial.

Last but not least: if you are caught on the move and you are confirmed with symptoms of the Covid-19, you can be charged with a procured epidemic, which may result in a few years of incarceration...

 

Edited by mccoy

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Here is a fascinating exploration as to why some areas may have been hit harder than others with COVID-19. It has to do with temperature and humidity.

 

 

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1 hour ago, mccoy said:
5. Presently, there is a severe restriction enforced by police and military patrols everywhere, along roads, bus and railway stations, airports. In particular, you can only leave Lombardy  (and every other place) if you are working on a necessary business or have some other verifiable authorizations. You must carry a signed sheet in the format released from the government, where you declare all the route and the reasons. This even if you go out to buy some necessities walking.

In the beginning, people were not following the restrictions much, until the police started fining. Now you can see very few people around, even walking dogs must be done within a narrow radius from the residence. But of course, someone manages to escape, although the probability of being caught now is substantial.

Last but not least: if you are caught on the move and you are confirmed with symptoms of the Covid-19, you can be charged with a procured epidemic, which may result in a few years of incarceration...

Wow, Mccoy. Thanks for the update. That's a pretty serious lockdown. It seems like it may be working though. Italy's rate of new cases and deaths appears to be leveling out. At 600-700 deaths per day it is obviously tragic (especially in the hardest hit area), but not unfathomably so. The US has ~5x the population of Italy, so the equivalent here would be 3000-3500 deaths per day.

If we could keep the mortality rate at that level in a few weeks I think we should count ourselves pretty lucky, given the slow rollout of testing and social distancing measures, and the very slim chance that we could impose the kind of travel restrictions you are experiencing now in Italy in order to slow the spread of the virus.

 I fear instead we could see a peak death rate of 5000-10,000 per day here in a month's time. We're at 250 deaths per day now. That's up from ~25 per day a week ago, suggesting a doubling time of less than 2 days. If that keeps up, or even slows down to "only" a 3-4 day doubling time as a result of efforts at social distancing, we'll get to those sorts of daily mortality numbers in much less than a month. Let's hope it doesn't come to that.

--Dean

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With all its flaws, the system is efficient in that it discourages unnecessary movements. The media advertise the total number and the daily number of fined (and charged) people and that's a good deterrent. The few times I went out, I had to make sure to have an ID, to reason out the route, what to write onto the sheet, what to tell the officers if blocked, how to prove the legitimacy of the outing. My wife hasn't gone out for 2 weeks now! 

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Sibiriak, as far as I understood, part of the army medical staff sent by Mr. Putin is a bio-warfare brigade. Good choice. Besides the specialist help, Russia will also gain some real-life understanding of the critical sides of Covid-19 treatments, eventually to apply in her homeland. 

 

 

Edited by mccoy

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Germany helping out,  a bit:

Quote

BERLIN — German hospitals with spare capacity will take in at least 47 coronavirus patients from Italy [out of 3,612  serious  Italian cases] in a sign of European solidarity, Foreign Minister Heiko Maas said on Thursday. 

"Because we stand by our Italian friends. We can only manage this together," Maas said in a short statement.

Meanwhile in Spain : a new record 769 deaths in the past 24 hours.

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I remember Michael Rae in a video from years ago, saying he doesn't shake hands (he was way ahead of the world on that one, haha).  Yesterday I saw some headlines like:

President Donald Trump suggested that Americans should consider giving up the tradition of greeting each other with a hand-shake — forever.no-handshake-zone.jpg

I'm thinking I will also give up handshaking forever most likely.  Just curious if others will?  I've already had a personal encounter where a guy reached out to shake my hand, this was at the early stages of the pandemic when few were taking it seriously and there were only a handful of cases in the U.S.  I just said "I don't shake hands" and it was awkward, but not really that big of a deal.  It would be kind of cool if we adopted the "bow" instead (but those heads are a bit too close, haha, 15 degrees should be adequate): 

da38284a58504ab9ec376b45dd35a301.jpg

 

Edited by Gordo

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And just like that, we have 4x the ventilator capacity...

 

VESper™ is a new device that allows one ventilator to support up to four patients under emergency use authorization by the FDA.

Hospitals can apply to receive the free source code and printing specifications for the device. 

 

Get More InformationWhat is VESper™?

VESper™ is a unique ventilator expansion device that allows a single ventilator to support up to four patients during times of acute equipment shortages such as the current COVID-19 pandemic.

Produced using 3D printing technology, the device is developed with material already in use for medical devices and produced at minimal cost.

The device:

  • designed to work with ISO standard respiratory connections;
  • can be easily produced;
  • allows for appropriate filtering of bacteria and viruses in the ventilator tubing;
  • is strong and impact resistant; and
  • does not impact the care of other patients connected to the same machine.
vesper-device.jpg
 
vesper-landing-1024x732.jpg

How VESper™ works  

Two VESper™ devices are needed for each ventilator, one on the intake and one on the return. VESper™ splits the airflow to the ventilator, acting as a Y connector.

Multiple combinations of the VESper™ device can be configured to allow a single machine to be used for up to four patients. It is important to match the clinical characteristics of the patients connected to a single machine as the machine will deliver the same settings such as oxygen concentration, amount of air in each breath and the pressure of the air delivered.

Is it FDA approved? 

Prisma Health has received emergency use authorization from the U.S. Food and Drug Administration (FDA) for VESper™. Emergency use authorization can offer critical care patients access to a medical device that has not gone through normal FDA approval; this is used when no comparable or satisfactory alternative options are available.

Prisma Health experts are working with national COVID-19 teams who have no more ventilator capacity and who can initiate emergency use of the prototype. We will be working closely with these teams during their field testing to monitor clinical outcomes. Those field tests will determine whether the device performs as designed, per FDA guidelines.

How was it developed? 

A Prisma Health Emergency Medicine physician realized the opportunity of using a single machine to breathe for multiple patients. She worked collaboratively with her husband, a software engineer, and with a Prisma Health pulmonary critical care physician to develop specifications for the device.

Physicians used Prisma Health’s Simulation Center to begin testing the VESper™ device with medical manikins, allowing for the simulation of multiple clinical scenarios. The device was able to deliver the appropriate breathing parameters without difficulty, creating an opportunity to pursue an application for emergency use authorization with the FDA in order to rapidly bring this life-saving device directly into clinical use.

Edited by Gordo

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Big crises bring  big opportunities:

 

Quote

The Environmental Protection Agency (EPA) issued a sweeping suspension of its enforcement of environmental laws Thursday, telling companies they would not need to meet environmental standards during the coronavirus outbreak. 

The temporary policy, for which EPA has set no end date, would allow any number of industries to skirt environmental laws, with the agency saying it will not “seek penalties for noncompliance with routine monitoring and reporting obligations.”

Cynthia Giles, who headed EPA’s Office of Enforcement during the Obama administration, called it a moratorium on enforcing the nation's environmental laws and an abdication of EPA’s duty. 

This EPA statement is essentially a nationwide waiver of environmental rules for the indefinite future. It tells companies across the country that they will not face enforcement even if they emit unlawful air and water pollution in violation of environmental laws, so long as they claim that those failures are in some way 'caused' by the virus pandemic. And it allows them an out on monitoring too, so we may never know how bad the violating pollution was,” she wrote in a statement to The Hill.

[...]In a 10-page letter to EPA earlier this week, the American Petroleum Institute (API) asked for a suspension of rules that require repairing leaky equipment as well as monitoring to make sure pollution doesn’t seep into nearby water. Other industries had also asked to ignite the “force majeure” clauses of any legal settlements they had signed with EPA, allowing for an extension on deadlines to meet various environmental goals in the face of unforeseen circumstances.  But Giles and others say the memo signed Thursday goes beyond that request, giving industries board authority to pollute with little overnight from the agency. 

“Incredibly, the EPA statement does not even reserve EPA's right to act in the event of an imminent threat to public health,” Giles said. 

[...]many were alarmed by the breadth of Thursdays memo. “It is not clear why refineries, chemical plants, and other facilities that continue to operate and keep their employees on the production line will no longer have the staff or time they need to comply with environmental laws...” 

[...]nearby communities would face prolonged exposure to a number of air and water pollutants that might be expelled through oil production – something they say would have “a very specific impact on public health and safety.”

 

Edited by Sibiriak

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About "Herd Immunity".... It's difficult to find info (if it exists) on another POTENTIAL type....

 

Say I get a pathogen infection, my immune system fights it off, and now I'm immune. 

Now, I've got a bunch of dead and/or weak pathogen particles in me. 

Can I pass these dead/weak particles off as "immunization" to others NATURALLY ? These may be via std. pathology communication transport: sneeze, breath, touch/contact. Essentially,  this is analogous to medical immunization inoculation or vaccine nasal spray. 

How realistic is this scenario?

If realistic, how common is this situation in Nature?

 

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Nature magazine has a new podcast ... Coronapod:

https://www.nature.com/articles/d41586-020-00940-6

The latest episode noted possible efficacy of convalescent plasma (transfuse blood from recovered patients to critical patients).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4781783/

It is a kind of an approach of desperation -- but practical (and shown to be effective from Ebola)

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On 3/25/2020 at 9:12 PM, Sibiriak said:

Ron,  one point was that it's not only political pressure involved.  I.e.,

... That's why I asked: "Where  are the health experts, economists,  social scientists et al. opposing these extreme measures-- authorities that  might  lend legitimacy and credibility to politicians who might be inclined to do the same? "   Of course, there are such experts (as in Sweden's Folkhalsomyndigheten),  but across Europe and the U.S.,  in the WHO etc.,  they seem to be a distinct minority. ... In any case,  as I wrote previously,  it's not an either/or choice: ...

Actually, I still think it's largely politically driven. Since meeting with Xi, Tedros Ghebreyesus has openly promoted the "China Model" of extreme measures, while only days before the meeting he was condemning virus-related restrictions on travel to and from China. It should be a lesson for Trump why global projection is important.

Don't let China start dominating UN agencies
"Drawing nearly as much media coverage as China's response to the outbreak are the words and deeds of Tedros Adhanom Ghebreyesus, director general of the World Health Organization. When the WHO declared the coronavirus outbreak a global health emergency on Jan. 30, there were complaints the U.N. agency had dragged its feet over concerns that an emergency declaration would harm China's international standing. At a news conference the same day, Tedros praised China's "unprecedented response" to the outbreak. A few days later he criticized moves by countries to suspend flights to China and restrict entry by people recently in China, saying there was no reason to "unnecessarily interfere with international travel and trade.""

The WHO and China: Dereliction of Duty
"On January 28, Tedros met with Chinese President Xi Jinping in Beijing. Following the meeting, Tedros commended China for “setting a new standard for outbreak control” and praised the country’s top leadership for its “openness to sharing information” with the WHO and other countries. ... On February 20 at the Munich Security Conference, Tedros doubled down on his praise for China stating that “China has bought the world time.” In contrast to his effusive praise for China, Tedros has been quick to criticize other countries for their responses to the outbreak. He called upon nations not to limit travel with China and warned against the “recrimination or politicization” of the outbreak. Domestic Chinese news coverage prominently features Tedros’ praise of Xi Jinping and criticism of foreign governments."

The WHO leadership trotted out the China narrative and it spread, as political opposition forces in the already polarized Western democracies used it to blame the party in power. In the US, the Democrats and much of the media have embraced Chinese propaganda against Trump, much like the Republicans have embraced Russian propaganda to defend Trump. Experts who disagree with the consensus are shouted down and their expertise is openly attacked on social media and the press -- when Gavin Newsom justified his shut down of the economy with, among other things, the death of a "healthy" teenager, the media barely acknowledged that his claim was false. Yet everything Trump says or does is painted as an inexcusable failure. BTW, I really hate to be in the position to defend Trump, as I believe he is a real threat to American global interests.

I still believe that when this is done, it will turn out to be not unlike a severe flu pandemic and that Covid-19 will be with us for the foreseeable future. Even in this generally moderate year, the number of dead from the flu is getting close to 30,000 in the US, and I doubt that the death toll from Covid-19 will be much different, based on data from other countries, the hour-by-hour death watch by the media notwithstanding. But of course, even if less, the Democrats and much of the press will credit the strong, severe actions of the two leading "strongmen," Cuomo and Newsom.

We are in the era of populism and "Great Leaders" and my fear is not driven by Covid-19 (which will pass and be adjusted to),  but the weakening of the liberal democracies of the world and the rise of authoritarianism as an appealing alternative in a time of turmoil. 

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I still believe that when this is done, it will turn out to be not unlike a severe flu pandemic and that Covid-19 will be with us for the foreseeable future.

Possibly. That doesn't mean that we're not all - or most of us - influenced by mass psychology. Even I, who considers himself fairly immune to mass psychosis (don't we all though, ha!), have taken some measures that I haven't for the ordinary flu: I'm taking 7.5 mg zinc twice a day plus 500 mg ECGC green tea extract, and generally avoiding crowds. But the reason I'm doing this is NOT because I'm sure COVID-19 is the new plague, but rather simply because I don't feel like I have enough information to decide whether it's just like the flu as you mentioned (which I agree is a distinct possibility), or maybe something much more damaging. In the absence of firm information, I operate on the precautionary principle until more definitive info becomes available. What makes me uneasy are the numerous reports of young apparently healthy people not dying but sustaining severe permanent lung damage to where they have such impaired PERMANENTLY lung function that they have difficulty walking without getting winded. It's not about dying - it's about surviving in a permanently compromised QOL. I'm not aware of the flu having this effect, which is what makes me somewhat leery of COVID-19. Granted, these are probably rare on a statistical basis, and apparently most folks have minimal symptoms, but the unease is there, because reliable statistics are hard to come by. And btw. I am extremely distrustful of all these stats - number of infected, number of dead, numbers of severely or minimally affected etc. - no way are any of these reliable across the world, including in apparently "first world" countries such as Italy. So, how am I supposed to base my decisions on data I can't fully trust? And so, I take precautionary measures, not out of panic - and as these don't represent any especial hardship, at worst I'll end up looking foolish, which I'm OK with. YMMV.

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On a more humorous note, even God has taken note of COVID-19 and decided to relax some of his (her? its?) ironclad rules:

Some bishops are granting Catholics permission to eat meat for rest of Lent due to coronavirus

So, eat the meat folks and God won't get his/her/its knickers in a twist. He don't care no more, yo. For now. 

Makes me wonder then if COVID-19 is the work of the Devil - because if it is, then it's kind of a climbdown for God to knuckle under and cry uncle to filthy Satan, it makes God look less hard and loses face - how embarrasing. So perhaps as we're told, God being a famous control freak micromanages and controls everything, is actually responsible for COVID-19 - but then how come he has to relax his own rules because of his own creation? 

I also like how God, through his representatives on earth (Bishops) communicates through twitter to dispense these precious heavenly rules. God's one hip cat and with it technologically!

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40 minutes ago, TomBAvoider said:

the numerous reports of young apparently healthy people not dying but sustaining severe permanent lung damage to where they have such impaired PERMANENTLY lung function that they have difficulty walking without getting winded

This is a concern I have also.  It is not at all clear to what extent this disease may cause permanent lung damage.  That said I would expect the odds of that would be pretty low, but at this point we really don't know for sure.  Plenty of younger, healthy people still seem to report some degree of labored breathing - no idea if this could translate into permanent lung damage though. Hopefully not.  If it were me, as soon as I saw any symptoms I'd want to be tested right away (which should be possible now, wasn't possible previously) and if positive I'd want to get on a treatment protocol immediately to avoid those later possible stages of lung damage.

I would however, NOT advise the Iranian treatment protocol:

Over 300 Killed in Iran After Drinking Industrial Alcohol to Save Themselves from Coronavirus

It's almost hard to accept that humans are really this stupid.

 

Edited by Gordo

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Yes, apparently it seems that SARS-COV-2 targets the lungs in a far more dangerous way than its cousin influenza. That translates to a higher rate of cases in ICU and longer recovery periods, the right recipe to clog the hospitals. What the authorities are thinking now in Italy is to give saturometers to patients with mild cases and admit them in the hospital only when oxygen saturation starts to go down from the baseline.

 

image.png.cb77173f0f1332bd84279c887475dc10.png

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Do you know at what level of oxygen saturation they will consider admittance necessary?

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Here is an detailed model that projects both hospital beds needed and deaths per day by US state and US overall, assuming pretty strict social distancing measures are implemented and remain in place.

Here are two of the graphs for New York, projecting a peak of daily deaths in 11 days (Apr. 8th) with ~550 deaths per day. They project the death rate will drop pretty quickly, with around 10K total deaths in NY between now and August.

Screenshot_20200327-175206_Chrome.jpg

 

Here are the same graphs for the whole US, with a projected peak in 17 days (Apr. 14th) with a peak daily death rate of ~2300 and ~81K total deaths between now and August.

Screenshot_20200327-175705_Chrome.jpg

 

The authors suggest several limitations of their study, most of which seem to me to suggest they are being optimistic about their assumptions. For example, they are assuming all states will quickly implement 3 out of 4 social distancing measures that Wuhan took pretty quickly (school closures, non-essential business closures including bars and restaurants, stay-at-home order and travel restrictions including public transport closures) and 3-out-of-4 will be enough to get Wuhan-like squashing of the spread (which seems pretty dubious to me, given the very strict travel restrictions Wuhan implemented). Interestingly, the time between Wuhan's strict lock down and the peak death rate was 27 days.

--Dean

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3 hours ago, TomBAvoider said:

What makes me uneasy are the numerous reports of young apparently healthy people not dying but sustaining severe permanent lung damage to where they have such impaired PERMANENTLY lung function that they have difficulty walking without getting winded.

Actually, after a brief search, I haven't found anything which says that Covid-19 is more dangerous to the young than the flu, which also kills some in their prime, and the flu is actually seemingly considerably more dangerous to the very young.

Notably, in his speech justifying the effectively shutting down of the state's economy, California's Governor Newsom warned about the young dying, and trotted out the case of a "healthy teener' who died from Covid-19. The news ran with it. A day later, after doing a search, I found out that the "healthy teenager" actually had serious preexisting conditions, which was barely mentioned in the news. Now, imagine the headlines if Trump had made such a misleading statement to justify a major policy change (it's weird to find myself defending Trump :)

Here is the death toll from Covid-19 by age and pre-existing condition: https://virusncov.com/covid-19-age-sex-cases-and-deaths

And here is the weekly mortality rate from what is a normal flu season (rough filtering by age from the menu in the upper right): https://gis.cdc.gov/grasp/fluview/mortality.html 

And to those who like predictions, here is one which in many ways makes more sense to me:

Why this Nobel laureate predicts a quicker coronavirus recovery: 'We're going to be fine'

And in reference to Dean's post above and the projected number of Covid-19 deaths for the US (81,000), this is just about the same mortality as for the 2017-2018 flu season. Except that we did shut down the whole economy and borrow more than 2 trillion dollars so that we can dole them out as "free money," because we are tripping over to follow China and lock the country down, destroying our economy in the process. My guess is that once we have robust testing, we'll find out that asymptomatic Covid-19 infections are far more widespread than assumed (similarly to the flu).

Edited by Ron Put

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30 minutes ago, Ron Put said:

And to those who like predictions, here is one which in many ways makes more sense to me:

Why this Nobel laureate predicts a quicker coronavirus recovery: 'We're going to be fine'

From that article:

In Iran, the number of newly confirmed COVID-19 cases per day remained relatively flat last week, going from 1,053 last Monday to 1,028 on Sunday. Although that's still a lot of new cases, Levitt said, the pattern suggests the outbreak there "is past the halfway mark."

Today is three days since that article was published, and Iran is now running at 3,000 new cases per day. So much for "relatively flat" and "past the halfway mark." Given that, I'm not sure his optimistic predictions should be given much credence.

--Dean

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