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Thread: Disease and pandemics thread (because it's science)

  1. #1081
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    Recession, meh. I worry about a worldwide Great Depression 2.0


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  2. #1082
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    Quote Originally Posted by Roger E. Moore View Post
    An article with a headline I don't dare repeat in this thread. Give it a look, and think about it. True or not?

    https://www.cnbc.com/2020/03/19/the-...isor-says.html
    Of course it's true, I did that math weeks ago, when we were told that the R0 value was like 2.3 and the mortality rate was like 1%. Those numbers are rough, but it's a simple calculation-- you say that the fraction f of people who get it must drop R0 down to 1, so that means (1-f)*R0 = 1, or f = (R0-1)/R0, perhaps about 60%. Then you take f and multiply by the mortality rate M, and multiply by the population N, and you get a number of deaths equal to N*M*(R0-1)/R0, here in the tens of millions worldwide.

    Now, of course those numbers only apply if nothing is done by the society to reduce R0, which won't be true. Also, this calculation assumes no correlation between M and f, in other words, it leaves out the possibility that we might find ways to reduce f in subgroups that have high M. This suggests two strategies. One is the "all-out war" option, where you make societal and economic changes of a fairly radical nature, and try to get R0 down below 1 while f is still small. This is what China did, and it works in the short run, but it's not clear what is needed to keep R0 below 1 in the long run. The other option is to notice that M is much higher for the elderly, so try only to keep f small in that subgroup by isolating them from the rest (also a radical option). That might produce less economic disruption, as many elderly are retired.

    The other problem to bear in mind, that not much is being said about, is that even though M is only about 1% when the health-care system is operating optimally, it goes much higher (as in Italy) when it is overwhelmed. So another key number is how many respirators you need at any given time, because if you don't have them, ten times as many people will die. So there's a kind of feedback mechanism here, where if the numbers get up to a certain level of death rate, the death rate goes much higher still.

  3. #1083
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    Easy prediction: The haphazard, patchwork, politicized, and monetized health care system of the US, might not operate optimally. And I have little faith that the bigwigs who created such an irrational system will step up and act rationally now.
    "I'm planning to live forever. So far, that's working perfectly." Steven Wright

  4. #1084
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    Quote Originally Posted by Noclevername View Post
    Easy prediction: The haphazard, patchwork, politicized, and monetized health care system of the US, might not operate optimally. And I have little faith that the bigwigs who created such an irrational system will step up and act rationally now.
    I think much the same thing can be said for any country. Certainly I have seen various comments about not moving in time, not having sufficient resources, etc. for other health systems in this crisis. Ultimately, this is an extraordinary situation and such are never dealt with as well as we would like. At one time I was working for the SBA dealing with disaster response and we, as well as other disaster response agencies, always had competing concerns. Most of the time, we didn’t do much, so it didn’t make sense to have a large staff sitting around doing nothing, or have a lot of spare capacity (computers and such) sitting around. On the other hand, when there was a big fire, earthquake, etc. we had to ramp up immediately. Of course, it could never be fast enough and there would always be complaints about too slow response. But in lean times there would be arguments that funding should go elsewhere.

    As for debating relative merits of different health systems, I don’t see how to discuss that without getting into politics so I won’t go there.

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  5. #1085
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    Quote Originally Posted by Van Rijn View Post
    As for debating relative merits of different health systems, I don’t see how to discuss that without getting into politics so I won’t go there.
    Agreed. I'll try to speak a little more conservatively. I could have worded that last sentence better.
    "I'm planning to live forever. So far, that's working perfectly." Steven Wright

  6. #1086
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    Quote Originally Posted by Noclevername View Post
    Originally Posted by Van Rijn
    As for debating relative merits of different health systems, I don’t see how to discuss that without getting into politics so I won’t go there.
    Agreed. I'll try to speak a little more conservatively. I could have worded that last sentence better.
    I don't see how this won't be political either. Please drop the topic.
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  7. #1087
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    Quote Originally Posted by Ken G View Post
    Yes, that's what I was wondering. Had Li initially received a minor exposure, perhaps by rubbing his eyes, it seems likely he would still be here today. I can't help wondering if this is not a significant fact that is being overlooked because it seems too risky.
    I don't understand this statement. Can you explain what you mean? It doesn't seem like it's being overlooked, the information is publicly available.
    "I'm planning to live forever. So far, that's working perfectly." Steven Wright

  8. #1088
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    My epidemiologist sister says there are two strains circulating, one mild, one horrible, and it seems 20 viral particles is enough, unusually small infectious dose. But she could be wrong, reading all that stuff. It’s the first i have heard that detail.
    sicut vis videre esto
    When we realize that patterns don't exist in the universe, they are a template that we hold to the universe to make sense of it, it all makes a lot more sense.
    Originally Posted by Ken G

  9. #1089
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    Quote Originally Posted by profloater View Post
    My epidemiologist sister says there are two strains circulating, one mild, one horrible, and it seems 20 viral particles is enough, unusually small infectious dose. But she could be wrong, reading all that stuff. It’s the first i have heard that detail.
    The "two strains" information comes from a small study published at the start of this month.

    L-type and S-type. One is often described as being more "aggressive", but that relates to R0 rather than case fatality--it probably transmits more readily, otherwise it wouldn't be becoming dominant. Social distancing is naturally selecting for the more transmissible strain.

    (Viruses do this. Again, it's not some terrifying new property unique to the COVID-19 virus.)

    Grant Hutchison

  10. #1090
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    Quote Originally Posted by grant hutchison View Post
    The "two strains" information comes from a small study published at the start of this month.

    L-type and S-type. One is often described as being more "aggressive", but that relates to R0 rather than case fatality--it probably transmits more readily, otherwise it wouldn't be becoming dominant. Social distancing is naturally selecting for the more transmissible strain.

    (Viruses do this. Again, it's not some terrifying new property unique to the COVID-19 virus.)

    Grant Hutchison
    Thanks, there is so much to learn whilst staying at home!
    sicut vis videre esto
    When we realize that patterns don't exist in the universe, they are a template that we hold to the universe to make sense of it, it all makes a lot more sense.
    Originally Posted by Ken G

  11. #1091
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    A medrxiv preprint appeared a couple of days ago, highlighting how SARS-CoV-2 (the coronavirus that causes the disease COVID-19) is showing multiple mutations (just like other viruses). The authors suggest it's evolving towards greater transmissibility with reduced virulence (a common trajectory for pathogenic organisms). Not peer reviewed yet, though, and it feels to me as if there might be a large edifice of speculation erected on a nugget of data.

    Grant Hutchison

  12. #1092
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    Quote Originally Posted by grant hutchison View Post
    A medrxiv preprint appeared a couple of days ago, highlighting how SARS-CoV-2 (the coronavirus that causes the disease COVID-19) is showing multiple mutations (just like other viruses). The authors suggest it's evolving towards greater transmissibility with reduced virulence (a common trajectory for pathogenic organisms). Not peer reviewed yet, though, and it feels to me as if there might be a large edifice of speculation erected on a nugget of data.

    Grant Hutchison
    Well that’s very interesting, thanks again, I guess there’s no pressure on the reviewers, I hope they have a great weekend.
    sicut vis videre esto
    When we realize that patterns don't exist in the universe, they are a template that we hold to the universe to make sense of it, it all makes a lot more sense.
    Originally Posted by Ken G

  13. #1093
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    Quote Originally Posted by Noclevername View Post
    I don't understand this statement. Can you explain what you mean? It doesn't seem like it's being overlooked, the information is publicly available.
    Information is available to piece together how you like, but no one has suggested that people in danger of high exposure might do better to intentionally undergo a weak exposure. Or that it might be good to get it over with while there is still a hospital system to turn to. These are unpleasant facts that are hard to act on because of the obvious risks, so are rarely if ever mentioned. I'm not in a rush to expose myself in this way, but the thought did cross my mind. If they could isolate a single viral particle, or two or three, and use them to intentionally expose people at risk of getting high viral loads later on, one wonders what the outcome would be. The ethics are certainly tricky.

    It's like the concept of herd immunity. We get exposed to the information that herd immunity can stop a virus, and that we are in some sense waiting to achieve that, but often that information does not come with the natural consequences. If herd immunity is achieved via exposure, rather than innoculation, the death toll will be horrendous, full stop.
    Last edited by Ken G; 2020-Mar-20 at 12:07 AM.

  14. #1094
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    On the issue of the two strains, does getting one strain provide immunity to the other? Because if not, then it's just two epidemics going on at the same time, so it really doesn't help if one is less deadly. If it does provide immunity, one wonders about the possibility of creating mutations intentionally, seeking a less dangerous version. Talk about tricky ethics-- what about releasing an extremely contagious mutation that is not virulent? How ironic would it be if germ warfare was used to solve the coronavirus crisis.

  15. #1095
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    Quote Originally Posted by Ken G View Post
    Information is available to piece together how you like, but no one has suggested that people in danger of high exposure might do better to intentionally undergo a weak exposure. Or that it might be good to get it over with while there is still a hospital system to turn to. These are unpleasant facts that are hard to act on because of the obvious risks, so are rarely if ever mentioned. I'm not in a rush to expose myself in this way, but the thought did cross my mind. If they could isolate a single viral particle, or two or three, and use them to intentionally expose people at risk of getting high viral loads later on, one wonders what the outcome would be. The ethics are certainly tricky.

    It's like the concept of herd immunity. We get exposed to the information that herd immunity can stop a virus, and that we are in some sense waiting to achieve that, but often that information does not come with the natural consequences. If herd immunity is achieved via exposure, rather than innoculation, the death toll will be horrendous, full stop.
    In the end, people are going to do what they want to do. To achieve the results you're talking about, exposure has to be done consistently, not piecemeal. And in most countries, having that kind of universal, coordinated control has implications I cannot go into here.

    If I thought it was practical to make natural herd immunity happen, and if I thought there were not going to be a vaccine, I'd be for it. I think there will be a vaccine, and that deliberate exposure of the masses is therefore unnecessary.
    "I'm planning to live forever. So far, that's working perfectly." Steven Wright

  16. #1096
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    Herd immunity is weaker than social isolation. If everyone avoids unnecessary socializing Covid-19 can be eradicated in the shorter amount of time than any forced social contamination. That seems to be the consensus and given the expected lag in results it seems to have been shown to be true in places like China and South-Korea, which are densely populated.
    Confirmed cases in India to-date: 184
    Herd immunity?
    If so, past exposure based or else?

  17. #1097
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    Quote Originally Posted by Noclevername View Post
    In the end, people are going to do what they want to do. To achieve the results you're talking about, exposure has to be done consistently, not piecemeal.
    The issue would be for someone like an ER nurse, who might have the technology available to be exposed to only a small number of virus particles if they were to choose to. And this would be balanced against the very real fear that soon ER healthcare workers will be exposed to high viral loads with insufficient protection, largely because of the state of complete chaos that our ERs will soon be in, and the very real lack of sufficient amounts of protective gear. On a battlefield in a war, the people in the trenches may find it necessary to consider solutions that were not in the manual. But yes, ultimately it is up to the individual to decide what to do.
    If I thought it was practical to make natural herd immunity happen, and if I thought there were not going to be a vaccine, I'd be for it. I think there will be a vaccine, and that deliberate exposure of the masses is therefore unnecessary.
    I share your hope that the vaccine will not take 18 months, but I don't know if that is sheer optimism. Certainly we are being told it might take 18 months, so we can hope that is just pessimism. But hope is not a method.

  18. #1098
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    Quote Originally Posted by a1call View Post
    Herd immunity is weaker than social isolation. If everyone avoids unnecessary socializing Covid-19 can be eradicated in the shorter amount of time than any forced social contamination. That seems to be the consensus and given the expected lag in results it seems to have been shown to be true in places like China and South-Korea, which are densely populated.
    The concern is that without true herd immunity, it will flare up again. But I agree that if the long-term strategy is innoculation, the medium-term strategy is enough social isolation to get R0 down below 1, and maintain those new societal behaviors as long as needed. We are watching China to help us see what that looks like-- can they sustain an economy for example? But although I do see both those strategies as workable, I really don't see herd immunity as a viable option. That sounds too much like the Spanish flu outcome. I don't know what the deal is in India, perhaps you're right that should be looked at more closely.

  19. #1099
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    Quote Originally Posted by Ken G View Post
    The issue would be for someone like an ER nurse, who might have the technology available to be exposed to only a small number of virus particles if they were to choose to. And this would be balanced against the very real fear that soon ER healthcare workers will be exposed to high viral loads with insufficient protection, largely because of the state of complete chaos that our ERs will soon be in, and the very real lack of sufficient amounts of protective gear.
    Sure. Infect them so their immune system does its work. And meanwhile they're infected and contagious.

    On a battlefield in a war, the people in the trenches may find it necessary to consider solutions that were not in the manual.
    Soldiers are selected and trained. Civilians tend to panic, run wild, and try everything without supervision no matter how nutty or ineffective.

    I share your hope that the vaccine will not take 18 months, but I don't know if that is sheer optimism. Certainly we are being told it might take 18 months, so we can hope that is just pessimism. But hope is not a method.
    No, searching for an effective means to achieve a result is a method. Deliberate infection is not such a means, IMO. It has glaring flaws in the execution.
    "I'm planning to live forever. So far, that's working perfectly." Steven Wright

  20. #1100
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    NEWS FROM UPSTATE SC: My office shut down except for a skeleton staff (bad pun in these times), so I am staying home, self-isolating, sheltering in place, etc. At least I have my research, silly as it is. And 10 daggone cats. My wife works at CVS, still has to work.
    Do good work. —Virgil Ivan "Gus" Grissom

  21. #1101
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    Quote Originally Posted by grant hutchison View Post
    A medrxiv preprint appeared a couple of days ago, highlighting how SARS-CoV-2 (the coronavirus that causes the disease COVID-19) is showing multiple mutations (just like other viruses). The authors suggest it's evolving towards greater transmissibility with reduced virulence (a common trajectory for pathogenic organisms). Not peer reviewed yet, though, and it feels to me as if there might be a large edifice of speculation erected on a nugget of data.
    Here's something I've been meaning to ask: How can you sort through all the COVID-19 papers on Med-rXiv and the others? I gave up. There are so many and I have no ability to sort them out.
    Do good work. —Virgil Ivan "Gus" Grissom

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    The progression of action is interesting: Bay area counties declared a stay at home order a day or two ago, then my Sacramento county did today. The California governor seemed reluctant to do the same, first recommending half-staff at work site, then quarter staff, but this evening declared a state-wide stay at home order to start tomorrow. Of course, standard exemptions apply, with getting food or medicine/medical help, or working at same. Indications are they will only go after people blatantly breaking the order, like big parties, etc.

    He says that projections show that 56% will get infected in the next eight weeks. My aim is to not be one of them, and once that many have gotten sick and then over it, it should be a bit easier to avoid.

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  23. #1103
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    Quote Originally Posted by Van Rijn View Post
    The progression of action is interesting: Bay area counties declared a stay at home order a day or two ago, then my Sacramento county did today. The California governor seemed reluctant to do the same, first recommending half-staff at work site, then quarter staff, but this evening declared a state-wide stay at home order to start tomorrow. Of course, standard exemptions apply, with getting food or medicine/medical help, or working at same. Indications are they will only go after people blatantly breaking the order, like big parties, etc.

    He says that projections show that 56% will get infected in the next eight weeks. My aim is to not be one of them, and once that many have gotten sick and then over it, it should be a bit easier to avoid.
    Of course with the stay at home order, the infections will top out much lower than this.
    The moment an instant lasted forever, we were destined for the leading edge of eternity.

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    If you don't leave your house the chance of getting Covid-19 is virtually 0%. Can't see the logic behind such high infection rate projections.

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    Quote Originally Posted by a1call View Post
    If you don't leave your house the chance of getting Covid-19 is virtually 0%. Can't see the logic behind such high infection rate projections.
    Maybe the governor missed the part where they said, if we don't do nothing, our infection rate incidence will jump to 60 percent of the population.
    The moment an instant lasted forever, we were destined for the leading edge of eternity.

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    https://www.theguardian.com/world/20...alted-covid-19

    Scientists say mass tests in Italian town have halted Covid-19 there

    The research allowed for the identification of at least six asymptomatic people who tested positive for Covid-19. "If these people had not been discovered," said the researchers, they probably would have unknowingly infected other inhabitants.
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  27. #1107
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    Quote Originally Posted by Copernicus View Post
    Of course with the stay at home order, the infections will top out much lower than this.
    Maybe. I suspect there will be a lot of 20 somethings assuming their own immortality that won’t be careful at all, and then spreading it to families. Same with kids. We’ve had some of that already. ‘Course, that might change when they see younger people on ventilators, and after that, families mourning them.

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  28. #1108
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    I think it's fair to say that this one pandemic ...and next, and the one after that... will dramatically reshape social structures and health organizations all over the world.

    https://www.ted.com/talks/alanna_sha..._next_outbreak

    We can get better at quarantines and travel restrictions, and we should, but they're not our only option, and they're not our best option for dealing with these situations.

    The real way for the long haul to make outbreaks less serious is to build the global health system to support core health care functions in every country in the world so that all countries, even poor ones, are able to rapidly identify and treat new infectious diseases as they emerge.
    Last edited by Noclevername; 2020-Mar-20 at 07:29 AM.
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    i expect there will be changes, but often in ways we don’t expect, and more and less than we might currently imagine. We’re using quarantine procedures similar to but more extensive than things I heard were used back 70 years ago or so, and even further back than that. Things I have never seen in my life. We probably aren’t going to have many pandemics like this, and people are going to want to get back to normal as soon as possible.

    I imagine there will be a lot of interest in new methods of rapid response, better response and perhaps new methods for rapid vaccine development. I hope there will be a lot of pressure against the antivaxers. But I expect a lot of the concern and money will go away once the crisis is over.

    But I can see other effects as well. Home delivery and teleworking have been becoming more popular but this will give both a big push, with people trying things they hadn’t bothered with before, and they will get used to it. That will change economies and how we live.

    "The problem with quotes on the Internet is that it is hard to verify their authenticity." — Abraham Lincoln

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    Re: India, it still does not compete as far as I am concerned:

    https://www.bbc.com/news/world-asia-india-51922204

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