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Gordo

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

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7 hours ago, Sibiriak said:

At least 5,500 care home residents in England have died with coronavirus, says ONS official

"Overall, the deaths in long-term care homes account for 79 per cent of total deaths in Canada."

https://globalnews.ca/news/6876802/coronavirus-update-federal-data-modelling/

When there was so much warning from flu, norovirus etc. infections previously, this was a serious failure.

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I have always been sceptical of "the sky is falling" larums wrt. the developing world being especially vulnerable to CV-19 - the factors cited were never convincing, and other factors not taken into account. Well, it seems - at least initially - that the doom and gloom prophecies were a bit premature:

India coronavirus: The 'mystery' of low Covid-19 death rates

Now, the pandemic is hardly over globally, so it's far too soon to declare victory, but what is indisputable is that the early dire prognostications have not come to pass. Things may still go south in a big way down the line, but it's certainly not the immediate catastrophic pileup alarmists were predicting.

Time will tell, but it's entirely possible that what will ultimately be the case is what I asked about earlier: what reason is there to be sure that the death rate due to CV-19 is going to be worse in these countries than it is in Sweden? So far at least, the answer - and it is early days, to be sure - is a resounding "NO!", there is no reason to suppose the developing world will be hit any harder. It might be a relative non-event in the big scheme of things when it comes to the developing countries (of course, the economic impact is a different matter - the world economcies are all connected, and the devastation in the developed economies will slam the developing countries too). We'll see.

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Sorry if both of these have been posted before, but I finally got a chance to watch them. They provide a nice point and counterpoint on how societies should response to the virus.

 

 

The first video is by a Swedish epidemiologist defending the Swedish approach of trying (and failing - he admits) to protect the vulnerable while the rest of society mostly stays open (voluntary social distancing) while progressing towards herd immunity. He says:

  1. The virus isn't much more deadly than the seasonal flu.
  2. It's much more widespread in society than people think to the point where Stockholm may already be approaching herd immunity.
  3. Trying to keep it in check is not possible long term, even in places which have been successful so far like South Korea.

As far as I can tell, the evidence to date suggests all three of these are false. As for #1, antibody tests in NY and Chelsea put the Infection Mortality Rate (IFR) between 0.6 and 1.0%, while the seasonal flu's Case Fatality Rate (CFR) is between 0.1 and 0.3.

But let's look at Stockholm, since it more directly addresses his claim of #1 in Sweden. Yesterday the Swedish government said serology tests in Stockholm shows about 26% of the population "will have been" infected by May 1st (which is strange - how does a test done in the past predict where the country will be on a future date?) But let's take that on face value.

Sweden will have seen ~2500 deaths by May 1st according to Worldometer. That's the whole country, but most of Sweden's cases and deaths are occurring in the relatively densely populated city of Stockholm. Let's say it's 75% of the deaths in this small country that are occurring in their main city of Stockholm, which would be 2000 deaths.

Stockholm has a population of very close to 1M people. That is an overall mortality rate so far of 2k/1M or 200 deaths per 100,000 population. For comparison, New York City has a population of 8.4M in the five borough area and has seen ~17k coronavirus deaths, including probable cases. That is an overall mortality rate of 202 per 100,000 population. So on a per-capita basis, Stockholm has been hit with a similar total death rate per person as NYC, not a statistic to be very proud of especially since NYC's population density is over twice that of Stockholm (~10,000/km2 vs. ~4800/km2).

If 26% of Stockholmers have been infected so far as the data suggests, that is ~260k people previously infected. That puts Stockholm's infection mortality rate at 2k/260k = 0.78%, which is precisely in line with the IFR seen in America's hardest hit spots (NYC and Chelsea), which is again far higher than the seasonal flu which has a CFR of only 0.1 to 0.3 and an unknown but much lower IFR.

So #1 is false even by Sweden's own data - coronavirus is much more deadly than the seasonal flu.

Claim #2 that Stockholm is close to herd immunity is false as well, off by at least a factor of two given the 26% penetration so far, meaning deaths in Stockholm would likely at least have to double before herd immunity is achieved.

With a IFR of 0.78% as implied by the Stockholm data, herd immunity in the US would entail suffering 1.6M deaths assuming a reproductive rate for the virus of 2.5. But that is likely an underestimate because of hospital overwhelm and the fact that Americans are much less healthy than Swedes with more risk factors for bad covid-19 outcomes. The obesity rate in the US is more than 2x that of Sweden (42% vs. 18.6%) and the same goes for diabetes prevalence (10.2% vs. 4.8%).

Time will tell on #3, but so far countries that took early and aggressive steps to contain the virus have been pretty successful (e.g. China, South Korea and Taiwan), although another (Singapore) is now struggling.

But it's another question as to whether it's possible to put the genie back in the bottle once the horses have left the barn (yes, a terrible mixing of metaphors). I'm not so sure that it's possible, but that seems to be what Neil Furguson from Imperial College London is advocating for in the UK in the second video - i.e. keep lockdown measures in place until the number get low enough for effective testing, contract tracing and isolation of nearly all new cases like South Korea is doing effectively. He says the assumption in the influencial model his college produced are turning out to be about right (e.g. an IFR of ~0.9) and that to not attempt to slow the disease would have been a mistake due to excess deaths from the healthcare system becoming overwhelmed.

He says the effective reproduction rate of the virus in Sweden is currently around 1.3 and will soon cause their health system serious trouble if it isn't already. He suggests no country has been able to effectively shield their vulnerable population to the degree necessary for a "go for herd immunity" strategy among the healthy to be ethically viable and he doesn't think such effective shielding is feasible given the amount of support the most sick and vulnerable require from the rest of us. This is especially true in countries like the UK and the US which have a much higher proportion of metabolically unhealthy individuals than Sweden.

But Furguson acknowledges that which strategy to pursue is a political question involving the (temporary) tradeoff between freedom and some amount of economic activity against additional deaths.

Both videos are worth watching if you haven't already so you can judge for yourself who has the better argument.

--Dean

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Recall yesterday I posted a long article from Medium about the origin of the virus.

Here is a much shorter and easier to understand story in Newsweek about the same topic, namely the gain-of-function experiments with coronavirus that have been going on for years in the US and China. It discusses a classified document from the US government which concludes that the creation and accidental release of SARS-CoV-2 from the Wuhan virology lab in the course of legitimate experiments (i.e. not bio weapons research) cannot be ruled out.

--Dean

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1 hour ago, Dean Pomerleau said:

Sorry if both of these have been posted before, but I finally got a chance to watch them....

As far as I can tell, the evidence to date suggests all three of these are false. ...

Yeah, posted on the previous page....

As far as I can tell, your biases still make you desperately cling to the authority of Furguson, who claimed that there will be a quarter of a million Covid-19 deaths in Britain and whose claim was the basis for the populist government to go into a lock-down.  Yet, you ignore the clearly false claims of those who pushed for marshal law, while you continue to attack the now clearly more sensible Swedish approach. 

To repeat Mark Twain, "It's easier to fool someone, than to convince them that they've been fooled."

 

--------------

1 hour ago, Dean Pomerleau said:

Recall yesterday I posted a long article from Medium about the origin of the virus.

Here is a much shorter and easier to understand story in Newsweek about the same topic, namely the gain-of-function experiments with coronavirus that have been going on for years in the US and China. It discusses a classified document from the US government which concludes that the creation and accidental release of SARS-CoV-2 from the Wuhan virology lab in the course of legitimate experiments (i.e. not bio weapons research) cannot be ruled out.

--Dean

Yes. The point still stands, you are reposting FUD which has been floating around social media for at least a month and has been used in propaganda, including propaganda against the US.  Writing stories based on "we cannot rule out" is hardly good journalism.

 

7 hours ago, Dean Pomerleau said:

The latest Medcram video is a really interesting look at the cardiovascular complications (including strokes and heart attacks) that emergency room doctors are seeing in covid-19 patients. ...

Do we need reposts of this every day?  As I noted earlier, the same CV complications are common to the other four coronaviruses which have become endemic and revisit us every flu season, so I don't see the point of all the scaremongering.

Edited by Ron Put

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On 4/27/2020 at 6:54 AM, Mike41 said:

Assumptions, many of which may end up to be meaningless.

Yep, and based on on such obviously meaningless assumptions some populist politicians in the "Free World" imposed the closest we've come to marshal law and crashed our economies.

BTW, with such small samples, "deaths per million" are meaningless, especially within a single, narrow period and with other variables. To illustrate, here are two US states:

New York (lock-down):  1211 deaths per million

Arkansas (no lock-down):  19 deaths per million.


Imagine the headline possibilities.... (I edited the example to make it simpler to grasp  :)

Same with many of the Covid-19 headlines and with the picking of specific periods to show misleadingly high mortality. 

We won't know the correct toll for at least a year, but the bottom line is, the world's democracies should never have allowed hysteria and bad data to drive the unprecedented closure of their economies.
 

Edited by Ron Put

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Prompted by the clearly manipulative stories in much of the media, I just looked at the CDC data for pediatric flu deaths and there are some really juicy possibilities for a tabloid to exploit. For example this would be a factually correct headline:

"CHILD INFLUENZA DEATHS 42 TIMES HIGHER THAN IN PAST YEARS! PRESIDENT REFUSES TO ACT!"

As I recall, in 2009 a couple of Republicans tried to point the finger at the new Obama Administration for not reacting to the swine flu, but the media simply ignored them. In this political climate, things ended up much differently.  It's so easy to manipulate headlines to scare people.

Here are the graphs for 176721856_ScreenShot2020-04-28at14_26_49.png.527d09a4ebd6fbba87a993b2cf141c7a.pngInfluenza-Associated Pediatric Deaths by Week of Death for the seasons 2005-6, 2009-2019 and 2019-2020:



 

Edited by Ron Put

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1 hour ago, Ron Put said:

Same with many of the Covid-19 headlines and with the picking of specific periods to show misleadingly high mortality.

The true infection fatality rate is a very critical number to know for the purposes of establishing policy recommendations.   What estimates have you seen and/or calculated based on reliable data (resulting from random antibody testing using a test believed accurate)?

I believe you also stated previously that you thought a 20 or 25% penetration rate would be sufficient for herd immunity.  This is based on what reliable data?   This of course is tied to R0, so presumably you think the R0 of SARS-CoV-2 is lower than consensus opinion, but again based on what?

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The folks at IHME have once again increased their estimates of total deaths before Aug 4th in the US and most of the European countries since deaths aren't coming down nearly as quickly as they have been predicting. The current US death toll estimate from IHME is now 75K (up from 68K most recently and 61K before that). This upward revision isn't a big surprise given how things are going (e.g. nearly 60k total deaths and more than 2400 new deaths today).

But there is another model from Columbia University that I hadn't looked into before but which is being used by the US Coronavirus Task Force. It appears to be doing a much better job than the IHME predicting actual deaths.

Here is the page describing the Columbia model and comparing it to the IHME model both methodologically and accuracy-wise. Here are two examples of the IHME predictions (green dashes) vs. the Columbia model predictions (blue dashes) vs. actual deaths (yellow line) starting around April 15 for New Jersey and Italy.

Screenshot_20200428-183359_Chrome.jpg 

Screenshot_20200428-183737_Chrome.jpg

As you can see, the Columbia model is tracking the actual death rate very closely while the IHME model has been consistently underestimating to the point where the actual numbers bust through the the IHME prediction of Aug 4th death toll after less than two weeks after the projection is made.

The developers of the Columbia model go into great detail on the shortcomings of the IHME model and why their model is more accurate and also founded on sound epidemiological principles and techniques rather than just curve fitting (with a symmetric gaussian curve no less!). It makes for a really interesting read for anyone who likes this stuff.

Here is the Columbia model's prediction through Aug 4th for the US:

Screenshot_20200428-184510_Chrome.jpg

As you can see their model's most likely prediction is 153K US deaths, compared to the IHME's 75K. Here is a table they provide of probabilities for surpassing various death counts by month:

Screenshot_20200428-185252_Chrome.jpg

According to their model there is a 85% chance the US death toll will be greater than 100K by Aug 1st and a 41% chance it will be greater that 150K.

These projections are much more in alignment with my original prediction (north of 100k but hopefully not by too much) and aren't far from the rough, rather pessimistic estimates I made using several back-of-the-envelope methods a week or two ago (up to around 200K US deaths). As a result, some around here might suggest I'm cherry picking a model to match my own preconceptions. Regardless of what you might think of me or my projections, it's hard to ignore that this model's track record is a lot better than the widely-touted IHME model. We'll see if it remains more accurate over time.

--Dean

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3 hours ago, Gordo said:

The true infection fatality rate is a very critical number to know for the purposes of establishing policy recommendations.   What estimates have you seen and/or calculated based on reliable data (resulting from random antibody testing using a test believed accurate)?

I believe you also stated previously that you thought a 20 or 25% penetration rate would be sufficient for herd immunity.  This is based on what reliable data?   This of course is tied to R0, so presumably you think the R0 of SARS-CoV-2 is lower than consensus opinion, but again based on what?

Hi, Gordo. First, no, I do not believe that the the R0 of SARS-CoV-2 is lower than the flu's R0. 

In fact, I have been pointing out that the calls to follow China in imposing a lock-down were based on WHO's false initial claim that the R0 of SARS-CoV-2 was much lower than the flu's R0.  The supposedly low transmission rate of Covid-19 is why WHO claimed the Covid-19 can be contained.  Tedross repeatedly warned against mitigation, as it was initially applied in the UK and California, and as is still the official policy in Sweden, or Arkansas, or Byelarus.

As to infection rates for the flu, I posted earlier on the subject:

"...[T]he required infection/immunization rate is highly variable, depending on the cause.

"The required percentage that would have been required to establish herd immunity against previous influenza viruses ranged from 13% to 100% for the 1918–19, 1957–58, 1968–69 and 2009–10 pandemic viruses, and from 30% to 40% for the 2008–09 epidemic virus."

https://www.sciencedirect.com/science/article/pii/S0091743512000588 "


We will not know that real mortality rate until the data is collected, crunched and finalized, probably in about two years, based on prior CDC reports. It took the CDC almost two years to issue the final report for the 2017-2018 flu season, which dropped the total deaths to about 61,000 from the estimate of 80,000).  

But we do know is that the mortality rate is not 3.4% as claimed by WHO as justification for calling for marshal law in the West.  The Covid-19 mortality rate is much lower and it's likely close to that of a bad flu season (but not as bad as 1957 or 1969).

Again, I am not arguing that Covid-19 is not a real pandemic.  What I am arguing is that we've been through similar and worse pandemics since the 1950s and we have not resorted to imposing marshal law or crashing the Western economies because of it. 

I am also arguing that the reasons we did so for Covid-19 are mostly political and that while China and the WHO leadership provided the initial false data, it was Western populist leaders who ultimately are responsible for this mess.

 

Edited by Ron Put

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2 hours ago, Dean Pomerleau said:

... As you can see their model's most likely prediction is 153K US deaths...

Again, all the models you keep posting have been wildly inaccurate.  We don't have the data yet, so garbage in, garbage out.  

0.7% infection rate?!!  Have you not see the preliminary serological surveys popping up with much higher infection rates?

What's the point, really, other than retelling scary stories?


Coronavirus Is Likely to Become a Seasonal Infection Like the Flu, Top Chinese Scientists Warn

Just like the other four coronaviruses since 2000.  While the article implies that Covid-19 will continue through the summer months, there are already indications that it is subsiding, so my guess is, it will be just like the other coronaviruses, too.

The economy, on the other hand, is in intensive care.

Oops....

Edited by Ron Put

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I think it is important that comparisons of the case fatality rate of flu and CoVid-19 need to be based on both symptomatic and asymptomatic cases when comparing data based on flu infection serology numbers and serology for CoVid-19 infection numbers.  People that get the flu mostly just figure "suck it up buttercup".  They do not get tested.  CoVid-19 is scary and people who can get tested clamor for it.  In studies such (1) they used data from hospitalized or lab-confirmed cases and got a median of 8.3% infected.  Figuring on a world population of 7.75 billion population and about half a million deaths from flu world-wide, in a typical year [ https://en.wikipedia.org/wiki/Influenza#Seasonal_variations ] suggest to me that flu's case fatality incidence in very low.  

1. Seasonal Incidence of Symptomatic Influenza in the United States.
Tokars JI, Olsen SJ, Reed C.
Clin Infect Dis. 2018 May 2;66(10):1511-1518. doi: 10.1093/cid/cix1060.
PMID: 29206909 Free PMC Article
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5934309/pdf/nihms944068.pdf

 

 

Edited by AlPater

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Ron,

Separate from politics and past statistics for COVID-19, is there a future threshold beyond which you would decide that COVID-19 might be significantly more serious than the flu? [For example, U.S. deaths assigned to COVID-19 by Aug 4.]

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1 hour ago, Todd S said:

Separate from politics and past statistics for COVID-19, is there a future threshold beyond which you would decide that COVID-19 might be significantly more serious than the flu? [For example, U.S. deaths assigned to COVID-19 by Aug 4.]

A fair question.  I don't have an exact number, but it should be something higher than the US or world deaths from past pandemics, where no marshal law was imposed, and where the economy was not destroyed, right?

Let's take something like the 1957-1958 H2N2 flu pandemic and compare it to Covid-19:

1957-1958 deaths:
116,000 deaths in the US (655 deaths per million, based on 177 million population)
1,100,000 deaths worldwide (381 deaths per million, based on 2.89 billion population)

Covid-19 deaths (preliminary):
60,000 deaths in the US (180 deaths per million, based on 333 million population)
220,000 deaths worldwide (29 deaths per million, based on 7.65 billion population)

Note that the 1957-1958 pandemic was deadly, but it did not impact politics or the economy. 

A related virus came back in 1968-1969, but it killed "only" 100,000 Americans (out of 203 million population).  Back then, Instead of imposing marshal law, we landed on the Moon. 

AlPater also makes a very good point above.  I personally think that the numbers in NY do not make any sense and that we'll have to wait for less politicised data to come out and be processed, before we can draw any meaningful conclusions.  But the bottom line is that we've been through much worse pandemics and we did not destroy the economy and impose marshal law.  I really hope we learn something from this disaster.

 

Edited by Ron Put

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Ron,

Did those 1957-1958 and 1968-1969 numbers cover a period of one or two years each? If so, does that mean that we won't get a fair comparison until an equivalent duration has elapsed with the existence of SARS-CoV2?

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47 minutes ago, Todd S said:

... Did those 1957-1958 and 1968-1969 numbers cover a period of one or two years each? If so, does that mean that we won't get a fair comparison until an equivalent duration has elapsed with the existence of SARS-CoV2?

As I understand it, a flu season usually refers to the winter period in each hemisphere, during which virus-caused infections are most prevalent.  Most of the deaths occur within three months or so, but there is generally a noticeable peak of 2-4 weeks. To see what the graphs look like, see the infant mortality chart I posted above.

Covid-19 should be included eventually in the cocktail of viruses we think of as the flu, joining the other coronaviruses which emerged over the last decades (Covid-19 appears deadlier than the past and now common ones, but its mortality rate is still within the upper third or so of the "flu" range.

Covid-19 appears have a somewhat high R0 (2-4?) but it peaks and subsides -- it's likely that it will be included in the "2019-2020 flu pandemic" (although in the current political climate, even this might become a fight). I believe that it is a fair comparison.

Edited by Ron Put

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Ron,

If you have watched the entire "Corona Virus Pandemic Update 61" Medcram video that Dean posted above, why do you think that Dr. Seheult would characterize the effects of COVID-19 as being so unusual?

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https://news.google.com/articles/CAIiECq8XgT0cmylP3tICgD7WbIqFwgEKg8IACoHCAowjuuKAzCWrzwwqIQY?hl=en-US&gl=US&ceid=US%3Aen

This Mornings New York Times article by none other than Thomas Friedman, who I greatly admire, is titled,

IIs Sweden Doing It Right?

Now Thomas is smart enough to admit no one really knows, but he makes the case for their approach and he indicates they are getting a lot of notice from other countries and that Policies are beginning to swing in that direction.

From the article:

 

Here’s the stone-cold truth: There are only different hellish ways to adapt to a pandemic and save both lives and livelihoods. I raise Sweden not because I think it has found the magic balance — it is way too soon to tell — but because I think we should be debating all the different ways and costs of acquiring immunity.

When I look across America, though, and see governors partly lifting lockdowns — because they feel their people just can’t take it anymore for economic or psychological reasons, even though their populations have little or no immunity — I worry we may end up developing more herd immunity but in a painful, deadly, costly, uncoordinated way that still leaves room for the coronavirus to strike hard again and overwhelm hospitals

 

Edited by Mike41

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I really like this solution:

Stanford has made a reusable mask from scuba gear — and it’s shipping it to the front lines of the pandemic
 

Depending on what course the pandemic takes, and how long it takes to develop a vaccine, I could see over time specially designed full facemasks with small, replaceable filters becoming a very common and effective tool. If many of us were vigilant about wearing these, we could really decrease transmission dramatically. I'm ready.


I bought a $20 full face mask snorkel. It doesn't have a filtered intake or exhaust, but I could see how something similar that is specifically designed to do that could be effective.

 

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The "whistleblowing ER Docs"  promoted by Ron Put et al. are getting some pushback after their video went viral.

California doctors with dubious COVID conclusions debunked

"...public health experts were quick to debunk the doctors’ findings as misguided and riddled with statistical errors..."

 

And now it seems their video  has been removed for "violating YouTube's Community Guidelines."      The new liberal democratic authoritarianism is upon us.

Eg.

Quote

Facebook said on Monday that it was banning users from organizing “events that defy government’s guidance on social distancing”. The company’s decision to selectively enforce state public health orders came amid a spate of rallies protesting against statewide stay-at-home orders in cities cross the US, and it drew condemnation from rightwing supporters of the protest movement, Donald Trump Jr, and the American Civil Liberties Union (ACLU).  [...] “This is the difference between accountable governance and unaccountable companies. A government that makes this decision is subject to law; they’re subject to real legal constraint and remedy. Facebook is not.” 

Edited by Sibiriak

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1 hour ago, Gordo said:

Germany faces having to bring BACK strict coronavirus lockdowns as cases surge just days after easing them

Not looking great so far for the idea that we can get by OK with just basic precautions, masks, social distancing but otherwise reopening the economy...

 

Well the Swedes idea for one is NOT based on an assumption that it will be OK. There assumption is that, yes, it will spread, most will be ok and develop some level of immunity, the vulnerable should be protected and the economy should not be shutdown. So, yes there will be more deaths at the beginning and they understand that. But the big question is wHat is the overall effect of shutting down economies/ death rates/ economic chaos and overall deaths. We do not know which model will prevent the most suffering overall in the LONG TERM! Time will tell. It may just be the Swedish model will result in less overall harm, including deaths in the long run. Then again they may be FOS! 

Are covid case counts meaningless
https://fivethirtyeight.com/features/coronavirus-case-counts-are-meaningless/ 

LIES, DAMN LIES-AND STATISTICS

MARK TWAIN

Edited by Mike41

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2 minutes ago, Mike41 said:

Well the Swedes idea for one is NOT based on an assumption that it will be OK. There assumption is that, yes, it will spread, most will be ok and develop some level of immunity, the vulnerable should be protected and the economy should not be shutdown. So, yes there will be more deaths at the beginning and they understand that. But the big question is wHat is the overall effect of shutting down economies/ death rates/ economic chaos and overall deaths. We do not know which model will prevent the most suffering overall in the LONG TERM! Time will tell. It may just be the Swedish model will result in less overall harm, including deaths in the long run. Then again they may be FOS! 

Good point, I guess the prospect of an effective vaccine being mass produced quickly is a critical bit of information for deciding which way to lean.  When you start crunching numbers on how many are likely to be infected eventually, and the infection fatality rates, it doesn't look very palpable to relax at least from a common modern American perspective.  It would make for an interesting survey though, how many lives would have to be saved for destroying the economy to be worth it?  I guess its the age old dilema of putting a dollar value on a life.

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Gordo said:

“ guess its the age old dilema of putting a dollar value on a life.”

unfortunately it’s just not so simple. We humans, including all the great scientists and all their data are not God. How do we know all the consequences of economic disruption like we are seeing. We do not. Depression, addiction, suicide, auto accidents, immune dysfunction related to these factors and diseases etc. etc. We assume so much. Science even the best science makes assumptions all the time. Just spend some time looking into the assumptions we made about material reality and still do!! 

It is complex indeed. We are in deep water. Way over our heads I’m afraid. All I’m saying is we shouldn’t assume anything. Too much is just unknown and uncertain.  The article I cite below is a good example of that. What works for NY, Say may not apply in Wyoming or Montana or even rural areas in general and those places could be better served by strong protection of the vulnerable and a loosening of the economic constraints. One size may just not fit all.

https://fivethirtyeight.com/features/coronavirus-case-counts-are-meaningless/

Edited by Mike41

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