[Cyberyeti]

y66, on 2020-May-10, 10:44, said:

This link to the BCG vaccine article posted by cyberyeti worked for me:

https://www.thelance...1025-4/fulltext

Which is utterly bizarre as it's the same link, but for some reason if you don't use the "url=" put it in quotes it gets chopped up, presumably doesn't like the brackets.

[y66]

Noah Smith at Bloomberg and Mill Valley CA's SaveABunny.org:

Quote

In the midst of the constant up-and-down of coronavirus news, both from science and the markets, it’s easy to lose sight of the scariest scenario of them all: the one where there’s no magic bullet. In this entirely plausible situation, there would be no effective Covid-19 vaccine or transformative therapy; the combination of testing and contact tracing wouldn’t successfully suppress the outbreak; and herd immunity would come, if at all, only after millions of deaths around the world.

Even raising this possibility is a big downer. But the fact that an outcome is terrible doesn’t make it impossible.

Since the end of February, I’ve conducted some 20 interviews with epidemiologists and virologists like Marc Lipsitch, Angela Rasmussen, and Carl Bergstrom; economists like Paul Romer, Stefanie Stantcheva and Larry Summers; and leaders at top hospitals and experts on government agencies whose names you may not know, but whose life’s work is preparing for moments like this one. Despite getting expert answers to dozens of my questions, the one question I haven’t been able to get an answer for is this: Who, exactly, is planning for the nightmare scenario in which we never get a vaccine or a breakthrough treatment?

Ideally, it would be the federal government’s executive branch, with its resources and bird’s-eye view of the problem. But the president, running for reelection, has every reason to insist on (unrealistic) optimism. In fact, the administration actually discussed disbanding its coronavirus task force.

The CDC and other public health agencies might be a good second option; but they’re busy (rightly) warning the public not to throw up our hands and let the virus spread unchecked. It’s not really a job for scientists — they are (understandably) devoting all their energy to searching for treatments and vaccines. Governors only have the authority to plan for their individual state. And the Fed is tasked with trying to save jobs and markets, not modeling the end of the economy as we know it.

I’m not one who enjoys doomsday scenarios. Yet realism absolutely demands considering every confluence of events that could occur with reasonable probability. If in fact there is no agency or department planning for the worst-case scenario, that is a major governance failure.

The fact that some 90 vaccines are being explored, with some clinical trials, is exciting and uplifting. It’s better than 80 vaccines or 40 or five or none. The sheer number tends to make us think that one or several will succeed. But the sum of many very low probability events doesn’t necessarily translate into a high probability that one will succeed.

There has never been a successful mRNA vaccine, like those being tested by Moderna and others, brought to market after approval. Ditto for a viral vector vaccine like the one the Oxford University group is pursuing. And traditional vaccines classically take many years to get to patients.

We’ve heard so many times that a vaccine will not be available for 18 months that we may have started to confuse that message for the very different idea that after 18 months, a vaccine will be available.

Transformative therapies are similarly very far from guaranteed. In a preliminary study, Remdesivir lowered mortality in hospitalized Covid-19 patients from 11.6 % to 8%. That’s statistically meaningful and could save lives. But even if broadly replicated, it won’t mean a fundamental change in how we accept the risks of contracting the disease. And when was the last time you heard the word hydrochloroquine?

The combination of testing and contact tracing is being heralded as a mechanism for reopening the economy. The challenges here include the reality that testing on a massive scale is not available now and is unlikely to be anytime soon. Manual contact tracing is only as good as the response rate and the willingness and capacity of contacting people to self-isolate. Digital contact tracing is new and raises challenging ethical questions, including around privacy. It, too, will work only if very large numbers of those who come into contact with infected people self-isolate.

Then there’s the little-discussed question of whether testing plus contact tracing can actually be used to suppress a disease that has achieved community spread on a massive scale like the novel coronavirus. The combination is classically applicable in situations where there are handful of cases and the disease has not yet spread widely; that was the situation in South Korea where it seems to have been highly effective. The technique is also said to have proven effective in the 2014 Ebola outbreak. But the epidemiologists I have spoken to about the novel coronavirus have not been able to provide a truly comparable case where testing and contact tracing reined in a disease that was this diffused across a huge geographical area.

Usually, when all other scenarios have been discussed, the topic turns to herd immunity. But as Bergstrom has been arguing for weeks, in practice that likely means a huge percentage of the population being exposed to the virus. Depending on the true case fatality rate, that could mean many millions of deaths around the world.

It’s time to start thinking about how we should react to this horrible scenario. It isn’t defeatism to ask what the world will look like if we lose the war we’re fighting. It’s realism.

“If you don’t know where you are going, you’ll end up someplace else.” ― Yogi Berra

[pescetom]

Cyberyeti, on 2020-May-08, 13:23, said:

England also has some pretty densely packed cities (the regional cities seem to be denser in Italy, but Rome is only 25% smaller than London with less than half the population), one of Italy's problems is that many more people smoke than other places, and old men seem to disproportionately catch this there and many of them die.

There are at least three more significant differences than smoking or social habits, I suspect:
1) the terrain (yes Italy has 25% more land area than UK, but half of it is mountainous and largely disinhabited)
2) urban density (as noted here)
3) particulate pollution.

[Cyberyeti]

pescetom, on 2020-May-10, 14:32, said:

There are at least three more significant differences than smoking or social habits, I suspect:
1) the terrain (yes Italy has 25% more land area than UK, but half of it is mountainous and largely disinhabited)
2) urban density (as noted here)
3) particulate pollution.

Much of Scotland and Wales is also mountainous and largely uninhabited, so comparatively are parts of England, but less so. Scotland has 5.4M pop in more than 1/4 of Italy's land area, and a goodly proportion of those are in a small belt containing Edinburgh and Glasgow. Wales also only has a very small area of >500 people per square km, and the vast majority is <100.
How different is particulate pollution ? We have lots of places where EU standards are exceeded in most cities, it's another reason London suffers.

[cherdano]

I read the PM's speech tonight, and I found it...weird.
Encouraging people to go back to work (if they can't work from home) seems a huge step - yet it was sold as a minor adjustment. And shouldn't the guidance for employers on making workplaces safe have come before encouraging people to return to work??

But I also don't understand the rush to prevent R from falling too far below 1 - wouldn't it be nice to significantly decrease the number of infected (oh and death counts btw) until contact tracing can become more effective?

Much prefer the approach by the Scottish government (though to be fair, so far the difference is mostly in communication).

[smerriman]

cherdano, on 2020-May-10, 18:11, said:

But I also don't understand the rush to prevent R from falling too far below 1 - wouldn't it be nice to significantly decrease the number of infected (oh and death counts btw) until contact tracing can become more effective?

I just read a transcript of the speech and don't see anything about preventing R from falling. Just preventing R from rising. Did you mean something else?

[cherdano]

smerriman, on 2020-May-10, 18:44, said:

I just read a transcript of the speech and don't see anything about preventing R from falling. Just preventing R from rising. Did you mean something else?

No, that's what I meant. He did not say so explicitly. But if your policy is to open thing up as soon as possible without letting R go above one, then implicitly your policy is to avoid letting R drop significantly below 1.

Of course, the tragedy is that if R was 2.5 before the lockdown, and if it's 0.7 now, then for any week you were late in starting to lockdown, you have to extend the lockdown by -log(2.5)/log(0.7) ~= 2.5 additional weeks to get back to the same level of infections. And it seems that they aren't prepared to do that.

I should add that in my impression, government advice is quite powerful in the UK. So if the government says that you are encouraged to go to work, that will have an effect.

[smerriman]

Right. I guess the idea is that if it were just about beating the virus, everyone would stay at home as long as it takes, and that's my preferred option - luckily NZ has taken this option. But I can understand how vital being able to work is for a lot of people. I don't envy people in government having to way up these sorts of things in the slightest

[cherdano]

smerriman, on 2020-May-11, 03:21, said:

Right. I guess the idea is that if it were just about beating the virus, everyone would stay at home as long as it takes, and that's my preferred option - luckily NZ has taken this option. But I can understand how vital being able to work is for a lot of people. I don't envy people in government having to way up these sorts of things in the slightest

But even at the moment, the UK government could have done a lot more to reduce R further with essentially no harm to the economy. E.g., like in most places, care homes in the UK are a tragedy, with a high rate of transmission and deaths. (The last week or so, more than 50% of covid-19 deaths in Scotland were in care homes.) One could try to reduce this significantly by testing as many asymptomatic care home workers as possible - e.g. if they were in contact with someone infected, or just randomly. But instead the "key worker" testing program the government rolled out to great fanfare is only for workers who *do* have symptoms. I.e., instead of using tests to stop asymptomatic coronavirus carrier from coming to work and spreading the disease further, the tests are only used to let those with symptoms return to work if they test negatively.
That seems madness.

[Cyberyeti]

cherdano, on 2020-May-11, 02:22, said:

No, that's what I meant. He did not say so explicitly. But if your policy is to open thing up as soon as possible without letting R go above one, then implicitly your policy is to avoid letting R drop significantly below 1.

Of course, the tragedy is that if R was 2.5 before the lockdown, and if it's 0.7 now, then for any week you were late in starting to lockdown, you have to extend the lockdown by -log(2.5)/log(0.7) ~= 2.5 additional weeks to get back to the same level of infections. And it seems that they aren't prepared to do that.

I should add that in my impression, government advice is quite powerful in the UK. So if the government says that you are encouraged to go to work, that will have an effect.

No, he is recognising a balancing act that needs performing. For every week of lockdown, more people will lose their jobs, more mental health issues will surface etc. People seeking help for potential cancers are 1/6 as many as before, meaning people will be dying later, domestic violence is way up.

He has judged (with help from his scientists) that less harm will be caused by a slight loosening of the lockdown than by keeping it providing R stays below 1.

Also his speech was basically "The main part of this announcement will be given on Monday in parliament". He screwed up by not saying "go back to work" was from Wednesday which has been clarified this morning.

[shyams]

These loosely worded "policy" statements by our dear leader(!) and Brexit saviour(!!) Boris are creating other problems.

https://www.bbc.co.uk/news/uk-52618005

Quote

Police officers need clearer guidance on the new lockdown measures as the PM's announcement was too "loose" and open to interpretation, a body representing law enforcement has said.

The Police Federation for England and Wales said the ambiguity of the new measures for England could make an "already challenging" job "impossible".

[Trinidad]

It is not a goal in itself to keep the R value as low as possible. It depends on the strategy that is chosen to get through this crisis.

In my opinion, depending on the characteristics of a country, there are two feasible strategies to take. They are supposed to be separated from each other and certainly not mixed and they have different consequence for the desired R value. For completeness, there is also the third strategy.

A) Wait for a vaccine
We keep R as small as possible. We do so until we have controlled the spread of the virus close to 0. From then testing and tracing is doable. After that we carefully open up and test massively. Outbreaks lead to an immediate quarantine. We keep doing so until a vaccine is available. In this strategy, the value for R needs to be as low as possible. It is followed by countries like South Korea. It works well with countries with a disciplined population where health information is shared with the authorities and who have a large test capacity.

B) Controlled herd immunity
We are not waiting for a vaccine, we are developing herd immunity. This means that we will have to get through the wave of the virus. It is important to flatten the curve to make sure that health care doesn't get overwhelmed. But we need to realize that the total area under the curve needs to be the same: this is the amount of people that have had the disease. We need people to have been sick and survived to reach herd immunity. The higher the value of R, the faster we can get through this. The lower the value of R, the longer it will take us to reach immunity.

In this second strategy, the damage to the economy will be larger with a flatter curve for two reasons: The measures will be tighter and they need to be in place longer. This means that we want to have the curve "as steep as we can afford". We want the hospitals fairly full, so that the time span is as short as possible and the measures that are taken have as little consequence for the economy as possible. For this, we first want to take away any overloading of hospital and when we have achieved that we want the value of R as high as we can afford: 1. The consequence is that as we proceed, we can slowly but steadily release the measures. After all, with a steadily increasing degree of immunity in society, the number of contacts between people that are needed to lead to an effective transmission will increase. This is because part of those transmission will be to people who are already immune. Without a change in the measures, R will decrease by itself.

This strategy is followed by countries with an excellent health care system, such as Sweden and Germany. (The German R fluctuates a little bit around the value of 1. Could the fact that they have a physical chemist in charge of the country have anything to do with that?)

And then, for completeness' sake, there is the third "strategy":

C) Let it run
In this scenario, the hospitals are overflowing. This is the way to get through the health crisis as quickly as possible. Within a relatively short period of time enough people will have had the disease and society is immune. Unfortunately, a large part of those people will have died unnecessarily. Of course, this is dramatic by itself for the needless loss of life. The economic consequences will be bad too: People that could have been saved are taken out of the economy. We have invested in their education and upbringing, but will not get the return for that investment. But there also is a mathematical consequence: Those people who are dead and buried do not contribute to herd immunity as they would have if they had survived. They are no longer part of our herd. So, apart from being immoral (if your ethics would use this qualification for the needless loss of life), this scenario is bad for the economy and it doesn't lead to herd immunity (until a significant part of the herd has died).

You can figure out which countries are following this scenario.

Rik

[y66]

In today's NYT morning briefing, David Leonhardt posted what he described as an impressively clear explanation by Eric Bromage of how COVID-19 spreads inside confined spaces, like restaurants, churches, workplaces and schools and what everyone needs to know to reduce risk (and a good summary of what most people who have been paying attention already know).

[hrothgar]

Good article

https://medium.com/@...ut-3e2c175245f8

[shyams]

hrothgar, on 2020-May-11, 06:58, said:

Good article

https://medium.com/@...ut-3e2c175245f8

Thank you for sharing, hrothgar.

My slight disagreement with the article is that the author ascribes too many actions to racism when (at least in my view) some are the outcome of large-scale stupidity. Much of the "free world" lives in an Idiocracy, and Donald Trump as the leader of this world is the undisputed Idiot.

The author's criticism of NY Times is much deserved; that Op-Ed she refers to is a mishmash of platitudes. I found this line from the NYT article particularly interesting:

Quote

Greece, usually viewed as among the European Union’s weakest members, has also been something of a surprise simply by doing better than might have been expected

... the subtext being a country that is so stupid as to bankrupt itself shouldn't logically be allowed to succeed. And then, in order to backtrack from the praise of Greece, the Op-Ed adds:

Quote

All these feats and figures, of course, require caveats. Germany’s relatively low mortality rate, for example, may reflect a far higher rate of testing than other countries, which makes for a greater number of people known to be infected and therefore a smaller percentage of virus-related deaths. Greece’s numbers, by contrast, may be low because less than 1 percent of the population has been tested.

In reality, Greece has 14 Covid deaths per million population compared to Germany at 90 per million. But then why should that statistic stop the NYT from taking a swipe at Greece while making a virtue of Germany's testing records?

[Winstonm]

shyams, on 2020-May-11, 08:07, said:

Thank you for sharing, hrothgar.

My slight disagreement with the article is that the author ascribes too many actions to racism when (at least in my view) some are the outcome of large-scale stupidity. Much of the "free world" lives in an Idiocracy, and Donald Trump as the leader of this world is the undisputed Idiot.

The author's criticism of NY Times is much deserved; that Op-Ed she refers to is a mishmash of platitudes. I found this line from the NYT article particularly interesting:

... the subtext being a country that is so stupid as to bankrupt itself shouldn't logically be allowed to succeed. And then, in order to backtrack from the praise of Greece, the Op-Ed adds:


In reality, Greece has 14 Covid deaths per million population compared to Germany at 90 per million. But then why should that statistic stop the NYT from taking a swipe at Greece while making a virtue of Germany's testing records?

I, too, found the article quite good and a refreshing change from the pat-each-other-on-the-back-to-survive reporting of major newspapers these days. At the same time, I remind myself that in newspapers it is the editors and editorial board that rule the roost. A change in editors can affect an entire news department, either for the good or the bad. Still, I am not sure if it is white privilege bias or simply an editorial choice to try not to antagonize anyone because of their iffy economics that leads major newspapers to gloss over criticism of white responses.

Most people I know would become defensive reading the article to which Richard linked. Me? I say screw em if they can't face facts.

[barmar]

shyams, on 2020-May-11, 08:07, said:

In reality, Greece has 14 Covid deaths per million population compared to Germany at 90 per million. But then why should that statistic stop the NYT from taking a swipe at Greece while making a virtue of Germany's testing records?

It's possible you're comparing different numbers. I think NYT may have been talking about the mortality rate of people diagnosed with COVID-19, not per capita.

[cherdano]

barmar, on 2020-May-12, 10:17, said:

It's possible you're comparing different numbers. I think NYT may have been talking about the mortality rate of people diagnosed with COVID-19, not per capita.

Quite possible. It'd be well in character for the NYT editorial board to base their judgement on one of the least reliable and meaningless figures.

[shyams]

barmar, on 2020-May-12, 10:17, said:

It's possible you're comparing different numbers. I think NYT may have been talking about the mortality rate of people diagnosed with COVID-19, not per capita.

I agree that the comparison was based on different numbers. My remark was not about numbers in the article; my focus was on how NYT uses language to caveat the praise showered on Greece in the previous paragraph.

Interestingly, if one re-reads the quoted paragraph, the logical callisthenics by NYT editors are self-evident. "Germany's low mortality rate" (which I presume means # of deaths as % of # of Germans identified as infected) has been compared to "Greece’s numbers" (which appears to be # of Greeks identified as infected). LOL!!

In contrast, I quoted a metric from Worldometers website which is simple. How many people died of Covid? (and, to normalise for size/population, I used a deaths/million pop). Greece is doing a good job because their deaths are much lower(*), compared to Germany. I agree with Indi Samarajiva who writes "By any objective standard, Germany has failed. Merkel presided over more deaths two days ago (287) than South Korea has had total."

Note:(*) I know that other factors --- e.g. population density, pollution levels, accuracy of reporting --- will influence the deaths/million population metric. However, I find it hard to believe that these factors can make a 6x difference across the two countries

[y66]

Experts’ 7 best ideas on how to beat Covid-19 and save the economy by Matt Yglesias at Vox is an excellent summary.