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Is the goal FLATTEN THE CURVE or ELIMINATE COVID?


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re what "social distancing" and the pro/con arguments looked like in 1917-18:

3 hours ago, Bootsie said:

This is an interesting historical collection of news surrounding the Spanish flu http://www.influenzaarchive.org/about.html.  

You can search for key words and find articles, for example on closing of churches, or bars, or pool halls, or schools, and see what people's reactions and arguments were at that time.  It is amazing how much the discourse was 100 years ago to what it is today.  There are also summaries by city, which can be interesting to see what was playing at your local theater, or what the board of health was doing, perhaps how even your local church was responding in the time of that crisis.

 

My rabbi did a whole adult ed workshop on this very subject a couple weeks ago, drawing some of those same archives. It was *fascinating.*

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13 hours ago, Ausmumof3 said:

I have missed some of this thread but which epidemiologists are advocating faster spread and herd immunity?  All the ones I’ve seen are advocating social distancing as long as possible.  The UK were going to do the herd immunity model then did the math and realised the health system would be overwhelmed rapidly.  

 

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.

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1 minute ago, Bluegoat said:

 

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.

The issue with the herd immunity theory is we don’t know if we actually get immunity and how long it lasts.  I understand the theory.  We may potentially have the issue of suppressing too well here and accidentally eliminating.  Economists don’t like that idea because it means long term border closures or quarantine to whatever.

 

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7 hours ago, kand said:

Well first, semantics matter, and no one in the US is “locked in”.  If an elderly or high risk person wants to go chat at the feed store, it’s clear no one is stopping them. If they want to walk around the block for exercise or go buy groceries, that’s legal in all states as far as I know. Second, I’m seeing multiple people use their at risk relatives who can’t leave their houses as evidence of why the shut downs are the wrong approach and instead at risk people should protect themselves while the rest of  society goes back to something closer to normal. That doesn’t make sense. Other at risk people will need to stay home and protect themselves as they see fit so the at risk elderly loved ones of people on this thread can finally go out? That’s how I’m reading a number of these posts, and I don’t understand the argument. 

 

 

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.

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8 hours ago, kand said:

Well first, semantics matter, and no one in the US is “locked in”.  If an elderly or high risk person wants to go chat at the feed store, it’s clear no one is stopping them. If they want to walk around the block for exercise or go buy groceries, that’s legal in all states as far as I know. Second, I’m seeing multiple people use their at risk relatives who can’t leave their houses as evidence of why the shut downs are the wrong approach and instead at risk people should protect themselves while the rest of  society goes back to something closer to normal. That doesn’t make sense. Other at risk people will need to stay home and protect themselves as they see fit so the at risk elderly loved ones of people on this thread can finally go out? That’s how I’m reading a number of these posts, and I don’t understand the argument. 

I don’t believe liquor stores are open because alcohol is soothing to some people, but because alcoholics going through physical detox cold turkey will use up medical resources. I don’t know if that’s really true, but that’s the argument I hear. I don’t drink at all, so I have zero interest in them being open, personally. I agree that church serves a very real and valuable purpose for people. That doesn’t necessarily mean there’s going to be a safe way to do it yet though. Wanting it isn’t a valid reason to open a church if there’s no way to do it safely. I do think drive in services should be something that can work many places with a lot of space. Likely not going to work in the city, though. 

Right. And I don’t even think that’s possible. Exponential growth means there’s not a way to get to herd immunity quickly without overwhelming the hospitals. It would make what we’ve seen so far look like the calm before the storm. The only way to not overwhelm hospitals is to take this slowly. Sucks, but it’s the nature of the beast. We can’t dictate how it should go.  The models I see of the ideal way to approach this do not actually end up with the same number getting it either way, and the mortality numbers in particular are much different depending on how quickly it spreads. 

 

Agree with your comments. 

8 hours ago, kand said:

Well, surely a few months of online or other alternative church experience is not going to make as big a difference in mortality as having churches meeting right now, resulting in large numbers of people contracting the virus and many inevitably dying from it. I saw a study earlier today on years of life lost due to covid19, and the number of years lost on average Is far greater than the years lost from a period of time with interrupted church attendance could possibly be. It’s not plausible that people would take ten years off their life due to missing church in person for a few months. I say that as a weekly church attender. 

 

Also I know people who are at risk of getting and thus also spreading a respiratory illness who if churches are open feel that they must go unless literally too sick to get there.  But if closed, then they feel they have a dispensation or legitimate justification not to go.  And this would not apply in the same way to feeling like they have an obligation to go to a bowling alley or even to personally go to a grocery store.  Allowing someone else to shop for some people is acceptable, but not going to an open church is a sin (whether or not that is a relevant term in the particular religion) for many believers.  

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The issue with the herd immunity theory is we don’t know if we actually get immunity and how long it lasts.  I understand the theory.  We may potentially have the issue of suppressing too well here and accidentally eliminating.  Economists don’t like that idea because it means long term border closures or quarantine to whatever.

 

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.

Edited by Bluegoat
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11 minutes ago, Bluegoat said:

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.

Really glad to see you're back, Bluegoat.

This part of your post seems to sum up the issue well, to me. I've been so frustrated with the idea that there can only be two extremes--long-term shut down of virtually everything and damn the consequences vs. devil-may-care-open-it-all-up-right-now and damn the consequences. Most people don't think like that. I believe that most people (including those who think the shutdown is not sustainable as an ongoing thing) DO, in fact, understand that what's normal will need to be different in the future because the question of how to protect the most vulnerable long-term is important.  And vulnerable covers a whole lot of problems and a whole lot people.

This whole discussion reminds me of every other thread where if you're not in lock-step then it's clearly because you're stupid and/or hate (insert group of people du jour).

Crawling back under my rock now...

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24 minutes ago, Pen said:

 

Agree with your comments. 

 

Also I know people who are at risk of getting and thus also spreading a respiratory illness who if churches are open feel that they must go unless literally too sick to get there.  But if closed, then they feel they have a dispensation or legitimate justification not to go.  And this would not apply in the same way to feeling like they have an obligation to go to a bowling alley or even to personally go to a grocery store.  Allowing someone else to shop for some people is acceptable, but not going to an open church is a sin (whether or not that is a relevant term in the particular religion) for many believers.  

So are you saying churches should remain closed because on individuals from specific faith traditions who feel they can't opt out? Churches should be under stricter restrictions than something like a bowling alley because people might feel obligated to go to church? 

Again, I'm talking about services that are appropriately distanced, not just church as usual.

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50 minutes ago, Bluegoat said:

 

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.

Ok, so do you not see value in trying to slow spread or minimize it until we have a better understandinf of the biology of the virus? How it is spreading, how best to treat people, how to test for it (current tests are only 70 percent accurate and in many places it takes a week to get results - by then can be too late), knowledge on if treating earlier has any benefit, etc etc etc?

And if you think it is better to get it over faster, and get more people infected more quickly, would that mean you do not think people wearing masks in public, washing hands frequently, curbside pick up and delivery instead where possible, etc is a good idea? Would you advocate for not wearing masks and dropping precautions, so that we can have people catch it faster?

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2 hours ago, EmseB said:

To the original question, here is a public health official in VA saying that business closings (part of Phase 1) will last until they get treatment or vaccine, or around 2 years. But the timing to even go into phase one is still 2 weeks away at least.

https://www.richmond.com/news/virginia/we-cannot-and-will-not-lift-restrictions-like-one-turns-on-a-light-switch-northam/article_cac6c890-386e-5481-b413-98787b12f685.amp.html?__twitter_impression=true

The Twitter thread where I found this: https://mobile.twitter.com/MelLeonor_/status/1253808850777620480

This article has been updated to say that Phase 1 will not actually last two years, or until a treatment or vaccine is available.

https://www.richmond.com/news/virginia/update-governors-office-says-phase-one-of-reopening-virginia-will-not-last-for-two-years/article_434516e1-9f6e-51f5-b30d-d328870cc8bc.html

 

 

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2 minutes ago, Innisfree said:

This article has been updated to say that Phase 1 will not actually last two years, or until a treatment or vaccine is available.

https://www.richmond.com/news/virginia/update-governors-office-says-phase-one-of-reopening-virginia-will-not-last-for-two-years/article_434516e1-9f6e-51f5-b30d-d328870cc8bc.html

 

 

I saw that just now. Kind of hilarious given what the guy actually said, but I do see the need for the governor's office to walk it way back.

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1 minute ago, mms said:

I don’t know what Bluegoat thinks but it seems to me that the rate of infection should be only controlled to the extent that medical facilities are not over taxed. What you are saying here is what the OP was concerned about: moving the goal post. And as a higher risk individual with most of my family high risk too, I cannot imagine asking society to pay the high human cost of learning more about virus biology. Moving in a rational manner to not overwhelm the system, yes, but not for the sake of finding a cure or a vaccine.

And I don’t know about your part of the country but here front line grocery store workers are elderly or in some other way high risk (lots of obesity and heart problems in this area). So, while well off (in the sense that they know about healthy food and can afford a gym membership) healthy people shelter in place till we learn more about the virus, the at risk are delivering their groceries.
 

I don't mean a cure - I mean better treatment, better understanding of how it spread, etc. For example, everyone talks about trying to protect the most vulnerable while opening up, but we can't really do that if we don't have a good grasp on how it spreads best. If we can figure that out, that makes a big difference in deciding which activities, places, etc are riskier than others. And since the at risk depend on the healthy to care for them (doctors, home health aids, grocery delivery, house cleaners, etc) knowing how to have them interact with those people in the safest way would be important. 

Not to mention, I'm back to how on earth do we protect the vulernable if trying to expose and build herd immunity in doctors, home health aids, grocery delivery people, housecleaners, etc?? Wont' those people, if the goal is to expose them, then be spreading it to those they are caring for? 

Same with the grocery store workers you mention. Yes, they are at risk. But they are much less at risk if everyone else is taking precautions to limit spread, wearing masks, staying home, etc compared to if everyone goes back to the stores frequently, and is actively trying to catch the virus and get it over with. To catch it they will be NOT wearing masks, and then spreading it before they develop symptoms to those who do NOT want to catch it. That seems way riskier to that elderly grocery worker you mention - full store of people without masks who are hoping to catch the disease and continuing to go out once they do - compared to stores with limits on number of people, everyone in masks, social distancing, etc.  

Am I missing something?

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5 minutes ago, Ktgrok said:

I don't mean a cure - I mean better treatment, better understanding of how it spread, etc. For example, everyone talks about trying to protect the most vulnerable while opening up, but we can't really do that if we don't have a good grasp on how it spreads best. If we can figure that out, that makes a big difference in deciding which activities, places, etc are riskier than others. And since the at risk depend on the healthy to care for them (doctors, home health aids, grocery delivery, house cleaners, etc) knowing how to have them interact with those people in the safest way would be important. 

Not to mention, I'm back to how on earth do we protect the vulernable if trying to expose and build herd immunity in doctors, home health aids, grocery delivery people, housecleaners, etc?? Wont' those people, if the goal is to expose them, then be spreading it to those they are caring for? 

Same with the grocery store workers you mention. Yes, they are at risk. But they are much less at risk if everyone else is taking precautions to limit spread, wearing masks, staying home, etc compared to if everyone goes back to the stores frequently, and is actively trying to catch the virus and get it over with. To catch it they will be NOT wearing masks, and then spreading it before they develop symptoms to those who do NOT want to catch it. That seems way riskier to that elderly grocery worker you mention - full store of people without masks who are hoping to catch the disease and continuing to go out once they do - compared to stores with limits on number of people, everyone in masks, social distancing, etc.  

Am I missing something?

You're missing how long it actually takes to build up that knowledge base and do those studies.

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2 hours ago, Ausmumof3 said:

The issue with the herd immunity theory is we don’t know if we actually get immunity and how long it lasts.  I understand the theory.  We may potentially have the issue of suppressing too well here and accidentally eliminating.  Economists don’t like that idea because it means long term border closures or quarantine to whatever.

 

If you can’t count on herd immunity then what is the point of waiting for a vaccine?  Isn’t the theory that vaccines should provide herd immunity?  Also, even if if covid doesn’t turn out to be a one time deal like say chicken pox, at some point it is no longer “novel” and our bodies should have some means to know how to deal with it.

Edited by Mom2mthj
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9 minutes ago, rebcoola said:

We're churches specifically called out to shutodwn in some places?  My I thought they were just covered in the various stages of no groups larger than x.  I assumed it would be the same on our way back up the steps.

They are, but obviously exceptions are made to that rule based on what cities and states deem as essential. So the legal issue is exempting a business from the gathering limit so they can allow, say, 25% max occupancy in their building while enforcing physical distance and masking requirements, but a church would not be allowed to open under those same parameters because they would not get the same exemption to the gathering rule.

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It was never only about flattening the curve. Not overwhelming our medical professionals includes adequate PPE and I'm pretty sure most places are still struggling there and that's with so much shut down. I honestly don't understand opening back up until we can make sure those we count on to treat us are protected. 

ETA: This week alone I've read at least two stories of first responders losing their children to this virus. We're not doing enough to protect them yet.

Edited by Joker
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1 hour ago, Ktgrok said:

Ok, so do you not see value in trying to slow spread or minimize it until we have a better understandinf of the biology of the virus? How it is spreading, how best to treat people, how to test for it (current tests are only 70 percent accurate and in many places it takes a week to get results - by then can be too late), knowledge on if treating earlier has any benefit, etc etc etc?

And if you think it is better to get it over faster, and get more people infected more quickly, would that mean you do not think people wearing masks in public, washing hands frequently, curbside pick up and delivery instead where possible, etc is a good idea? Would you advocate for not wearing masks and dropping precautions, so that we can have people catch it faster?

 

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.  

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1 hour ago, kand said:

Perhaps this is a misunderstanding then, because I’m not advocating for us to stay in this current level of shutdown, nor do I believe many other people are. I’m advocating for following the plans layed out in many models now of careful, phased openings with testing and tracing and all of that, to minimize new spikes after this initial phase is under control. What I’m objecting to is the idea of taking the fastest path to herd immunity being a viable option. I have given the reasons I disagree in several posts above. 

 

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.

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38 minutes ago, mms said:

Unfortunately I only have a minute and cannot respond to your other points but in my mind there is a distinction between actively trying to catch something and resigning one self to the idea that in the process of going about one’s business one gets sick. The later is the principle of double effect. People were told that they were making these sacrifices for the sake of not overwhelming the system. Most rose to the occasion and it would be breaking trust to expect them to continue complying with those measures once the curve has been flattened to the point where everyone who needs care can get it.  I do know some people who are actively trying to catch it, but they are a tiny minority. Most people, I imagine, just want to go back to work and school and church and are willing to be exposed to the virus in the process.

 

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.

29 minutes ago, Joker said:

It was never only about flattening the curve. Not overwhelming our medical professionals includes adequate PPE and I'm pretty sure most places are still struggling there and that's with so much shut down. I honestly don't understand opening back up until we can make sure those we count on to treat us are protected. 

ETA: This week alone I've read at least two stories of first responders losing their children to this virus. We're not doing enough to protect them yet.

 

Having enough PPE is part of medical services not being overwhelmed.

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18 minutes ago, Danae said:

 

The problem is still exponential growth.  As long as the number of new cases per day is going up the health system will eventually be overwhelmed. So far most areas have just postponed that, not prevented it. 

I'm in Minnesota.  When Governor Walz announced the shutdown in mid-March he said it was already too late to flatten the curve, the goal of the shutdown was to delay the peak while building up ICU capacity, including emergency hospitals in stadiums.  At that point we were on a 2-day doubling curve.  We've pushed that to 12 days and right now we're only using 50% of our original available ICU beds. That sounds wonderful!  But on our current rate of new cases that means we hit our original ICU capacity in 18 days. (The ICU in use doubling is at 18 days, because of the people who either recover or die.)  I haven't been able to find out how many beds we've been able to add, but if we doubled that still means we hit capacity in 36 days at our current growth rate. Sooner if the rate increases.  

 

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.

Edited by Bluegoat
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12 hours ago, Frances said:

But we’re talking attendance over a long period of time. Surely missing a few months is not much in the grand scheme of things. It’s not as though the health benefits drop off immediately. And I’m sure some parts of the benefits still remain even when not attending in person.

This may depend on the age and life situation of the individual.  For older people, church is a much bigger proportion of their social life, and also it is more relevant spiritually as they get into their later years.  I'm very thankful for online church, but it definitely doesn't take the place of in person church.  For one thing, a lot of people take communion very seriously, and that isn't happening.  I have noticed about twice as many people attend communion services than non-communion services in my church.  It matters.

Again, I'm not saying open up TODAY, I'm saying people should not be dismissive of the importance of church (or other communal worship) to many people.

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3 hours ago, EmseB said:

So are you saying churches should remain closed because on individuals from specific faith traditions who feel they can't opt out? Churches should be under stricter restrictions than something like a bowling alley because people might feel obligated to go to church? 

Again, I'm talking about services that are appropriately distanced, not just church as usual.

 

 I am hopeful that most churches will gradually figure out safer ways to do things.

 And that the people going to them will.

more distance

masks

perhaps no singing for some time if that’s an issue

no social hugs and kisses... 

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20 hours ago, frogger said:

Well, even though restaurants are allowed to have dine in up here with the limitations and sanitation most from what I can see are sticking with just pick up and delivery. Maybe not. I haven't seen a comprehensive list but even those who don't care about safety (some do) they realize they will lose pick up customers by allowing the dine in customers. 

I think you're right. Many restaurants in my area had gone to pick up and delivery only even before our governor gave the stay at home order. I have a feeling that if he opens the state back up many will continue to do so at least for a while.  

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11 minutes ago, SKL said:

This may depend on the age and life situation of the individual.  For older people, church is a much bigger proportion of their social life, and also it is more relevant spiritually as they get into their later years.  I'm very thankful for online church, but it definitely doesn't take the place of in person church.  For one thing, a lot of people take communion very seriously, and that isn't happening.  I have noticed about twice as many people attend communion services than non-communion services in my church.  It matters.

Again, I'm not saying open up TODAY, I'm saying people should not be dismissive of the importance of church (or other communal worship) to many people.

My mom is a elderly person for whom church has always been very important. And communion is integral to the Catholic faith. but as I mentioned above, she frequently can’t attend mass due to serious health issues, so watches on TV. She still talks regularly to her church friends. her faith is as strong as ever. she watches mass, prays, and says the rosary daily. sure, she would rather attend in person, but that frequently hasn’t been an option at various times in her life. I certainly am not dismissive of the importance of church inner life, but I also don’t think the long term health benefits of church you cited above have disappeared for her in the last month or will disappear for her if she can’t attend for awhile. Most elderly people I know are coping quite well because they have already weathered so many challenges in their lives. I actually find them quite inspiring.

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1 hour ago, mms said:

Unfortunately I only have a minute and cannot respond to your other points but in my mind there is a distinction between actively trying to catch something and resigning one self to the idea that in the process of going about one’s business one gets sick.

Ok, but where does social distancing, mask wearing, having easy access to hand sanitizer, working from home, etc fit into that spectrum? I'm truly not getting if people are suggesting we stop wearing masks, stop doing social distancing, etc or?

25 minutes ago, Bluegoat said:

 

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.

Is that really true? Are those who are staying home, using contactless delivery for groceries or shopping with social distancing and mask wearing, disinfecting what comes into the house or leaving it outside for the appropriate period of time, etc still"likely" to catch it ? If so, what happens to the idea of protecting the most vulnerable - if those are the things we want them to do?

19 minutes ago, SKL said:

This may depend on the age and life situation of the individual.  For older people, church is a much bigger proportion of their social life, and also it is more relevant spiritually as they get into their later years.  I'm very thankful for online church, but it definitely doesn't take the place of in person church.  For one thing, a lot of people take communion very seriously, and that isn't happening.  I have noticed about twice as many people attend communion services than non-communion services in my church.  It matters.

Again, I'm not saying open up TODAY, I'm saying people should not be dismissive of the importance of church (or other communal worship) to many people.

I don't think those saying church needs to wait are being dismissive of the importance of church. 

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1 hour ago, rebcoola said:

We're churches specifically called out to shutodwn in some places?  My I thought they were just covered in the various stages of no groups larger than x.  I assumed it would be the same on our way back up the steps.

 

Afaik, that is true for USA.  

Other parts of world have done things differently. For example, Saudi Arabia, iirc, very specifically shut down religious worship sites that attract pilgrims from all over the world. 

I have no idea about Canada approach, or many other places. 

 

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1 hour ago, Joker said:

ETA: This week alone I've read at least two stories of first responders losing their children to this virus. We're not doing enough to protect them yet.

 

? 2 dead children this week? I haven’t seen that. Or adult children? 

 

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12 minutes ago, Ktgrok said:

Is that really true? Are those who are staying home, using contactless delivery for groceries or shopping with social distancing and mask wearing, disinfecting what comes into the house or leaving it outside for the appropriate period of time, etc still"likely" to catch it ? If so, what happens to the idea of protecting the most vulnerable - if those are the things we want them to do?

I would like to know this also.

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49 minutes ago, Bluegoat said:

 

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.  

 

Quote

People modelling how the common cold behaves are also going to count on everyone getting it eventually because that's just realistic.  

 

Analogy of CV19 to common cold seems even even more troubling than to ordinary yearly influenza. 

 

 

Quote

 

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.

 

Same as you cautioned people that USA is not whole world, neither is your local area.  It is really interesting to hear what is going on in other places, and I am sort of shocked that Canadians would be treating health care workers badly .  But your experience is not a given.   Where I am there have been no reports of problems for health care workers with housing, and public schools are providing day care for children of essential workers—with longer time and extending to pre school aged children who would not normally be at school. 

Obviously what is happening where I am no more applies to where you are than vice versa.

But I’d like to see better strategies from one place get adopted by another — instead of a race for bottom. 

Quote

Having enough PPE is part of medical services not being overwhelmed.

 

I agree.  

I wonder if returning to some washable gowns etc would be helpful. Gowns, scrubs, overwear... for the staff...     

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18 minutes ago, Ktgrok said:

Ok, but where does social distancing, mask wearing, having easy access to hand sanitizer, working from home, etc fit into that spectrum? I'm truly not getting if people are suggesting we stop wearing masks, stop doing social distancing, etc or?

Is that really true? Are those who are staying home, using contactless delivery for groceries or shopping with social distancing and mask wearing, disinfecting what comes into the house or leaving it outside for the appropriate period of time, etc still"likely" to catch it ? If so, what happens to the idea of protecting the most vulnerable - if those are the things we want them to do?

I don't think those saying church needs to wait are being dismissive of the importance of church. 

 

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.)

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7 minutes ago, Pen said:

 

 

Analogy of CV19 to common cold seems even even more troubling than to ordinary yearly influenza. 

 

 

 

Same as you cautioned people that USA is not whole world, neither is your local area.  It is really interesting to hear what is going on in other places, and I am sort of shocked that Canadians would be treating health care workers badly .  But your experience is not a given.   Where I am there have been no reports of problems for health care workers with housing, and public schools are providing day care for children of essential workers—with longer time and extending to pre school aged children who would not normally be at school. 

Obviously what is happening where I am no more applies to where you are than vice versa.

But I’d like to see better strategies from one place get adopted by another — instead of a race for bottom. 

 

I agree.  

I wonder if returning to some washable gowns etc would be helpful. Gowns, scrubs, overwear... for the staff...     

 

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.

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53 minutes ago, Bluegoat said:

 

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.

I see your point. This is so much more difficult given the current 'climate' in the world (in the US specifically). Flattening the curve to not overwhelm our healthcare system with a goal of herd immunity requires trust in our institutions, news media, and each other. 

A goal of herd immunity requires the majority of us to go into the world assuming that we'll get it and will be fine. That means that we must trust those (who?) telling us that having COVID will neither kill us nor cause long term complications that might shorten our lives. That's difficult for many of us in the US because we've received such bad information during this crisis from our government and the media. Who do we trust? 

I know that my personal risk is low. I know my daughter's risk is almost zero. My husband is higher risk because he's male and had a very serious case of pneumonia as a child. But his risk is still probably relatively low. Even though I'm relatively sure that our risk is low, I think I'm a bit skeptical because I can't forget everyone who assured me that this was "just like the flu." And most of these people didn't understand that the flu is actually serious and kills people. 

I'm sure some people struggle with the same skepticism based on the models. I didn't pay that much attention to the reporting about the models so I don't know how they were explained. I know that the media generally does a pretty bad job of reporting on medicine and science. Look at heart disease. One day we see a news article with a headline claiming that we should become vegan because of X and Y study. The new day there's a different article claiming that doctors say we should not eat grains because of A and B study. Who do you trust? 

This is not simple to understand and most of us must rely on someone else to interpret the data for us. Who do we trust? That's a partisan decision in the USA. 

We also come to this with preconceived notions. If you want everything to go back to normal, I think you're probably more likely to believe the risk is low because you need to believe that. 

This is the perfect storm for the world today and particularly for the US. It highlights every crack in our system. 

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9 minutes ago, Bluegoat said:

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.

80% of the US population is over 260 million people. Even if we somehow manage to "protect the most vulnerable" and bring the fatality rate down to 0.75%, that's 2 million deaths. Even if we could somehow manage to spread out those deaths evenly throughout an entire year (which of course is impossible), that's 5,500 deaths PER DAY in the US for an entire year. No matter how much PPE we have, no matter how many ventilators US hospitals have, there is no way the US healthcare system can handle 2 million pandemic deaths in a single year.

Are people who are advocating the "herd immunity ASAP" approach just not doing the math? I am seriously confused as to how people can advocate a "solution" that results in 2 million deaths in a year and think that will not overwhelm the hospitals, destroy the economy, and totally freak people out???

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I am a little perplexed by the church discussion.  Are churches really going to reopen anytime soon, even if groups are legally permitted?  What are more centralized denominations, like the Catholic Church and the LDS Church doing?

I saw a report today that all synagogues in the United States are legally closed, regardless of what the law in their jurisdiction happens to be.  At this point they are staying closed as a matter of Jewish law more than US law.  All synagogues in Israel are closed on the basis of both secular and Jewish law.  There are other synagogues scattered around the world, of course, but I seriously doubt any are open.  

The general assumption among people I know is that synagogues will stay closed for a very long time, possibly until there is a vaccine or at least a major advance in how this virus is controlled/treated.  It is devastating to Jewish communal life, obviously, and I personally find it extremely painful, as do countless others, but I think we're just in one of those periods of Jewish history when we don't get to be together.  At least this time it's because of a general threat and not because we are being persecuted.

 

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3 minutes ago, Corraleno said:

80% of the US population is over 260 million people. Even if we somehow manage to "protect the most vulnerable" and bring the fatality rate down to 0.75%, that's 2 million deaths. Even if we could somehow manage to spread out those deaths evenly throughout an entire year (which of course is impossible), that's 5,500 deaths PER DAY in the US for an entire year. No matter how much PPE we have, no matter how many ventilators US hospitals have, there is no way the US healthcare system can handle 2 million pandemic deaths in a single year.

Are people who are advocating the "herd immunity ASAP" approach just not doing the math? I am seriously confused as to how people can advocate a "solution" that results in 2 million deaths in a year and think that will not overwhelm the hospitals, destroy the economy, and totally freak people out???

 

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.  

 

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4 hours ago, Valley Girl said:

This whole discussion reminds me of every other thread where if you're not in lock-step then it's clearly because you're stupid and/or hate (insert group of people du jour).

Crawling back under my rock now...

It makes me laugh a bit when posters say that in a way that throws fuel on the fire. I’m pretty sure it takes 2 to have those kinds of discussions.

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47 minutes ago, Innisfree said:

I would like to know this also.

 

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.

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22 minutes ago, JennyD said:

I am a little perplexed by the church discussion.  Are churches really going to reopen anytime soon, even if groups are legally permitted?  What are more centralized denominations, like the Catholic Church and the LDS Church doing?

I saw a report today that all synagogues in the United States are legally closed, regardless of what the law in their jurisdiction happens to be.  At this point they are staying closed as a matter of Jewish law more than US law.  All synagogues in Israel are closed on the basis of both secular and Jewish law.  There are other synagogues scattered around the world, of course, but I seriously doubt any are open.  

The general assumption among people I know is that synagogues will stay closed for a very long time, possibly until there is a vaccine or at least a major advance in how this virus is controlled/treated.  It is devastating to Jewish communal life, obviously, and I personally find it extremely painful, as do countless others, but I think we're just in one of those periods of Jewish history when we don't get to be together.  At least this time it's because of a general threat and not because we are being persecuted.

 

 

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.

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14 minutes ago, Bluegoat said:

 

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.  

 

Of course there are options besides the extremes of total quarantine and "let it rip."

It seems that lot of people thought "flattening the curve" was a short-term, one-time thing, and then its back to normal. "Back to normal" will very quickly overwhelm the medical system. The lock down was designed to get things under control before we had bodies piled up in the street, but until there is a vaccine or much better treatments, there is going to be some level of "not normal." No it won't be a total lockdown, businesses will gradually reopen with various measures in place to minimize risk, and people will need to continue a certain level of social distancing, mask wearing, etc.  But the idea that the only "real option" is that we sequester the elderly and let everyone else catch it so we can get to herd immunity ASAP is NOT viable. Two million deaths will cause far more economic disruption — not to mention psychological trauma — than continuing some level of social distancing until we get a vaccine or much better treatment options.

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1 hour ago, Lady Florida. said:

I think you're right. Many restaurants in my area had gone to pick up and delivery only even before our governor gave the stay at home order. I have a feeling that if he opens the state back up many will continue to do so at least for a while.  

Locally, many chefs are deciding to close restaurants than to do takeouts because they fear that their employees and themselves (most of whom do not have good health insurance) will catch this virus and die. A few of them even wrote emails to their customers saying that they are only Chefs and not health experts and that they do not understand how this virus works and that they do not want to risk the lives of their employees by staying open.

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1 hour ago, Corraleno said:

Does anyone know how these children contracted Covid? Was it from their parent? It makes me a bit nervous because I thought that if we were really careful and took good precautions we wouldn’t bring it home from work. I realize that if I contract it at work I can pass it on. Were the parents sick? I couldn’t see that it said those kinds of details in the article.

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32 minutes ago, Ordinary Shoes said:

I see your point. This is so much more difficult given the current 'climate' in the world (in the US specifically). Flattening the curve to not overwhelm our healthcare system with a goal of herd immunity requires trust in our institutions, news media, and each other. 

A goal of herd immunity requires the majority of us to go into the world assuming that we'll get it and will be fine. That means that we must trust those (who?) telling us that having COVID will neither kill us nor cause long term complications that might shorten our lives. That's difficult for many of us in the US because we've received such bad information during this crisis from our government and the media. Who do we trust? 

I know that my personal risk is low. I know my daughter's risk is almost zero. My husband is higher risk because he's male and had a very serious case of pneumonia as a child. But his risk is still probably relatively low. Even though I'm relatively sure that our risk is low, I think I'm a bit skeptical because I can't forget everyone who assured me that this was "just like the flu." And most of these people didn't understand that the flu is actually serious and kills people. 

I'm sure some people struggle with the same skepticism based on the models. I didn't pay that much attention to the reporting about the models so I don't know how they were explained. I know that the media generally does a pretty bad job of reporting on medicine and science. Look at heart disease. One day we see a news article with a headline claiming that we should become vegan because of X and Y study. The new day there's a different article claiming that doctors say we should not eat grains because of A and B study. Who do you trust? 

This is not simple to understand and most of us must rely on someone else to interpret the data for us. Who do we trust? That's a partisan decision in the USA. 

We also come to this with preconceived notions. If you want everything to go back to normal, I think you're probably more likely to believe the risk is low because you need to believe that. 

This is the perfect storm for the world today and particularly for the US. It highlights every crack in our system. 

 

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.

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54 minutes ago, Bluegoat said:

 

 

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.

We are using washable gowns at work but we still have a manageable caseload. Don’t know how it would work if we had more patients.

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