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Started by bacardiandlime, January 30, 2020, 03:20:28 PM

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bacardiandlime

Quote from: marshwiggle on May 05, 2020, 07:21:50 AM
Until then, deaths will always be evaluated against the precautions put in place (or not) to prevent them.

Yes, and from a legal standpoint there is no way a school would be liable for a student catching the disease.
Unless they were somehow forced into a lab and the Dean shoved a sample of the virus up their nose.

Meanwhile, the whole "kids can't get sick, let's reopen schools" might not be looking so good. The NYT is reporting 15 hospitalised children.

apl68

Campus libraries will face challenges maintaining social distancing while still providing services.  For example, library computers tend to be in clusters.  At our (public) library we have 18 public access computers.  In making our plans to reopen we have found that we can only accommodate patrons at six of these while maintaining social distancing.  Campus libraries will probably find a similar proportion of their public access computers unserviceable while social distancing rules remain in effect.

Then there's the question of whether to let patrons use the stacks.  Personally I believe there's very little risk in having an open-stack policy, as long as patrons in the stacks practice social distancing.  Yes, the virus can survive for some days on paper, but there's little if any evidence that it can spread effectively that way.  But the fear of indirect infection among some staff and patrons is so great that we will probably have to limit circulation to curbside service for a time after we reopen.  My observation from working at academic libraries is that you rarely glimpse an undergrad in the stacks, but closing the stacks is going to be awkward for public library patrons and many faculty.
All we like sheep have gone astray
We have each turned to his own way
And the Lord has laid upon him the guilt of us all

pigou

My Twitter feed for a while was also full of doctors/nurses tweeting how they just had a patient in their 20s/30s die and COVID is a threat to everyone. It's important to recognize that those are outliers.

Massachusetts has a great dashboard that gets updated daily, reporting data by age: https://www.mass.gov/info-details/covid-19-response-reporting

Of the 8,500 confirmed cases of people in their 20s, 149 have been hospitalized and 3 have died. The death rate across that entire age group is less than 1 per 100,000. For comparison, traffic deaths are about 14 per 100,000.

It's the 80+ group that gets hit massively by this. Of 10,500 confirmed cases, 2,100 have been hospitalized and 2,600 have died. The death rate in that age group is 884 per 100,000. That's around 1,000x higher than for people in their 20s.

Caracal

Quote from: bacardiandlime on May 05, 2020, 07:37:08 AM
Quote from: marshwiggle on May 05, 2020, 07:21:50 AM
Until then, deaths will always be evaluated against the precautions put in place (or not) to prevent them.

Yes, and from a legal standpoint there is no way a school would be liable for a student catching the disease.
Unless they were somehow forced into a lab and the Dean shoved a sample of the virus up their nose.

Meanwhile, the whole "kids can't get sick, let's reopen schools" might not be looking so good. The NYT is reporting 15 hospitalised children.

The key words you're missing all through that story are "rare" and "dozens."

Hegemony

Quote from: pigou on May 05, 2020, 07:56:10 AM
Of the 8,500 confirmed cases of people in their 20s, 149 have been hospitalized and 3 have died. The death rate across that entire age group is less than 1 per 100,000. For comparison, traffic deaths are about 14 per 100,000.

It's the 80+ group that gets hit massively by this. Of 10,500 confirmed cases, 2,100 have been hospitalized and 2,600 have died. The death rate in that age group is 884 per 100,000. That's around 1,000x higher than for people in their 20s.

The trouble with statistics like Pigou's (no offense, Pigou) is that they can lead to conclusions of "No worries, young people are hardly affected, open it back up!"

But apart from those three people in their 20s who have died, every one of those 8500 young people is at great risk of spreading the virus on to other people. It typically requires only one or two transmissions to get from a 20-year-old to someone in a category of significant risk. In the U.S., 1.8 million people are diagnosed with cancer every year — all of those people will be at risk. Add in the people who've had organ transplants, the people with immune diseases, and so on — it's not a negligible number of people. And these people are not walled off from the carriers in their 20s.

Even if we restrict our view to people in their 20s, there are 44 million of those in the U.S. Let's say half of them get the virus. 3 out of 8500 is a rate of 0.035%. At that rate it would mean 7700 deaths of people in their 20s. You may say, "Well, cars kill lots more than that!" Well, that's not good. 7700 additional people are still 100% dead.

And the worst of this argument is that, oh well, it only kills older people in significant numbers, so who cares? They mostly don't work and earn money any more, if they do earn money, they're probably taking up tenured positions that we want to get our hands on, they're annoying, their lives are worth less than those of the rest of us. All Lives Matter, but not old people's lives. Away with 'em!  Not going to go out of my way to save them!

I think this position is beneath our dignity. And when you in turn are one of these older people, you may come to believe it too.

pigou

The transmission risk for elderly from residential college students is probably pretty minimal: they'd have to get infected on campus right just before they were traveling home for Thanksgiving to spend time with grand parents. Are we really mitigating that risk when we shut down hair salons? Or could we instead discourage holiday travel in the Fall semester? I wouldn't estimate a 0.035% case fatality rate either: most people in their 20s with mild symptoms wouldn't get tested and so this figure is likely too high.

I haven't argued that we should just let the elderly die. There's a very large continuum of responses between limiting the hours of the day people can leave their home (parts of Europe) and pretending nothing is happening and just letting it run its course (probably no country at this point). But if age groups differ in their risks, that matters: maybe we shouldn't allow visitors in long-term care facilities, but opening up primary and secondary schools is fine.

I'm not sure what our alternatives are to a gradual re-opening. We're seeing that throughout Asia and Europe and I suspect we'll see it beyond the red states in the US, too. A mass-produced vaccine is probably two years off in a near best-case scenario; longer if the first candidates don't work. Even if we could somehow increase our testing capacity 100x in the meantime and test all Americans every 10 days, we'd still get infections before people show symptoms. That's assuming we could get people to test with such regularity in the first place.

Tracing isn't looking very promising at this point either. Australia launched an app a week or so ago and fewer than 20% of people with smartphones have installed it. We'd need uptake around 100% of smartphone users for that to have a shot. And we kind of assume that everyone will get vaccinated when the vaccine becomes available... I don't know: H1N1 uptake was under 40% in the US and under 30% in Europe. It'll be higher now for sure, but enough to provide herd immunity? I'm skeptical, especially given that this vaccine won't have time to go through the usual safety testing phases. Unless we're willing to wait many more years, at least.

Hegemony

It depends on what you mean by a residential campus, doesn't it?  A small liberal arts college may have all students living on campus, so the chief danger would be that they bring the infection to their professors, who are taking care of elderly parents, or when they go home for the winter break — hard to believe you could keep an appreciable amount of them on campus for the winter break. And then you'd have to hope that in spring 2021, when they go home for the summer, the infection has essentially vanished, and that none of them have any contact with elderly people, or work in stores that elderly people use such as grocery stores. And of course you'd have to hope that none of their professors were immune-compromised or over a certain age.

Our university, though, is heavily integrated with the outside world, which I would guess is true of most public universities and most urban universities. Our students already live off campus and work — in groceries, coffee shops, even in nursing homes. Many of them live in apartment buildings also used by non-students. Some 20% of them are married and have children. Their spouses are sometimes students, sometimes just people who work in the community. They are no less integrated with the general population than a non-university student. A good percentage of the American university population is in this category.

nebo113

from pigou:  Are we really mitigating that risk when we shut down hair salons?

As someone whose hair is getting longer and greyer by the nanosecond, I will continue to avoid visits to the hair salon, as I can be fairly confident that it is absolutely impossible for anyone with a head stuck in the wash sink to wear a mask.....and that means the head in the wash sink right next to mine. 

Caracal

Quote from: pigou on May 05, 2020, 05:33:23 PM

Tracing isn't looking very promising at this point either. Australia launched an app a week or so ago and fewer than 20% of people with smartphones have installed it. We'd need uptake around 100% of smartphone users for that to have a shot. And we kind of assume that everyone will get vaccinated when the vaccine becomes available... I don't know: H1N1 uptake was under 40% in the US and under 30% in Europe. It'll be higher now for sure, but enough to provide herd immunity? I'm skeptical, especially given that this vaccine won't have time to go through the usual safety testing phases. Unless we're willing to wait many more years, at least.

That Australian App isn't actually even really being used yet. The data is being collected but the health authorities aren't using it yet, so I wouldn't take that number as a benchmark. Apps would only be part of contact tracing. Trevor Beford, a Washington Virologist had a twitter thread where he pointed out that contact tracing isn't an all or nothing proposition. Even very modestly successful contact tracing could reduce transmission by significant amounts.

I think that's the thing that lots of discussion about mitigation measures misses. Is reducing student numbers in class going to make it impossible for students to transmit the virus to each other or others? Banning more than one visitor in a room? No, of course not, but everything that reduces the number of people who could be exposed chips away at the transmission number. Do enough of those things and that's the difference between having a growing outbreak that forces more drastic measures and something that can be managed.

I wouldn't make assumptions about how many people would get a vaccine based on flu vaccines. First, and most obviously, this is a lot worse than the flu. It has also made a huge impact on our lives in the way that no flu strain in recent times has. The 2014-15 year was the worst in at least ten years. I think there were 70k deaths or so. We are already past that no matter how you count. Nothing shut down, there weren't constant ambulance sirens in NYC or temporary hospitals being set up. I can promise you that a high proportion of the population will want to get a vaccine if it becomes available. It will also probably be a good deal more protective than a flu vaccine. I would also assume that a vaccine would be required by schools, as well as lots of employers. You'd be down to a hard core of anti vaccers who would refuse.

Stockmann

Quote from: pigou on May 05, 2020, 05:33:23 PM
.... and pretending nothing is happening and just letting it run its course (probably no country at this point).

Letting it run its course is more or less what Sweden is doing, and definitely the Brazilian federal government (although some state government have implemented serious restrictions that the federal government is actively fighting). It appears to be Nicaraguan policy also. Officially Turkmenistan and North Korea have no cases; reportedly in Turkmenistan you can be arrested for wearing a face mask. If they are lying about having no cases then they're just letting the disease run its course.


A vaccine isn't necessarily the only way this ends. An effective cure would also allow re-opening. It was the use of Tamiflu, and social distancing, that stopped swine flu in Mexico City. If a safe, effective drug (or cocktail of drugs) for it becomes widely available, that would largely be pandemic over. There are also serious suggestions that, for some reason, the TB vaccine may confer some protection, which if confirmed might mean a combo of track-and-trace, mass use of the TB vaccine and whatever drug treatments are available might be a game-changer, even if none of them are a game-changer on their own.

Caracal

Quote from: Stockmann on May 06, 2020, 07:06:44 AM

A vaccine isn't necessarily the only way this ends. An effective cure would also allow re-opening. It was the use of Tamiflu, and social distancing, that stopped swine flu in Mexico City.

Swine flu wasn't contained. It spread all over the world. It just turned out that it actually was a pretty mild strain of flu. My impression is that a "cure" isn't very likely in the sense of some drug that would make this no big deal. Viral infections are hard to cure. Tamiflu does seem to reduce the time people are sick with flu if they get it really early, but there's not any clear consensus that it reduces mortality rates. Drugs and treatments could help, but I wouldn't expect any of them to be a magic bullet.

secundem_artem

Quote from: Stockmann on May 06, 2020, 07:06:44 AM
Quote from: pigou on May 05, 2020, 05:33:23 PM
.... and pretending nothing is happening and just letting it run its course (probably no country at this point).

Letting it run its course is more or less what Sweden is doing, and definitely the Brazilian federal government (although some state government have implemented serious restrictions that the federal government is actively fighting). It appears to be Nicaraguan policy also. Officially Turkmenistan and North Korea have no cases; reportedly in Turkmenistan you can be arrested for wearing a face mask. If they are lying about having no cases then they're just letting the disease run its course.


A vaccine isn't necessarily the only way this ends. An effective cure would also allow re-opening. It was the use of Tamiflu, and social distancing, that stopped swine flu in Mexico City. If a safe, effective drug (or cocktail of drugs) for it becomes widely available, that would largely be pandemic over. There are also serious suggestions that, for some reason, the TB vaccine may confer some protection, which if confirmed might mean a combo of track-and-trace, mass use of the TB vaccine and whatever drug treatments are available might be a game-changer, even if none of them are a game-changer on their own.

And as we open up the economy, this is functionally what we will be doing as well.  It worked somewhat in Sweden due to public acceptance of social distancing and other measures, but they ended up having about 24,000 cases and 3,000 deaths compared to Denmark (10,000 cases, 500 deaths) and Norway (8,000 cases and 200 deaths).  Sweden's population is roughly twice that of their neighbors, so, even adjusting for population size, Sweden has had a substantial case load.

Sweden appeared to take the approach that they were willing to let the disease run through the population as fast as possible so as to achieve a reasonable amount of herd immunity as quickly as possible.  Britain tried the same thing - at least until Boris got it at which point they backpedaled fast.  In the long run, Sweden may possibly have chosen the better option if they can get to the 60% herd immunity figure I've seen as being required.  But in the short run, they appear to have accepted some very troubling outcomes.

Unlike bacteria, viruses are intra-cellular pathogens which has made finding viracidal drugs very difficult.  Drugs like Tamiflu (and it seems Remdesivir) shorten the course of the disease by a a few days, but are not a cure.  And in the case of Tamiflu, if therapy is not started very early in the course of influenza, it's generally ineffective.  The pandemic will likely subside when a combination of an effective vaccine and sufficient herd immunity have been achieved.  And that ain't gonna be before school opens in the fall.

Change of topic -- I was in Target yesterday picking up some essentials (wine and whisky mostly).  Maybe 50% of the people were wearing a mask, but social distancing was pretty much universal.  There was one older guy in the checkout area without a mask.  He was expounding loudly to everyone within earshot how he was not about to let no gub'mnt tell him what to do.  It was all I could do to keep my big mouth shut, pay for my stuff and get out of there. 
Funeral by funeral, the academy advances

polly_mer

Quote from: Caracal on May 05, 2020, 09:52:41 AM
Quote from: bacardiandlime on May 05, 2020, 07:37:08 AM
Quote from: marshwiggle on May 05, 2020, 07:21:50 AM
Until then, deaths will always be evaluated against the precautions put in place (or not) to prevent them.

Yes, and from a legal standpoint there is no way a school would be liable for a student catching the disease.
Unless they were somehow forced into a lab and the Dean shoved a sample of the virus up their nose.

Meanwhile, the whole "kids can't get sick, let's reopen schools" might not be looking so good. The NYT is reporting 15 hospitalised children.

The key words you're missing all through that story are "rare" and "dozens."

Try this article instead https://www.nytimes.com/2020/05/05/health/coronavirus-children-transmission-school.html?action=click&module=Top%20Stories&pgtype=Homepage#commentsContainer


It turns out when you actually test kids, the kids are indeed infected and can spread it to others, just like adult asymptomatic spreaders, even if the kids themselves don't become hospitalized in large numbers.
Quote from: hmaria1609 on June 27, 2019, 07:07:43 PM
Do whatever you want--I'm just the background dancer in your show!

Stockmann

Quote from: Caracal on May 06, 2020, 08:33:26 AM
Quote from: Stockmann on May 06, 2020, 07:06:44 AM

A vaccine isn't necessarily the only way this ends. An effective cure would also allow re-opening. It was the use of Tamiflu, and social distancing, that stopped swine flu in Mexico City.

Swine flu wasn't contained. It spread all over the world.

I wrote how it was stopped eventually in Mexico City (the worst-affected place), I didn't say it was contained which indeed it wasn't. It wasn't that mild, either. But it wasn't very contagious and there was a reasonably effective treatment from nearly the start.

Quote from: secundem_artem on May 06, 2020, 11:34:43 AM
Quote from: Stockmann on May 06, 2020, 07:06:44 AM
Quote from: pigou on May 05, 2020, 05:33:23 PM
.... and pretending nothing is happening and just letting it run its course (probably no country at this point).

Letting it run its course is more or less what Sweden is doing, and definitely the Brazilian federal government (although some state government have implemented serious restrictions that the federal government is actively fighting). It appears to be Nicaraguan policy also. Officially Turkmenistan and North Korea have no cases; reportedly in Turkmenistan you can be arrested for wearing a face mask. If they are lying about having no cases then they're just letting the disease run its course.


A vaccine isn't necessarily the only way this ends. An effective cure would also allow re-opening. It was the use of Tamiflu, and social distancing, that stopped swine flu in Mexico City. If a safe, effective drug (or cocktail of drugs) for it becomes widely available, that would largely be pandemic over. There are also serious suggestions that, for some reason, the TB vaccine may confer some protection, which if confirmed might mean a combo of track-and-trace, mass use of the TB vaccine and whatever drug treatments are available might be a game-changer, even if none of them are a game-changer on their own.

And as we open up the economy, this is functionally what we will be doing as well.  It worked somewhat in Sweden due to public acceptance of social distancing and other measures, but they ended up having about 24,000 cases and 3,000 deaths compared to Denmark (10,000 cases, 500 deaths) and Norway (8,000 cases and 200 deaths).  Sweden's population is roughly twice that of their neighbors, so, even adjusting for population size, Sweden has had a substantial case load.

Sweden appeared to take the approach that they were willing to let the disease run through the population as fast as possible so as to achieve a reasonable amount of herd immunity as quickly as possible.  Britain tried the same thing - at least until Boris got it at which point they backpedaled fast.  In the long run, Sweden may possibly have chosen the better option if they can get to the 60% herd immunity figure I've seen as being required.  But in the short run, they appear to have accepted some very troubling outcomes.

Deaths per million are significantly worse in Sweden than in the US, so I'd dispute that it "worked somewhat," unless you're comparing only with Italy and Spain. Apart from the UK and the Netherlands, Sweden is by the same criterion the worst-affected country in Northern Europe. As I've written before, the Western response (except basically in New Zealand) has been an abject failure.
Sure, there are plenty of measures, like shutting down schools and businesses, that can't continue indefinitely. But other useful measures most certainly can - South Korean-style testing and contact tracing, the use of facemasks in public (which in the Far East is close to 100%) and selective, local lockdowns if cases shoot up. Note that the Far East is largely reopening or has largely re-opened, so it makes sense economically (with the Spanish flu, there is evidence the places that dealt with it best in terms of minimizing casualties also had the most vigorous economic recovery). By international standards, the Swedish approach is objectively a failure, and any evidence-based approach needs to look at places that were actually, objectively successful (Taiwan, Vietnam, South Korea, Macao, New Zealand and even Costa Rica) rather than at what fits our prejudices.

Caracal

Quote from: polly_mer on May 06, 2020, 12:44:00 PM
Quote from: Caracal on May 05, 2020, 09:52:41 AM
Quote from: bacardiandlime on May 05, 2020, 07:37:08 AM
Quote from: marshwiggle on May 05, 2020, 07:21:50 AM
Until then, deaths will always be evaluated against the precautions put in place (or not) to prevent them.

Yes, and from a legal standpoint there is no way a school would be liable for a student catching the disease.
Unless they were somehow forced into a lab and the Dean shoved a sample of the virus up their nose.

Meanwhile, the whole "kids can't get sick, let's reopen schools" might not be looking so good. The NYT is reporting 15 hospitalised children.

The key words you're missing all through that story are "rare" and "dozens."

Try this article instead https://www.nytimes.com/2020/05/05/health/coronavirus-children-transmission-school.html?action=click&module=Top%20Stories&pgtype=Homepage#commentsContainer


It turns out when you actually test kids, the kids are indeed infected and can spread it to others, just like adult asymptomatic spreaders, even if the kids themselves don't become hospitalized in large numbers.

Important to note that there's actually not a lot of clarity around this. See https://twitter.com/mugecevik/status/1257392347010215947 for a much more extensive take that tries to look at multiple studies.
Suffice to say, it is actually a pretty complicated question.