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Bluegoat

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Everything posted by Bluegoat

  1. No, what I've said, from the beginning, and more than once, is that the goal is to flatten the curve in order to not overwhelm health services, until there is herd immunity, and that it is not good for those with serious risk factors, as well as for many other reasons, to try and flatten it beyond that. And that the goal is herd immunity if it is possible, and that if so the expectation is that about 80% of people will have to have the virus to achieve that. How long that would mean spreading it out is unclear and will depend on your health services anyway. I suggested a few posts back that the planners here are anticipating 30% exposure this year, and I think they are satisfied they can manage that. However if they couldnt it doesn't necessarily mean that they could keep strict measures in place for longer to compensate. Again - the OP asked, is the goal herd immunity, or is it elimination, and are people starting to think it is the latter, and are any governments saying that. Elimination isn't an option in most places, was my answer, and some people do seem to be thinking it is the goal, but governments generally are not saying that.
  2. Yeah, that's not really what I was suggesting, it was a follow on from the post I was responding to which was about how people behave.
  3. I don't mean distancing just after he shops, I mean distancing from him altogether. As in, you don't touch him at all, you don't get closer than six feet from him, you don't sleep in the same bed. Some health care workers here, if they have vulnerable family members, are living separately in airbnbs, not seeing their kids. Most people who are just higher risk, say with obesity, or asthma, aren't doing that stuff. But for the most vulnerable that's the recommendation. I don't know if it amounts to lip service, but that level of isolation can really only be maintained for a short time IMO, some may not be willing to do it at all. I think what gets a little lost sometimes is that those people are already at high risk to die of some infection, but then you essentially are having to tell them you can't do anything for them. I'm not sure fatality rate alone is what is in question. It's more what difference can you make by acting, and what are the trade-offs (like fatalities caused by the measures.). I suppose we could have a highly contagious virus that kills 50% of us come up next week, if we do the maximum possible (whatever that is) and it prevented most of those deaths, we'd still have to ask how long they would be sustainable, and eventually settle for something less. And that still might be "too many" deaths.
  4. Look, I am not sure what you are arguing here. Herd immunity at a level that doesn't overwhelm health care means not so many dead at once, that's the point. No one is saying that some measures won't carry on, but they are not going to be able to be maintained at the higher level they have been long term. And that means there will still be transmission, more than under current restrictions, until either there is vaccination, or immunity, or maybe we will have to get used to them permannenly. Keep in mind that the most significant restrictions may be the ones it's most difficult to keep up long term. But you do realise how that impacts those who have been told they need to be sequestered? And what if there is no vaccine, or much better treatment options? Do you want them to come out, knowing that if they catch it they will almost certainly die? Some people have called this the "sacrifice the elderly" approach. It may be that its the only realistic option if it becomes simply a regular yearly infection, but I am struggling how anyone is seeing is as evidence of being kinder.
  5. I think you are right about lack of trust in the information. It's become a problem in so many areas. And lack of trust in government tends to cause elevated reactions and I think contributes toward things like hoarding. If you can't trust the larger social structure it quickly becomes every person for themselves. I'm not sure it's all about trusting that most will be fine if they get sick though that must help a lot. But I think the people I know who are most calm see it more in terms of - there are many things I could die from, and this is just one of them, one day, it will be one thing or another. To some extent that's personality I guess, that's a very phlegmatic response. But it might also depend in part to the larger social attitude about things like healthcare and death, and also the way those things are supported in the larger culture.
  6. Most churches here closed, or as good as closed, before restrictions on meetings. Restrictions are that no groups larger than 5 and two meters apart, some some churches are having tiny services (like, minister and organist or something like that) and broadcasting them, or even just doing them without broadcasting them.
  7. So, I've asked my relative just now what the numbers they are anticipating are. He said 30% of the population in the next year, 60% in the next apox. 24 months. But a lot will depend on whether there is immunity, and that will become clearer as they begin to open things up again. Also, it's possible a second or third wave of infection might be worse than the first. If there is total immunity, some of the models say that after the initial group of those who become ill die, there will be a general population immunity, the virus will just be around but most will be immune. If there is no immunity, or partial immunity like the flu, it will probably come and go, maybe seasonally. The only option would be measures that can be sustained long term to reduce chance of illness, and hope for some sort of vaccination or other way to control it to emerge. But in any case planning needs to watch carefully what happens as they begin to open things up in order to decide what to do next.
  8. It's not really an "even if" discussion though. What's the other option? It's not under our control, it's a virus. Even with people washing hands, working at home, not travelling, and all the rest, there is still transmission. Are you suggesting we go for a complete quarantine until, and if, we manage to find a vaccine? It seems to me like you are saying that because this is too many deaths, we can't allow that, but I'm not sure why you think we can control it. We don't manage to control many illnesses. And how would you plan to manage the problems created by maintaining long term social isolation? If that is what you are advocating you have to account for that end of it too. With a larger population their will be a larger number of deaths, that's the math as you say, but do you really think places with a smaller population are in a different situation? They have fewer resources.
  9. Sure, I'm not suggesting that it is a given. Local situation plus what you might call national character plays a role. I was really just saying that here, the impression many people seem to have is that the measures are meant to prevent transmission altogether. When I've talked to people on the US or UK, there seems to be a similar group of people who are understanding it the same way - their response might be different, but that seems to be the impression a lot of people are getting from the way things are being described. ETA: I think your idea about washable stuff is interesting. At the moment their might not be the infrastructure to manage the washing - I'm not sure. But in general I think there has been a really significant demonstration that global supply lines and dependence on disposable items of all kinds are not as reliable as people have felt.
  10. Well, it's what most jurisdictions are anticipating even with the social distancing measures. They are still expecting to have a herd immunity situation at the end of it, so something like 80% or more who have caught it. The most vulnerable people, ie people on immuno-suppresent drugs and the very fragile, those in care homes, etc are here not being told to do just those things. They are being told that if they want to avoid infection they need to completely quarantine. For example if their spouse goes out to do the shopping, they need to social distance from their spouse in their own home. That's not what the public is being told to do, it's what the doctors are telling them privately and how they are managing the care homes. (Although the latter isn't working well because they can't make the workers live in.)
  11. It depends on where you live - some places have managed and hit peak without overwhelming services or are anticipating that they will. Others even with very strict care will not manage. A lot depends on the state of the health system to start and how far ahead they were able to plan. Unfortunately if you are in the sort of place where services will be overwhelmed they will have some hard decisions to make about things like triage, because they won't eliminate transmission. They can only keep measures in place until the worst is over. ETA: All that is still an attempt to flatten the curve though, it's just not flat enough to completely solve the problem.
  12. Yeah, I don't try and get colds, but they are horribly contagious and there is no vaccine, so I know I will get them from time to time. People modelling how the common cold behaves are also going to count on everyone getting it eventually because that's just realistic. People where I live are really very good about complying, the main group we see not doing it has been teenagers and that's because they are teenagers. But we've had some problems in the other direction, like people reporting neighbours, or getting angry because people were doing things they thought were wrong even though they were allowed, and a lot seems to be driven because they have the impression that if they just follow the rules carefully, people will not become ill - themselves or others. There have started to be problems with people refusing to provide childcare for health workers or allow them to rent properties. They don't seem to understand that just like with a cold, even taking precautions they are likely to catch the virus in the next six months or so, and that is part of what is making them very reactive. Having enough PPE is part of medical services not being overwhelmed.
  13. The original question in the OP was, is the goal to flatten the curve, or eliminate covid. I think you have to read the answers in that context. Flattening the curve was always meant to get us to herd immunity. But a lot of people are behaving (in the world, not here) as if the goal now is to eliminate it, or at least stop many people from ever getting it.
  14. Trying to slow spread to better understand the biology of the virus doesn't particularly seem to be a concern for the doctors and scientists making the plan. I know data is a concern - one of my relatives that's involved in covid management is mainly a data person and so that's something she is really concerned with along with projections of different scenarios, and they are adapting as new information becomes available, but my sense is that's just not part of a realistic approach. They are already trying to slow down transmission in order to avoid overwhelming health services. IN any case if people don't become immune slowing the spread more won't change that and there are still limits to how much people can do and for how long. I'm not sure where you got the idea I want people to get it faster, as what I said was the goal is to keep it at a level that keeps health services viable, which means slowing it - how much that requires will depend on where you live, in some cases it may not be possible to prevent it. What I am questioning is the value (and the possibility frankly) of slowing it beyond that. You might improve management a little. Vaccination is not likely in the near term and maybe not at all so it's probably not sensible to wait for that. But it also comes with big downsides which you don't seem to be counting as very significant. And a major major one is those who are the most physically at risk will not be able to resume anything like a normal lifestyle as long as you are going for suppression. Their choice become really significant health risks or personal quarantine at a level far beyond what you or I are having to deal with.
  15. Yes, that is a concern, though they seem to think there is a really good chance that there is going to be at least partial immunity. But we can't really control that, it's just a matter of finding out as it becomes clear. If there is no immunity than none of the strategies being used will work, everyone is going to need to come up with a new plan. To some extent the economists are right, and the behaviourists - we can shut down some things short term that cannot be shut down long term, so if there is no herd immunity we likely won't be able to prevent it going round altogether. I actually think one of the benefits potentially of all this is that people might realise that more local sustainability is important, and that we can do fine with less energy and time and money spent on production of consumables. But there are things we do need. And I don't think people will be willing to do things like never have social gatherings, not have funerals, see local family, etc, in the long term, even if there is a risk they will become ill.
  16. The US isn't the world. In many places care homes are completely locked down - residents cannot leave, and only workers can come in. Recommendations for the immunocompromised and others with sever risk are to stay in their own homes only, and to socially isolate even there. So if their spouse goes out to do the shopping, or their kids interact with said spouse, they are not meant to touch them or share a bed with them etc. Now, they are not forced to do this, but that is the recommendation of what is required to be sure they are not exposed. That is the level of isolation required to actually prevent transmission rather than just slow it down. Front line health care workers are also being recommended to socially isolate from their families in a similar way. There are also many places where there are serious questions around production - in my area for example fish plants are struggling to find workers as they normally depend on non-Canadian workers. The same is true of many farms throughout Canada going into their busy season - most have temporary Jamaican workers coming in now. It's possible there could be full seasons lost in parts of the fishery or agricultural sectors which is not an abstract cost. (And there are also questions around the ethics in terms of the health of the temporary workers - why should we be relying on them risking their health in this way, living in tight spaces etc?) People are not necessarily saying shut downs are the wrong approach, I don't think any posters in this thread are saying that. What is being said is that it can't be a long term approach, and that means there will be a herd immunity end point. And that end point is desirable in the sense that it is only then that the really vulnerable will be protected. As long as there is active transmission they won't be. There is a reason well organised countries who have taken the virus seriously are also taking seriously the need to lift restrictions as soon as it's viable, and aren't trying to totally prevent the spread altogether.
  17. Well, that is not what I've said. The UK originally planned to use the Swedish plan, which was to let the virus spread normally until herd immunity was reached. They would protect the immunocompromised and elderly by quarantine and it would be over fairly quickly as herd immunity was reached. At that point things would go back, more or less, to normal, and social costs (including deaths, health, effects on those quarentined, etc) would be minimised. What put a wrench in that idea is that they realised that the health services would be overwhelmed by having so many people ill at once. So rather than just the expected deaths from the virus, they would get significant additional deaths due to lack of available medical care. So the plan became flatten the curve, which means to attempt to slow spread of the virus so health services would not be overwhelmed. That would prevent or at least minimise additional deaths. But the end point is still herd immunity, where the virus stops moving through the population. The downside of this of course is that all the quarantined people have to remain quarantined that much longer, and social costs will be greater. So the balance is to keep health services functional, without creating more costs for those who are most seriously at risk, or increasing social costs more than is absolutely necessary. And I'll remind you that social costs doesn't mean people having fun at parks, it means the elderly having no contact with their families, it means kids in abusive homes being home with their abusers all day, it means people forgoing care for other illnesses, etc. Continuing to suppress as much as possible, rather than basing it on the capacity of health services to cope, simply continues to elevate those costs, but it can't change the endpoint of herd immunity. Unless you live in a very isolated population, or a vaccine is developed early, which can't be counted on, there isn't any advantage to that. And you are essentially telling those at highest risk that they need to be in sever quarantines for the foreseeable future, so that the more healthy can maintain the illusion that they can avoid getting sick.
  18. The things that you are saying will not allow people in care homes, or like my aunt to go out. Not in places like the US, Canada, or the UK. Because there will still be non-insignificant transmission. Taiwan and also places like Australia are not in a similar situation. It's possible they may in fact be able to simply bring the numbers down to zero, though it remains to be seen if that is possible long term, there are epidemiologists who don't think it will be. But in countries where there are far more infected and there are shared borders etc, that is not going to work. At least that seems to be the almost universal assessment of epidemiologists in those countries. The provincial pandemic officer in my province, an epidemiologist, is all about minimising deaths, and he is still of the view that only herd immunity will protect the seriously at risk. So the concern is that in those sorts of populations, the people with that kind of elevated risk need to basically completely remain isolated for quite a long time. It's not a moral failing to take what seems to be the medical consensus seriously. If you disagree that it's correct, that's a disagreement about the behaviour of the virus, but it's not because you care about people and others are somehow willing to sacrifice them. Given that none of us here are really in a position to argue the medical question at a deep level, it's a bit strange to see people who are otherwise generally pro-science saying that it is wrong to listen to their assessment. People who are "agitating for back to normal" in most places are not the American protestors of the last weeks who have been on the news, who have been significantly overplayed by the media - their numbers are tiny, and outside of the US they are basically completely irrelevant. They are mainly people concerned with movement restrictions, worried about the survival of small business, how crops are going to get picked. People with parents who they cannot see and who they are no longer even allowed to go to the windows of their rooms to wave to, and who are worried because the homes are short staffed and conditions are deteriorating. Or just people who want some sort of indication how governments are making the decisions to lift restrictions as time goes on. Which goes back to the OPs question - are people now thinking that the governments strategy to flatten the curve is something else? Clearly from this thread, a lot of people think so, because government strategy in Europe, the US, the UK, and Canada remains flatten the curve until there is herd immunity, and a lot of people are arguing that it shouldn't be.
  19. Yes, I think it is security theatre. It's not going to prevent transmission in any meaningful way. It's probably not adding any work though, at least. Some things seem pointless but create more work or stress. One of the grocery stores near me keeps changing their bag policy, so it seems like I've either brought my bags and can't use them, or I've not brought them and have to buy more when I already too many at home .
  20. I'm not sure at this point what your real objection is to what I've been saying. I don't care if people's risk is elevated for reasons beyond their control or because they make an informed and completely free decision to smoke and drink and eat whipped cream all day. I do care that there are elderly people in homes who have been locked in for weeks and who can't come out, or see their relatives, even if they are dying, and that is how it will be until there is no more COVID around. Which will also be better for people who are high risk but aren't in a position to totally isolate, or who don't want to do so. You said you don't particularly think a vaccine is forthcoming, so what option is there for the first group other than to stay locked up? Or the second other than wait until they get it, even if it takes a year? Even if we keep up with social isolation to some degree in the long term, we'll have to see many or most go back to work, and kids go back to school. The virus is still spreading now, with current measures in place, and it will spread more once they are relaxed. Those at risk will still be at risk, having to be locked in.
  21. I think there are a few issues here, but the main thing is I think you are looking for a solution that doesn't exist. Yes, it would be nice if we could keep people with more risk safe and so they would be protected while keeping the virus from spreading and letting people go on about their essential business. The question is, is that possible at all medically, is it possible from a behavioural perspective, and what would be the trade offs of doing that? It's possible that the answer is no, no, or the trade offs are worse than what they are preventing. Someone having more risk is also not really the same as high risk. People who are obese, or men, or possibly people who are black, have a higher risk. There probably isn't a lot we can do to level that, they are a result of having different physiological factors, populations always include a profile of people with different risk levels, unhealthy populations will have more. People that are immunocompromised or very elderly are high risk at another level that goes beyond normal risk differences in the population. There probably isn't a hard line between these two groups but when doctors talk about trying to shield the most vulnerable, it's really the second group they are talking about. But protecting those people is not just about people avoiding crowds, social isolating, etc. Those things are not meant to stop the spread, because they won't. They will only slow it, people who are moving about in the world will still almost certainly eventually be exposed as long as the virus is in the population. The really vulnerable, if they want to be protected, have to take much more extreme measures - they really can't go to work, see anyone outside their household, they need to practice social isolation from others in their own household unless they too are completely socially isolated. So potentially not sleeping with their spouse, touching their own small kids. That's the kind of situation that isn't sustainable for any significant amount of time. I have an aunt in that position now. Under normal circumstances her life largely revolves around her apartment, she gets out on her scooter somewhat and she attends NA meetings three times a week which is her main social life. She has no spouse, roommate, or kids. She has the VoN in to cook for her, and help her bathe, and deal with her urostomy. Now, she can't go out and there are no NA meetings, and she can't have anyone in. Her VoN nurse is a risk she'd have to take except that she can't get one regularly as they have become seriously short staffed. So she has to manage with fewer visits as best she can. No one should have to live like that long, and she probably can't though I don't know where she's go. It's not impossible she will have a fall or otherwise deteriorate as a result of the situation. The only way for people like her to get out, unless she chooses to take risks, is when the virus is no longer moving in the population. And barring a few places where they can totally control movement into the country on a long term basis, and maybe not even then, reducing transmission alone won't accomplish that, only vaccination or immunity. Or at least that's the view of many epidemiologists. Vaccination may or may not happen, so that leaves immunity. So how long should people like my aunt have to isolate completely to wait for that? The longer we draw out the time to immunity, the longer they wait. No one wants to overwhelm health services, but stretching things out more, for unsure benefits, that has a significant human costs. And that's even with ignoring things like predictions around issues with agriculture and such.
  22. The poster I was quoting mentioned people with hypertension several times, presumably as a typical example of people at high risk. I find the continued claim that the course of action recommended as best for at risk people by many epidemiologists is actually about people being selfish pretty dismissive.
  23. The cashiers might not want the hassle of arguing with people. A lot of the cashiers I've seen the last few times I've shopped seem pretty stressed out and the customers are touchy as well. It's mostly only disadvantageous to the people who lift the bag so they may think, well, if that's what they want to do...
  24. Sure, you could attempt to stretch it out longer in order to achieve some of those things, though it's a bit of a crap-shoot for most of them. That's not without balancing considerations however. While you are doing that people in care homes or prisons or in hospitals are unable to see their families, or leave their institutions. Kids or wives in neglectful or abusive households are struggling, people living in poverty are struggling, people like my aunt who is an addict and at high risk has mental health issues are struggling, health care workers are having to isolate themselves from their kids and spouses, and even forgetting about "the economy" as such which I don't really give a fig for, we have to figure out how to get enough food grown for everyone (should we conscript locals to live in close quarters or ship in foreign workes as usual and risk their health?) and oh, world starvation is looking to double. I'm really finding this implication that those of us who are suggesting a entirely reasonable view held by many epidemiologist are just asshats who don't care about people with hypertension really, really grating.
  25. But no one is talking about deliberately exposing people, any more than we deliberately expose people to colds. People will be exposed going about their lives. I am in zero doubt that I will get it in the next year, probably the next six months. Health care workers will almost certainly get it sooner. That's just going to happen. In the long term, if you have something like a virus that means regular outbreaks, I think it would look a lot like it did in the past. Probably it would be somewhat cyclical, and we'd have to institute regular testing of people coming in with relevant symptoms. When it started to appear you'd have infected individuals in strict isolation, contact tracing, and ramping back other activities until it dies down. I daresay it would be ball games and concerts closed down but not shops and schools if was a yearly thing, but mostly people would choose to be careful. Capitalism would cope though the US would need to think seriously about their social services. And people would get used COVID being on a lot of death certificates along with the other big killers. I don't know - there's never been a reason to think that we won't again have diseases like that as we had in the past. That's always a possibility.
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