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For WHOm the Bell Tolls - Covid-19 #11

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Not left to the actual reader: how many people actually have pre-existing conditions. Remember, one of the pre-existing conditions is being overweight, which over 60% of the US population is. Fuck those guys, I guess. 

I do love how it's just glossed over, like oh well, if you have any pre-existing condition time to die. 

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Posted (edited)
25 minutes ago, Kalbear said:

I do love how it's just glossed over, like oh well, if you have any pre-existing condition time to die. 

Couldn’t be further from the truth. It’s about having different approaches to different risk categories. Cause its gonna spread anyway. Unless you are proposing a lockdown until a vaccine is available in 6 months or a year’s time. Good luck with that.

Edited by Free Northman Reborn

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11 minutes ago, Free Northman Reborn said:

Couldn’t be further from the truth. It’s about having different approaches to different risk categories. Cause its gonna spread anyway. Unless you are proposing a lockdown until a vaccine is available in 6 months or a year’s time. Good luck with that.

I'm not proposing a lockdown. I'm saying that the notion of separating out people with pre-existing conditions that appear to be problematic for covid related issues is not like separating out everyone in nursing homes. It's separating out literally more than half the population. Good luck with that approach. 

You don't need to have a full lockdown if you can have good testing and good contact tracing. I don't know why people don't understand this more. You have basically two choices if you want out of the lockdown: you either let millions get sick and potentially die, or you ramp up testing. That's it. There's no other tricky way out of it. There's no special sauce. 

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The WHO has come out with some initial results on antibody tests...and it's not great reading. Even in hard-hit areas, only 2-3% of the population had the virus. 

It feels way too early to say anything definitive based on these early results, but it does make me feel less comfortable about future waves. 

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12 minutes ago, Kalbear said:

I'm not proposing a lockdown. I'm saying that the notion of separating out people with pre-existing conditions that appear to be problematic for covid related issues is not like separating out everyone in nursing homes. It's separating out literally more than half the population. Good luck with that approach. 

You don't need to have a full lockdown if you can have good testing and good contact tracing. I don't know why people don't understand this more. You have basically two choices if you want out of the lockdown: you either let millions get sick and potentially die, or you ramp up testing. That's it. There's no other tricky way out of it. There's no special sauce. 

The thing about testing is if you tested someone today there is no reason why he might not need to be tested again tomorrow or next week. Testing only tells you his status at that point in time. That might sound like stating the obvious, sure, but in a post lockdown world that means you’re gonna have to do a shitload of repeat testing to try and keep track of pretty much the entire population.

Still a better option than the lockdown, without a doubt, but seems like a monumental task, that’s for sure.

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5 minutes ago, Free Northman Reborn said:

The thing about testing is if you tested someone today there is no reason why he might not need to be tested again tomorrow or next week. Testing only tells you his status at that point in time. That might sound like stating the obvious, sure, but in a post lockdown world that means you’re gonna have to do a shitload of repeat testing to try and keep track of pretty much the entire population.

Still a better option than the lockdown, without a doubt, but seems like a monumental task, that’s for sure.

That's why the trick would be to lock down people, then test them by clusters (say neighbourhoods, big buildings and the like), re-test them a few days later to be sure, and then let them out when they're Corona-free. You do this on a national scale during 8-10 weeks and then you've actually beaten the virus. Meanwhile, sure, your economy has taken a massive hit for 3 months - which isn't worse than what we're going through right now, the world over -, and you've saved hundreds of thousands of people.

Of course, you need a bloody huge infrastructure and organization, but, I mean, that's why big States like the USA exist to begin with. If they can't do it, what good are they?

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10 minutes ago, Free Northman Reborn said:

The thing about testing is if you tested someone today there is no reason why he might not need to be tested again tomorrow or next week. Testing only tells you his status at that point in time. That might sound like stating the obvious, sure, but in a post lockdown world that means you’re gonna have to do a shitload of repeat testing to try and keep track of pretty much the entire population.

Still a better option than the lockdown, without a doubt, but seems like a monumental task, that’s for sure.

Yes...so? 

Are you saying that the US can't do things that South Korea is able to do regularly? 

Again, those are your options: lots of testing, or lots of death. I know you are fine with lots of death, especially if it's pre-existing condition people. I'd prefer the lots of testing. 

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4 minutes ago, Kalbear said:

Yes...so? 

Are you saying that the US can't do things that South Korea is able to do regularly? 

Again, those are your options: lots of testing, or lots of death. I know you are fine with lots of death, especially if it's pre-existing condition people. I'd prefer the lots of testing. 

I’m saying combine isolating vulnerable groups with whatever other measures are feasible - such as lots of testing, ramping up medical facilities, contact tracing, whatever. And at the same time get the bulk of the healthy population back to work.

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Just now, Free Northman Reborn said:

I’m saying combine isolating vulnerable groups with whatever other measures are feasible - such as lots of testing, ramping up medical facilities, contact tracing, whatever. And at the same time get the bulk of the healthy population back to work.

How do you isolate 60% of the US population? 

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Just now, Kalbear said:

How do you isolate 60% of the US population? 

How do you isolate the entire population? By locking them down. Even now I know of work places with contingency plans that include dividing their employees into two groups - those who are low risk and those who either have a vulnerable condition or have someone at home with a vulnerable condition. So let those in the second group stay in lockdown. And let the rest go back to work.

And in the meantime do all the testing and other steps to manage any increased breakouts as best possible.

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11 minutes ago, Free Northman Reborn said:

How do you isolate the entire population? By locking them down.

Which is what we're doing now. Realistically we're isolating about 70-80% of the total population. Doing it for 60% requires essentially the same steps. 

11 minutes ago, Free Northman Reborn said:

Even now I know of work places with contingency plans that include dividing their employees into two groups - those who are low risk and those who either have a vulnerable condition or have someone at home with a vulnerable condition. So let those in the second group stay in lockdown. And let the rest go back to work. 

Those places are making plans on incomplete data that is going to get people killed.

11 minutes ago, Free Northman Reborn said:

And in the meantime do all the testing and other steps to manage any increased breakouts as best possible.

Until you have the testing, you're just sending people out to die. 

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1 minute ago, BigFatCoward said:

That doesn't sound right. New york has 240000 cases so 2%ish of the population is confirmed. There must be a huge number of people with no/minor symptoms. 

Really hard to say anything definitively without major testing. We still don't know if antibodies provide immunity yet. 

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The idea of isolating only the most vulnerable members of society (to keep the economy running I guess) might seem attractive at a glance.

But the less vulnerable still fall sick. For about two weeks on average.

And this supposes that we know who is vulnerable and is not. What about people whose "comorbidities" have not been identified yet?

So I'd say... In a country with universal health care, perhaps you could offer a chance to everyone to test for comorbidities AND a three or four-week sick leave for the people who fall ill.

So the irony is, I think the plan could work. Just not in the US.

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Also, on the 'only 1% or less will die' remember that while that's true, the actual studies we have also have about 20% of the 20-45 crowd who have gotten it require hospitalization, and 2% of the 20-45 crowd with no pre-existing conditions require ICU treatment/ventilators.

2% of the 20-45 population is close to a million people. By itself. And that would more than overwhelm our hospitals. 

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11 minutes ago, Kalbear said:

Really hard to say anything definitively without major testing. We still don't know if antibodies provide immunity yet. 

Preliminary indications are that the people with no/very minor symptoms don't seem to be getting a level of antibodies to expect to be immune, but people who get moderately/very sick do.  Which would mean that the talk of herd immunity is still a really long way off, even in the hardest hit areas.

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Posted (edited)
21 minutes ago, Kalbear said:

We still don't know if antibodies provide immunity yet. 

I mean, decades of science say that the antibodies produced by the body exist for a reason, namely to protect against infection. I think WHO's point got a bit muddled, because what they're really saying is that people shouldn't trust antibody tests on the individual level to be 100% certain about level of immunity one may have. Which, at present, may be true. But I'm not going to buy the idea that antibodies versus a coronavirus are useless. Especially when there are already studies that are suggestive of the fact that, yes, antibodies still work, and the question now is simply how long they are effective for, and how well does the body become primed to deal with this when the immediate immune response wears off? 

To put this another way, just think -- if antibodies don't provide immunity, then we are fucked as a species because vaccination will not work, since it depends on getting us to create antibodies, and we sure as hell are not going to eradicate this so the only way to go is to get used to a lot more old people and overweight people dying from here to eternity.

Edited by Ran

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Just now, Ran said:

I mean, decades of science say that the antibodies produced by the body exist for a reason, namely to protect against infection. I think WHO's point got a bit muddled, because what they're really saying is that people shouldn't trust antibody tests on the individual level to be 100% certain about level of immunity one may have. Which, at present, may be true. But I'm not going to buy the idea that antibodies versus a coronavirus are useless. Especially when there are already studies that are suggestive of the fact that, yes, antibodies still work, and the question now is simply how long they are effective for, and how well does the body become primed to deal with this when the immediate immune response wears off? 

To put this another way, just think -- if antibodies don't provide immunity, then we are fucked as a species because vaccination will not work, since it depends on getting us to create antibodies, and we sure as hell are not going to eradicate this so the only way to go is to get used for a lot more old people and overweight dying from here to eternity.

That's fair and a more expansive point of what I was making.

Antibody tests only reveal that at some point the person had the virus. What it doesn't say:

  • How long the antibodies are effective
  • How much exposure does a body need before it produces antibodies
  • How long does the immediate response last
  • How many people cannot for whatever reason produce antibodies and will remain vulnerable

Really, the novel coronavirus is so new and interesting and different that we barely understand all the ways in which it actually kills or harms people. We still don't understand enough to make declarative statements about what will work. There are strategies we can put in place IF things are certain ways (frex: a larger population that is asymptomatic and immune than we think, a version where many people don't have a strong immunity response and can get reinfected), but we simply don't know enough right now to say anything.

What we do know is what we have from experimental evidence in places like South Korea which work:

  • Major testing and aggressive quarantining of anyone who is infected and who has contacted them
  • Public contact testing results allowing everyone to know what is going on
  • Major public health measures to allow for good social distancing and gathering
  • Strong unified messaging and methods

That is so far the only thing that has been reliable. Everything else is a gamble based on incomplete information.

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3 minutes ago, Ran said:

To put this another way, just think -- if antibodies don't provide immunity, then we are fucked as a species because vaccination will not work, since it depends on getting us to create antibodies,

Eeeh, Ran, hold on. I'm no doctor so I might be talking out of my ass but...
I don't think anybody said that antibodies don't work.
I think the question is whether you can develop antibodies if you're asymptomatic.
In other words, the question is whether a "healthy carrier" becomes immune to the virus or not.
But even if that's not the case, a vaccine could still be produced.
It's just that it would then be likely to cause extremely mild symptoms.

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Just now, Rippounet said:

Eeeh, Ran, hold on. I'm no doctor so I might be talking out of my ass but...
I don't think anybody said that antibodies don't work.

Kal has clarified his point, but what he said was literally that we didn't know if antibodies provide immunity, and that's what I was responding to.

Just now, Rippounet said:


I think the question is whether you can develop antibodies if you're asymptomatic.

Yes, but then there needs to be study into why people are asymptomatic and appear to fight off the virus without their immune system adapting itself to deal with it. Here is an article from yesterday that has some interesting things to say. Could it just that a lot of people (mostly younger) have great innate immunity? Could be! But if so, then that reduces R, and herd immunity is actually probably closer, not further away.

 

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