Shanghai Disneyland will close in effort to contain coronavirus

So disease is sexually transmitted or its airborne? Only two options?

Dude, I'm making a joke.

So this may be cognitive dissonance, and maybe there really is some combination of better treatments, better preparation, and a younger population getting infected, but I still find it completely strange that death rates are not climbing +/-14 days behind case count. We're just on the cusp of the 14 day mark since the case count really started to take off, and we're basically seeing no change in death rates right now at all. Is the exponentially growing case count truly being completely counteracted by better treatments, better preparation, and a younger infected population?

Some of the increased case counts is also increased testing. Some cases that were not identified in the earlier stages are now being found. Ohio right now has growing case counts and growing hospitalizations but the growth in the latter is slower than the former. And health officials are saying increases in Ohio in the number of positive cases is increasing as a result of increased testing and additional spread.

ApolloAndy said:

Is the exponentially growing case count truly being completely counteracted by better treatments, better preparation, and a younger infected population?

I think so.

I'll go as far as the even suggest that we need to let the next two weeks play out, figure the mortality rate for just that time period (generally with things "open") and then consider the CDC's take that we're likely undercounting cases by a factor of 10 and you're finally somewhere near the ballpark of the actual fatality rate.

And as low as that number is going to be, you still have to consider that the idea that the over 65 crowd account for roughly 80% of all deaths seems to be holding up.

I don't know if your link is pointing where you want it or I don't get what you're linking.

And maybe I don't fundamentally understand something about transmission, but how is an exponential growth among "young people" not also spreading to older people, nursing homes, meat packing plants, and prisons? There are contact points between all those things. Are masks really preventing that spread and if so, why isn't it preventing that spread to the young people?

Because many of the young people getting it are the ones that packed into bars and clubs between Memorial Day and mid June? Whereas those of us that are going to amusement parks and restaurants masked and taking precautions seem to be faring okay?

I honestly don't know. I'm just spit balling here.

ApolloAndy said:

I don't know if your link is pointing where you want it or I don't get what you're linking.

Simply that I said the same thing yesterday. I'm answering affirmative to your question by linking to what I said yesterday rather than typing it again.

Pro tip: Right-click, copy link from the "link" on a post. That's the permalink. Especially if you're a moderator, there are most pages of posts (some deleted), so the page number depends on your permissions.

While death counts are not rising, hospitalization rates are a lot closer to proportional right now. Houston is maxed out, but even here in Orange County we went from 1% to 41% ICU utilization in under two weeks. The hospitalization rate is important to watch, because when it gets closer to maxed out, even the fear of infection is enough to keep people away for other life threatening issues, as we saw during NYC's peak.

Jeff said:

Pro tip: Right-click, copy link from the "link" on a post. That's the permalink. Especially if you're a moderator, there are most pages of posts (some deleted), so the page number depends on your permissions.

I had no idea.

So here's the correct link, Andy.

How the hell have you been Gonchbacking this whole time? ;)

ApolloAndy said:

And maybe I don't fundamentally understand something about transmission, but how is an exponential growth among "young people" not also spreading to older people, nursing homes, meat packing plants, and prisons? There are contact points between all those things. Are masks really preventing that spread and if so, why isn't it preventing that spread to the young people?

The young people getting sick are disregarding the virus. They are clubbing, having basement parties, etc, without masks or social distancing.

But presumably those young people then go to the grocery store, work in offices, go to church/protests/rallys/beaches with nursing home workers, prison workers, meat packers, and old people, right? I mean, that was my argument from the very beginning and maybe I am/was totally off base, but I'd like to know what my mistake was, if it turns out that way. Like, apparently (for now) it seems like it is being contained within a very particular segment of the population, but that undercuts everything I've read (thus making me the ever-dangerous internet expert) on epidemiology.

I think Andy's point is that we don't live in generational bubbles isolated from each other. Even if young people were basically indestructible (and that is most certainly a myth), they play the same role as every human in transmission, so the most vulnerable are by extension at greater risk.

Going back to the death rate, there has definitely been some selective interpretation of that data. The death rate never really declined in California, Texas, Arizona and Florida, and it's starting to tick up now... as we get two to three weeks into the case resurgence. In other words, it's exactly what everyone predicted and consistent with earlier observations here and abroad.

Look, I'm not against trying to figure out how to coexist with this virus, including giving theme parks the opportunity to make it work, but how hard do we have to keep failing before Joe Six Pack plays along? 44 Florida ICU's are at capacity right now. How does Disney make a case for making it work when people are having pool parties with dozens of others?

Disney makes the case by saying "Here are the recommended precautions, here's how we are going above and beyond those precautions, and our neighbors down the road have been open for more than a month and it's going reasonably well with no outbreaks traced back to their parks. By attending our parks you assume the risk but you also will get x, y, and z as guaranteed precautions." Whereas your neighborhood pool party may just be a group of people that say they can't wear masks because freedom.

I did not mean literally how does Disney explain it (I'm failing to articulate today). I'm saying that it's hard to make a case for a quasi-open economy to function when people are not doing their part to contain the disease. Disney and other businesses can do all the right things, but the noise caused by poor behavior risks invalidating the efforts by the businesses. The poor behavior says this is why we can't have nice things, now go back to quarantine ya morons. That narrative is already starting to play out in the court of public opinion here, and Disney hasn't even opened the gates yet. A vocal segment on social media is saying "close the parks!" even if the parks aren't the problem. Swimming pools full of drunk Midwesterners on TV aren't going to make that better either as infection rates continue to rise.

ApolloAndy said:

But presumably those young people then go to the grocery store, work in offices, go to church/protests/rallys/beaches with nursing home workers, prison workers, meat packers, and old people, right?

As it's simplest, the vulnerable are still dying at the same rates. But the majority of the new spread seems to be among those that will not have many issues.

At that point it's simple math. More cases, same deaths = lower mortality rate.

At least that's my guess. I really think it's that simple.

If those vulnerable segments are increasing precautions or treatments are getting even marginally better results, that adds to the effect.

Or maybe the threat was overstated from the start because we focused on the most vulnerable and assumed or expected that to be the norm?

I'm not 100% following you, but I think what you're saying is that the rate of spread among vulnerable populations is the same, but the rate of spread among non-vulnerable populations is much larger but with little effect on mortality numbers. I feel like that's restating the data, and I agree.

My question is how those two populations can stay so insulated from one another, because (as you pointed out) a few months ago I did not think that was possible. Even in super strict Santa Clara County, I can tell you for a fact strict social distancing isn't happening with vulnerable populations - lots of my old church ladies are getting together which each other for back yard parties and tea. But maybe since they're not getting together with their grandkids, it's okay?

If the threat was overstated from the start then why did we see 2k deaths per day early on when the active caseload was in the same order of magnitude? It's not like we ran out of old people to contract the virus? Or are the nursing homes, prisons, and meat packing plants just doing that much better at protecting their residents (again, anecdotally, I know that the few nursing home residents from my church are literally not allowed to come out of their rooms for 23.75 hours a day).

And if it is the latter, then is that where we land ultimately as a policy? "Everyone do your best to limit spread at Disney World. If you're in a high risk situation, just lock yourself down completely for the next 6? 12? 24? months while everyone else returns to some sort of almost normal."

Umm, yes?

Andy said:

My question is how those two populations can stay so insulated from one another, because (as you pointed out) a few months ago I did not think that was possible.

Not that they're staying insulated from each other, but rather that we went from all being locked down (equal chance of infection) to all being unlocked. I would expect greater mobility (increased chance of infection) from younger and less vulnerable populations just by human nature. (kids party, old people sit)

Thus, greater spread among the least vulnerable and the same spread among the more vulnerable when compared to tighter lockdown life.

Just Gonch theory. Usual disclaimers about experts, science and such...even though I feel like my guesswork has held up as well as some of theirs. 😉

Or are the nursing homes, prisons, and meat packing plants just doing that much better at protecting their residents (again, anecdotally, I know that the few nursing home residents from my church are literally not allowed to come out of their rooms for 23.75 hours a day).

Yes, I think this adds to the above idea. We're likely being much more cautious with our most vulnerable. This increases the disparity in the infection rates.

And if it is the latter, then is that where we land ultimately as a policy? If you're in a high risk situation, just lock yourself down completely for the next 6? 12? 24? months while everyone else returns to some sort of almost normal."

I think this is exactly what we need to consider. (that's just a link to the same post again)

But I will copy and paste what I said there:

"Who was dying in the beginning was a bigger piece than anyone was giving credit to. If entire populations can take precautions to reduce the risk to acceptable levels, it doesn't seem unreasonable to expect to be able to do the same to the most vulnerable segment of our population while letting that herd immunity build up among the least vulnerable.

If we're not going to stop moving forward, we need to move forward safely and with purpose. I think that's entirely possible."

Jeff said:

I'm saying that it's hard to make a case for a quasi-open economy to function when people are not doing their part to contain the disease.

I think the larger, more overriding issue is - is this virus really containable?

We saw just about every kind of measure enacted to try and deal with the virus - lockdowns, masks, social distancing, etc. The fact is, that most every country had pretty much the same curve with cases and particularly with deaths. Yes, there were some exceptions at the edges of the bell curve, but by and large most every country that had a significant amount of cases saw the exact same thing. Look at the mortality curves for each country:

• UK
• US
• Sweden
• Peru
• Brazil

We see the same thing with the flu each year - it comes in, does some damage for a few months, and then goes away. One of the more interesting thing I've seen recently is this little tidbit from China regarding the flu from the Lancet (Source):

We estimated that an annual mean of 88,100 influenza-associated excess respiratory deaths occurred in China in the 5 years studied (2011-2015).

US annual seasonal flu deaths during that same span were about 36,000 (Source). This is not substantially different given the sizes of population in each country. It continues:

Approximately 71,000 (annual) influenza-associated excess respiratory deaths occurred in individuals aged 60 years or older, corresponding to 80% of such deaths.

This is essentially the same story with COVID. I'm not trying to say that COVID hasn't been impactful, because it has been impactful. I just think that too many people are jumping to conclusions about people living in China, S. Korea, Japan, seeing their COVID numbers and jumping to superficial conclusions. Some are saying that the relatively low numbers in those three countries are because the majority of the population is wearing masks. Why, then, are those same three countries seeing seasonal flu outbreaks each year and, per capita, seeing similar numbers to the US?

Pretending that we can contain any respiratory illness is a fools errand. Let's protect the most vulnerable and let the others get on with life.