COVID-19 Megathread 5: The Trumps catch COVID-19

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This is such an embarrassment. What the hell is this crap?

https://twitter.com/atrupar/status/1253455713034211328

For anyone who still supports this guy, this is your wake-up call. Look at this. We deserve better than this.

Donald Trump actually predicted that the left-wing media will report him as misconstruing his enthusiasm for the results about UV sunlight and alcohols' effect on the Corona-virus.

It was not that bad if anyone watched the briefing. Donald was asking Dr Birx great questions about how best to use these new results.

The media was very excited about the results and asked a great question about sunlight.

"If sunlight is so great, then should we ask people to go outside more to avoid infection?"

We are not getting any interesting scientific discussion of these new results here. We are getting the "Tweet - I Hate Trump" brigade hijacking the thread daily with their political bent and missing some of the really interesting outcomes that were discussed today.

The effect of summer heat and humidity is worth discussing.

These are not "great questions". These are questions I would expect from an 8-year old who just learned UV-light and disinfectant are used to kill viruses on hospital equipment.

Even if they were great questions about speculative treatments, then a nationally televised press conference is not the place to ask them. It is the place for concrete information. Last time Trump talked about a speculative treatment people who actually needed that drug lost access because idiots inspired by Trump started hoarding (and taking) it. At least this time he didn't skip straight to declaring it a miracle cure. Let's hope that means this time no one will try to self-administer.

[Smeulders]

“The New York Department of Health, for example, made the decision in early April to count deaths in the state that were probably due to COVID-19, but the person was never diagnosed or treated for the disease. The addition raised the national death toll by over 3,700.”

Again, I posit: How can you possibly make any good policy decisions when you have completely inaccurate data. Beyond stupid.

Because... as well as Covid-19 there is another mysterious pneumonia that is killing thousands of New Yorkers that no-one else has picked up on?

This is how Belgium is counting Covid-19 deaths as well (by counting all suspected cases, even without tests). I guess by sheer coincidence our Covid deaths match excess deaths almost perfectly.

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https://twitter.com/NateSilver538/status/1254825274786668546

Good news.

I don’t really see how this can be interpreted as evidence the lockdowns are working.  It’s seems just as likely to me that this is an inevitable consequence of approaching herd immunity, with about 25% of NYC’s population already infected.

Let me get this straight. You are doubting that keeping people away from one another reduces the transmission of the virus? What mechanism of transmission do you think the virus has, that apparently doesn't need physical access to new hosts?

You are right that immunity does reduce transmission. But again I am curious by what mechanism 25% immune managed to reduce transmission by more than 50%.

Your herd immunity, not distancing hypothesis also fails to account completely for the mass of other countries that managed to push R below 1 without the massive rate of infected NY has.

It's clear you are refusing to understand very simple things because of your dislike of lockdowns. Be intellectually honest, argue the lockdowns should end despite their advantages.

[Smeulders]

Looking at the current trends in cases per day, testing, and positivity rates, I think 10-12 States can probably safely begin reopening. Ironically, many of the States that should reopen aren’t while the ones that are reopening shouldn’t.

Whether re-opening makes sense only depends on current case numbers to a small degree. What matters is whether states and countries have a plan to keep R below 1 after the re-opening. Less cases helps, as it makes contact tracing more feasible. Opening with a low numbers of cases, but insufficient ability to test and quarantine just means you start a countdown clock to the next lockdown.

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The real number of COVID deaths in the US is probably much higher already, 130.000 to 150.000 - if you factor in people dying at home.

Those people are not showing up in the daily hospital and nursing home statistics.

Not likely.

Doctors are complaining  in hospitals of deaths due to other causes being reported as Corona-virus, that is every mortality regardless when co-morbidity is the major cause.

There are not 90,000 corpses sitting in homes around the USA......I hope.

Based on my numerical observations, Germany and the US datasets are reasonably clean.

You seem to be going too much in the other direction. Especially your comment implying Covid deaths are being overestimated due to misattribution. Excess death analysis suggests that, like almost every other country in the world, the US is undercounting. See for example https://www.nytimes.com/interactive/2020/04/28/us/coronavirus-death-toll-total.html, which found a gap of 9000 between Covid-19 deaths and excess deaths in just 7 (admittedly hard-hit) states between March 8 and April 11. Lots of caveats everywhere of course. Not all excess deaths are necessarily Covid deaths (especially in NY, where the health care system was stressed to breaking point leading to additional non-Covid deaths). Additionally, some of those states have added backlog to their Covid-deaths tally, removing some of that undercount. On the other hand, the states in this set acknowledge the scale of the pandemic. The rate of undercount in "head in the sand" states is not likely to be smaller. Too early to estimate a total number, but very unlikely that there is an underestimation by half, like Tender Branson suggests, nor is it likely that the current US count is accurate.

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On a different note, here is some xkcd.

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Now they are saying we may be dealing with this for several more years. Are we still planning to shut the economy down into the mid 2020s now?

And after that I bet we will shut the economy down every winter due to seasonal cold and flu until 2030 when we are all required to wear hazmat suits everywhere.

We're not. We'll figure out a way to minimize risks and get back to our social and economic lives. Probably not in the exact same way as before, but a lot better than the current situation. Right now we need some time to study the virus and prepare for post lockdown management of the pandemic. Please don't think that "we need lockdowns now" and "the virus is not going away" means "we need lockdowns in perpetuity".

[Smeulders]

On a different note, here is some xkcd.

Hopefully I haven't been playing too much armchair epi on here.  Hell, I've been extremely hesitant and unwilling to give even common-sense medical advice. 

To me the point of the comic is that some armchairing is not a bad thing. In fact, it's completely human that we try to think and reason about this even if we're not experts... As long as we understand that we know less than people who've studied this their whole lives and probably shouldn't confidently promote the first thing that pops into our heads as THE SOLUTION TO EVERYTHING.

[Smeulders]

Now they are saying we may be dealing with this for several more years. Are we still planning to shut the economy down into the mid 2020s now?

And after that I bet we will shut the economy down every winter due to seasonal cold and flu until 2030 when we are all required to wear hazmat suits everywhere.

We're not. We'll figure out a way to minimize risks and get back to our social and economic lives. Probably not in the exact same way as before, but a lot better than the current situation. Right now we need some time to study the virus and prepare for post lockdown management of the pandemic. Please don't think that "we need lockdowns now" and "the virus is not going away" means "we need lockdowns in perpetuity".

I am opposed to all the states reopening up next week. But right now it is like we have no plan on what to do to reopen the economy effectively.

Only thing I see is people proposing indefinite debt.

Yes, it seems the US had no decent plan at the federal level, and isn't really making one. Luckily some states seem to be picking up the slack.

[Smeulders]

2nd highest number of cases today.

Deaths are down some though.

The new case numbers are not very important.  Since we are only identifying a small fraction of actual infections, this is mostly a function of testing, and we had a record number of new tests today.

Deaths are a much more important stat, especially deaths outside of New York, since the decline in NYC can be attributed to progress toward herd immunity.

We are not trying to get herd immunity through infections! I am not sure why you keep repeating this line. Any effort to accomplish herd immunity would be hugely destructive even if we could somehow limit infection just to people we suspect are more resilient. We are trying to stall transmission until there's a vaccine so we don't overwhelm hospitals. That's it.

The decline in New-York-City-area deaths, which you are attributing to herd immunity, also just so happens to coincide with a massive and successful lockdown. Are you saying that's a coincidence? What do you think the true death rate of this disease actually is?

New York City has had a similar lockdown to almost every other major metropolitan area in the country.  And yet they are seeing steep declines in cases and deaths while other cities are seeing continued increases.

I think over the past two weeks we have established a much better understanding of the true death rate of the virus through the serology studies.  The consensus estimate is around 0.6%.

(Also, the post of mine you quoted doesn’t say anything about trying to accomplish herd immunity through infection, so I’m not sure why you say I keep repeating it.)

Some days ago you made a similar point, that lockdowns don't work and progress in NYC is due to the large number of immune people slowing down spread. I asked you the following questions then, in a post you either missed or ignored. Given that you're still beating on the same drum, I'm just going to copy paste that post. I hope you think about the answers this time.

Let me get this straight. You are doubting that keeping people away from one another reduces the transmission of the virus? What mechanism of transmission do you think the virus has, that apparently doesn't need physical access to new hosts?

You are right that immunity does reduce transmission. But again I am curious by what mechanism 25% immune managed to reduce transmission by more than 50%.

Your herd immunity, not distancing hypothesis also fails to account completely for the mass of other countries that managed to push R below 1 without the massive rate of infected NY has.

[Smeulders]

Some days ago you made a similar point, that lockdowns don't work and progress in NYC is due to the large number of immune people slowing down spread. I asked you the following questions then, in a post you either missed or ignored. Given that you're still beating on the same drum, I'm just going to copy paste that post. I hope you think about the answers this time.

Let me get this straight. You are doubting that keeping people away from one another reduces the transmission of the virus? What mechanism of transmission do you think the virus has, that apparently doesn't need physical access to new hosts?

You are right that immunity does reduce transmission. But again I am curious by what mechanism 25% immune managed to reduce transmission by more than 50%.

Your herd immunity, not distancing hypothesis also fails to account completely for the mass of other countries that managed to push R below 1 without the massive rate of infected NY has.

Ah, OK, I must have missed that.
It is very plausible that a 25% infection rate might reduce transmission by 50%, depending on how fast the transmission is.  It’s basically the same logic behind how a less than 100% infection rate can reduce the virus to 0.

Let’s say the virus has a baseline R0 of 2 (each person infects 2 new people).  If 25% of the population is infected, the virus has an R0 of 1.5 (since 25% of the new people who would have been infected can no longer be infect).

With no one immune (R0=2), a single infected person infects 2 people.  In the next round, those 2 people infect 4 people.  In the next round, those 4 people infect 8 people.  So over 3 infection cycles, 14 new people have been infected for every 1 person infected at the start.

Now with 25% immune (R0=1.5), a since infected person infects 1.5 people.  Those 1.5 people infect 2.25 in the next round, and those 2.25 people infect 3.375 people in the third round.  Some each infected person infects 7.125 people (compared with 14 people when no one is immune).

If you imagine a 5-day infection cycle, a 25% immunity will reduce transmission by 50% about every 15 days.

Obviously these numbers will change if you alter the length of the infection cycle, but I do find a 50% reduction over some time period given 25% immunity to be totally believable.

I see I used an ambiguous term with "transmission". I meant "R", as jn, how would 25% immunity reduce R by 50%. (Indeed, assuming R(0) is 2 or more, we need a reduction of R by at least  50% to get a decline below 1, which is required to get a decreasing number of cases in NYC.)

[Smeulders]

It is likely that neither the 25% herd immunity nor the lockdowns alone have reduced R0 significantly below 1.  But they have worked in combination to reduce it below 1. 

It does seem like a lot of cities without significant herd immunity are no longer exponentially growing in infection, but either slightly increasing or slightly decreasing.  So we might imagine that the lockdowns have themselves reduced the R0 to around 1.

Stack the lockdown effect with a 25% herd immunity effect and you get an R0=.75. 
With R0=1, each new infection will infect 3 new people over the course of 3 cycles of the virus.
With R0=.75, each new infection will infect .75+.5625+.422=1.734 people over 3 cycles of the virus.

Which is why you could see a very stable number of new infections in most cities, but an almost 50% reduction in new infections in a city with similar restrictions but a 25% herd immunity.

I completely agree with this post, it is more or less where I was heading with this discussion. From your previous posts I got the impression you were denying that lockdowns were effective and that herd immunity was responsible for the majority of the decrease of R,  which is what I took issue with. Indeed, a significant fraction of the population that is immune will help, and can tip a weaker lockdown below R = 1. This might be happening in NYC. (Though I would hope that after last month, New Yorkers are carefull enough that their behaviour changes alone would ensure R < 1.)

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[Link]

What had been a national effort to save lives, a noble effort of national unity, has been twisted by Democrat governors into something unnecessarily punitive that reeks of a partisan power play to destroy President Trump’s re-election chances. Give me a better explanation.  Because this is the bottom line…

Unless you’re willing to wait for a cure (that is at least a year away or might never come at all), when there is no risk the health care system’s going to crash, what is the point of waiting one more day to open up the country when waiting doesn’t make us any safer?

Normal, non-partisan people are asking this question as well.

There is so much wrong in those 5 lines that it is unclear where to begin. It is telling that they start with "Democrats are evil" and work backwards from there. Given that start, they can think of only 1 answer to the question "what is the point of waiting one more day to open up the country". Someone without those blinders on would easily come to correct answer to the question. Longer lockdowns give more time to prepare for post-lockdown virus suppression (testing capacity, setting up contact tracing, preparing quarantine capacity, workplace reorganization to allow distancing, ...) as well as lower the number of active cases, so that those suppression measures have a higher chance of being successful.

I also note that pretending lockdowns can not have any use anyway is convenient if your idol is pissing away the opportunities a lockdown provides.

[Smeulders]

If the task force is disbanded, I don't think we'll ever be free of this pandemic. Not until we have a vaccine, which might never happen; we've never created a vaccine for a coronavirus.

We would have to learn to live with it, although I think it's impractical to expect social distancing, masks, and all the rest to continue indefinitely. Our society eventually acclimatized itself to HIV/AIDS, to give an example of what the path forward might look like if there is no vaccine.

HIV/AIDS is much easier to prevent transmission of. If this coronavirus is truly with us forever, we're looking at an eventual herd immunity scenario as the only realistic ending. Of course that probably means 1-2 million deaths.

We are only looking at 1-2 million deaths if we achieve herd immunity through a random spread throughout the population.  If we had targeted infections among the young and healthy, we could achieve herd immunity much more quickly with likely under 100,000 deaths.

I am going to start by saying that I am not against targeted infection on principle. We do not live in a perfect world where we can think about healthcare without thinking about trade-offs.  In my job I actually (on occasion) work on allocation of scarce resources in healthcare.  That said, I have serious reservations about the targeted infections "plan".

The idea of targeted infections sounds appealing at first. The plan in two sentences: People are going to get infected anyway, let's achieve herd immunity at minimum cost to get this over with. We achieve minimum cost by making sure that people least (less) likely get severely ill get infected. In two sentences this sounds sensible, but a lot falls apart when you get into more detail.

Let's start with why "getting this over with" is not necessarily a good thing. Slowing down infections means we may achieve herd immunity through vaccines instead of infections.  Second, slowing down infections means we have time may find better treatment options, so people infected have better survival chances. Third, even if we we manage to only get healthier people ill, we are still risking severe peaks in hospitals, further reducing survival chances. Not just for Covid, but also for other things requiring hospitalisation. Fourth, the more people still infected when herd immunity is reached, the higher the "overshoot" (people who are infected after R < 1 is reached).

By trying to fast-forward to the end of the pandemic, we get more people infected at worse chances of survival.

Next is the "targeted" infections thing. People are very confident that we can sufficiently control the spread of this disease. I fail to see where this confidence comes from. Problem 1: who is vulnerable?  That is a question I haven't seen a good answer to yet. You can read that in 2 ways. a) at how much risk should someone be before they get quarantined under the plan? b) Are we confident we have enough information about underlying conditions to accurately assess the risk of people? (What factors determine risk, and can we identify them in individuals or populations?) Problem 3: Is the "safe" population even big enough to achieve herd immunity?

Problem 2: Setting up a good quarantine. It's easy to say we should separate vulnerable from low-risk. It's another to do so. Let's take retirement homes, how would this work? We have an at risk population that requires constant care from people in the "low risk" category. How do we separate them? We can't, so we would need to quarantine the complete staff of retirement homes. What if they have families? What if they need to care for children? Are they thrown in quarantine as well? A full quarantine of retirement homes will put their staff in impossible positions. Quarantining everyone that comes into contact with at risk people lowers the odd you have enough infected for herd immunity.

Retirement homes are an easy case. The physical infrastructure is there already, there is a professional staff. What happens to vulnerable people living at home? My grandmother (80+) still lives at home, alone. She still has some freedom. As infection is mostly suppressed in the general population, she can go to neighbourhood shops with a very (very) low chance of getting infected. My father can visit her (with 2 chairs set far apart in her garden), because we know he has a very low chance of being ill. Does she have to sacrifice all of her freedom so younger people get more? How many months should she go without seeing anyone?

As far as I can tell "managed infection plans" are more wishful thinking than actual plans. I haven't seen anyone try to actually model what the costs and benefits of it would be, nor have I seen any plan on how to organise it. Get me a good plan, and I may support it. Right now it looks more like a way to argue against lockdowns.

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Social distancing assumes that, at some point or another, you will eventually come into contact with a high enough concentration of the virus to get infected.  The only thing that varies is the timing. 

No I don't think that's right. Suppose a kid is asymptomatic and visits his grandma. If they try to stay 6 feet apart she'll probably get a smaller load than if they hug and kiss when they meet/leave. This affects her mortality. After that, if she survives she's immune. It doesn't matter how many other infected people she comes into contact with at that point.

Not to nitpick, but that is what social distancing assumes because the "flatten the curve" models are unspecified in regards to viral loads/divergent infectivity.   

Even so, viruses are not poisons - within the body they are self-replicating.  While the initial "dose" of virus someone receives may affect their disease's progression (their innate immune response could be overwhelmed, thus making their later acquired immune response less effective), higher viral loads are themselves a result of severe cases more so than a cause.  Asymptomatic children are not going to be carrying enough virus to seriously impede the innate immune response of an (even older) adult; if grandma gets sick this way and dies, her immune system was already operating at severe disadvantage.   

"Social distancing" does not mean "move from this steep curve to that smaller curve with the same area". The first graphs and arguments published in support of "social distancing" may have used a very simple model where that is the only real effect, but that does not mean that a more thorough understanding can not reveal additional advantages to social distancing. Can you please stop insisting the only effect of slowing down virus spread through minimising contact (= social distancing) are exactly those highlighted by the first model you saw? A model, I am going to add, was probably deliberately kept as simple as possible to be easily understood by an uninformed public.

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Not directly related to US, but a huge deal if true: Now there are reports the first Covid19 case in France could be dating back to November 2019. For reference, the PRC informed WHO on December 31. Haven't seen US media picking this up yet, but if confirmed, we may be talking about a much earlier spread in the US and elsewhere.

Weird report. The "if" is doing a lot of lifting in "huge deal if true". We know what unchecked spread looks like. We've seen examples in North Italy, Spain, New York. We know what this virus can do even if checked by lockdowns. See most of Europe and the US. It is extremely unlikely that this virus was at large in November, didn't cause any noticeable outbreaks anywhere and then suddenly exploded in Wuhan after which it spread around the world causing very noticeable outbreaks wherever it appeared.

Also of interest for those who can not read French themselves. The press report (at least the part in the image) does not say suspected Covid case. It says "compatible with Covid" or "typical for Covid. In other words, the symptoms they saw were consistent with Covid, which is not the same as the hospital claiming it thinks that is a Covid case. (A slightly stronger example to make the point; getting a fever is consistent with Covid, but my fever of 3 years ago is not a suspected Covid case).

Edit: The article linked in the tweet does contain quotes by one of the doctors involved who claims?suspects that these were Covid cases.

[Smeulders]

Not directly related to US, but a huge deal if true: Now there are reports the first Covid19 case in France could be dating back to November 2019. For reference, the PRC informed WHO on December 31. Haven't seen US media picking this up yet, but if confirmed, we may be talking about a much earlier spread in the US and elsewhere.

I've been saying this for a while, I don't know if it was like this where you guys live but here, EVERYONE was sick like constantly between November and mid-late January. Like, it seemed like everyone I knew (including my wife and myself) got sick with weird respiratory sh**t back during the winter, and everyone I know who went to the doctor for it said they tested for the flu but it wasn't the flu, just "unknown upper respiratory infection" was the diagnosis.

I really think this has been going around longer than people realize, and everyone was fine.

If everyone was fine then, it wasn't Covid-19. This virus is being tracked constantly. The complete genome of this virus has been mapped in hundreds of different places, and variations can all be traced back to the Wuhan outbreak. Unless someone can explain how the Virus suddenly got much more deadly, and why no trace of this non-lethal variant making the rounds Nov-Jan is being found, then the conclusion is simple, Covid-19 did not have community spread outside of China before New
Years.

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So....

Does anyone else think we've massively misplayed this.

No, I don't think meat packers tend to be that elderly. Maybe I'm wrong on that.

^This. Meat packers tend to be below fifty, and have a physical job that requires a degree of physical fitness. They are literally the worst possible group to draw the kind of assumptions that The Free North is making. The OP is clearly just looking for data that fits a specific narrative.

There is a mountain of data showing what this epidemic to whole countries with regards to hospitalisation and mortality, but look at this little mole-hill of a single plant! (Please ignore that this is a healthy population, and ignore that the onset of symptoms is after people start testing positive).

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Can someone with more expertise than me give any insight into how this works and what it would mean?

https://twitter.com/ScottGottliebMD/status/1259194332793446402

Suppose you have two populations. In population A, all are normal people. Population B is split down the middle, half say hello by French kissing, the other half constantly wear a biohazard suit.

 In the initial stages of the disease, it may spread equally quickly in both populations. Let's say R0 = 3. In population A, 66% need to get the disease to push R < 1. This is different in population B. The biohazard people are not getting it, (R0 = 0) but the kissers are keeping the average up (R0 = 6). Once 83% of the kissers have the disease, herd immunity is reached, which is only 41% of the total population. By having different subpopulations with different suspectibility, the total number of people needed for herd immunity goes down. 

What this means in practice is very unclear. From what I am reading on epidemiologists Twitter feeds, they are skeptical the effect will be large. Apparently you need to have large and consistent variation between individuals for this to have a significant effect. On the other hand, you have forum experts who just heard of this effect and conclude it means herd immunity has already been achieved.

[Smeulders]

Can someone with more expertise than me give any insight into how this works and what it would mean?

https://twitter.com/ScottGottliebMD/status/1259194332793446402

Suppose you have two populations. In population A, all are normal people. Population B is split down the middle, half say hello by French kissing, the other half constantly wear a biohazard suit.

 In the initial stages of the disease, it may spread equally quickly in both populations. Let's say R0 = 3. In population A, 66% need to get the disease to push R < 1. This is different in population B. The biohazard people are not getting it, (R0 = 0) but the kissers are keeping the average up (R0 = 6). Once 83% of the kissers have the disease, herd immunity is reached, which is only 41% of the total population. By having different subpopulations with different suspectibility, the total number of people needed for herd immunity goes down. 

What this means in practice is very unclear. From what I am reading on epidemiologists Twitter feeds, they are skeptical the effect will be large. Apparently you need to have large and consistent variation between individuals for this to have a significant effect. On the other hand, you have forum experts who just heard of this effect and conclude it means herd immunity has already been achieved.

This is a preprint that has not been peer reviewed

The effect itself is not controversial. What the preprint adds, is fitting the data of the Covid-19 to different degrees of heterogeneity to model what is to come and at what rate of infection herd immunity appears (given those assumed degrees of heterogeneity).

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So the virus is apparently running amok in a place where they've been doing constant testing of the people who work there.  Just what do they expect to happen in workplaces that don't have access to that level of testing?

It is running amok in a place run by an idiot. All the testing in the world isn't going to help you if you don't take any further precautions. Hopefully other workplaces are organised in a more sensible way.

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Did anyone else see the Michael Osterholm interview on Meet the Press this morning.  He’s one of the two medical experts that Chuck Todd interviewed in the first block.  I thought his interview was bizarre, because he seemed to be directly contradicting the other guest, but neither that guest nor Chuck ever pushed back at him. 

This seemed to me to be his message:
- Enhanced testing and tracing as futile at the point
- It is not possible to test any more than we are now anyway
- Social distancing restrictions will not substantially reduce infections, only “nibble at the edges”
- We cannot control the spread of the virus at all, and it will inevitably infect 60-70% of the population
- We “need a plan” to get from 5-15% infection rate to 60-70%, though he never really clarified what the basic contours of the “plan” should be

Is this a respected person?  If so, what “plan” is he talking about? 

More generally, it is striking to me that medical experts never really challenge one another in any of these interviews, even when it is obvious that they hold very different beliefs and positions.  They rarely even try to clarify their differences or the assumptions that are generating them. They all just seems to speak as if they are agreeing with each other even when it is obvious they are not.

He's very respected. Him and Marc Lipsitch at Harvard have been saying this since the beginning. The problem is, if they're wrong, then this kind of advice tends to become a self fulfilling prophecy.

I am not familiar with Osterholm, but I find your characterization of Lipsitch's positions strange. He is one of the people responsible for https://covidpathforward.com/ (well worth having a look at). The "path forward" plan goes directly against most of the points Osterholm apparently makes in that interview. Maybe his position has changed in the meantime, or maybe he made some points that have been twisted to appear in support of a herd immunity strategy (he did speculate herd immunity may be reached much earlier than 60-70% infected due to network effects, which the open up, herd immunity crowd obviously liked. I haven't seen him advocate that position though).

[Smeulders]

Did anyone else see the Michael Osterholm interview on Meet the Press this morning.  He’s one of the two medical experts that Chuck Todd interviewed in the first block.  I thought his interview was bizarre, because he seemed to be directly contradicting the other guest, but neither that guest nor Chuck ever pushed back at him.  

This seemed to me to be his message:
- Enhanced testing and tracing as futile at the point
- It is not possible to test any more than we are now anyway
- Social distancing restrictions will not substantially reduce infections, only “nibble at the edges”
- We cannot control the spread of the virus at all, and it will inevitably infect 60-70% of the population
- We “need a plan” to get from 5-15% infection rate to 60-70%, though he never really clarified what the basic contours of the “plan” should be

Is this a respected person?  If so, what “plan” is he talking about?  

More generally, it is striking to me that medical experts never really challenge one another in any of these interviews, even when it is obvious that they hold very different beliefs and positions.  They rarely even try to clarify their differences or the assumptions that are generating them. They all just seems to speak as if they are agreeing with each other even when it is obvious they are not.

He's very respected. Him and Marc Lipsitch at Harvard have been saying this since the beginning. The problem is, if they're wrong, then this kind of advice tends to become a self fulfilling prophecy.

I am not familiar with Osterholm, but I find your characterization of Lipsitch's positions strange. He is one of the people responsible for https://covidpathforward.com/ (well worth having a look at). The "path forward" plan goes directly against most of the points Osterholm apparently makes in that interview. Maybe his position has changed in the meantime, or maybe he made some points that have been twisted to appear in support of a herd immunity strategy (he did speculate herd immunity may be reached much earlier than 60-70% infected due to network effects, which the open up, herd immunity crowd obviously liked. I haven't seen him advocate that position though).

The path forward is saying that things should be done, yes, but it's short of saying this can be contained. If you look at his twitter feed, he's still talking about herd immunity thresholds and speculating about 20%-60% of the population getting infected, which is down from his earlier estimate of 40%-70%.

That being said, he does pretty strongly deny supporting herd immunity in an article on India, so perhaps I've gotten his views wrong.

You are talking about this tweet?
https://twitter.com/mlipsitch/status/1258831576416374784
I read this differently from you. Saying he believes X to Y% infected before the herd immunity threshold is different from X to Y% will get infected. The first is in the absence of measures stopping the pandemic (vaccination, lockdowns, test and trace), the second suggest that even with these measures that many people will be infected.

@Emailking: I believe he is saying neither of the two.

[Smeulders]

Not wearing masks and going back to" normal" can still "Kill grandma" if the irresponsible behavior causes hospitals to become overwhelmed.

Avoiding overcrowding the hospitals isn't a static goal. We've avoided it thus far, but if people just go back to life like normal, cases will begin multiplying at an exponential rate once again and thus overwhelm hospitals (even though they are now prepared now) and cause grandma to die because she had a stroke and there weren't any available ICU rooms. If we reopen slowly, continue using masks, and are cautious, we can keep the R value low while getting people back to work.

This isn't just a "yay we did it and now we're done" thing. Is we're going to use the stupid war symbolism, this is a war of attrition and we're under siege. If we go back to living like normal, the siege will be effective and starve us. If we stick with rationing, we can outlast this thing until reinforcements arrive. It's not fun, but it's effective and we have above evidence that it's working.

I saw (but unfortunately can't find to properly credit) another siege analogy some time ago that I think fits a bit better. We've shut the gates just in front of the arriving hordes. Some people are calling for the gates to be opened, because if they don't go out and harvest their fields they're going to lose money. They are arguing that the barbarians haven't killed many people in the last couple of weeks, so they can't be that dangerous. They are ignoring that they haven't killed many because the city walls are keeping everyone safe.

Yes, staying holed up in the city means we starve eventually. We're going to be pretty hungry if we wait for the relief forces/vaccine. That said, we should be taking some time to make weapons and train our troops, scout out where the barbarians are encamped. Once we've done that we can venture out to places we know are relatively safe or that we can defend. Throwing open the gates without those preparations is inviting disaster.

[Smeulders]

Meanwhile, King Emperor Chokwe A. Lumumba has decided that restaurants/gyms in the City of Jackson can go ahead and reopen tomorrow, but he's implementing a new citywide curfew as well as a mask mandate to go into effect over the weekend.  If he believes this to be the right course of action, where were these mandates 2-4 weeks ago?  In a press conference announcing the end of the city's SAHO, he said he was only allowing reopening so the city wouldn't become an "island".  So the mayor is opening the city while simultaneously chastising the Republican suburbs for doing the same; a nakedly cowardly move to have his political cake and eat it too.  His motivations appear misplaced.

In the Elon Musk thread you were criticising California for sticking to their guns on lockdowns and thus enforcing stricter regulations than other states. Businesses moving out was apparently their just reward. Here you are criticising another government official for not sticking to their guns. Being worried about public health, but acknowledging that the economic cost of lockdowns is too great when neighbouring areas use their leniency on public health to outcompete you, is apparently wrong as well.

It's hard to find better examples of the lose-lose situation that a race to the bottom brings.