Shanghai Disneyland will close in effort to contain coronavirus

Maybe older people and those at highest risk have learned how to avoid the young jack-asses in their life after they go to a lake-party in Michigan.

Side tangent, how gross was that anyway? Nothing beats wading arm-to-arm in 3-foot water filled with piss.

Oh, to be young again.

I think its a contribution of things. Better treatments and more experience. Read an interview of the head of an emergency room physicians group a couple weeks ago who said we know a lot more now than we did at the start. Doctors weren't sure which treatments would work and which ones wouldn't. So they ultimately spent time on treatments that didn't work. Ventilators were all the talk early but less now because they learned ventilators are often not a good option. Oxygen treatments are more successful (particularly if given earlier in the illness). There are medical treatments known to work (and some known to be ineffective). Now they can start with the effective ones. New treatments are being developed as well.

Increased testing allows you to identify cases earlier. At one point you needed to be extremely ill and often in a risk group to get a test. Now its much easier to get tested. And we tested a lot of nursing homes, prisons and meatpacking plants. And continue to test those locations. Those locations from what I have read have also made a lot of changes to their operations to reduce risks.

People getting the virus is one part of the equation, but spreading it is the other. Younger people are getting the virus in higher numbers. Doesn't mean they necessarily are spreading it to at risk groups in proportionally higher numbers. People in at risk groups aren't going in high numbers to pool parties and bars. When they go to the grocery store, there is mandated distance (at least at some stores) and required masks (again in some stores) where there is reduced risk. You can get food delivered as many high risk people are doing. Limiting people you see in person. Only participating in lower risk activities will reduce your risk even if there are more infections.

Saw an article on super spreaders. There are a lot of things that have to line up to have a super spreader situation. Any one of them isn't there and you don't have a super spreader.

Gary Dowdell said:
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.

This is absolutely not true. First, it's not an issue of "containment" as much as it is mitigation. Using the same data source, the per capita case counts and deaths are much lower in most of the world. It's not even close. It is interesting though that the UK, Italy, Belgium, Spain, France and Sweden (you know, the didn't lock down anything country) has had more deaths per capita. The next largest country with more cases per capita is Peru, with a tenth of our population.

And it's not even remotely true that the US had the same curves. The US in fact didn't have a curve at all. America gave up before it ever came back down, which is vastly different even from the UK, Italy, Belgium, Spain and France, all of whom did have a proper bell curve (Sweden is still on the up and up). Look for yourself.

The Lancet piece you refer to is about the flu, and does not have anything to do with Covid-19 rates. In fact, going back to the same data source you quoted, in NYC they put 1 in 4 deaths at 64 or younger. 47% of the deaths are over 74, which is a far cry from 80%.

And while we're on the subject, race in the US plays a huge role in infection and fatality rates, and it's not the genetics, it's the institutional racism that already put people of color at a disadvantage in access to healthcare and jobs that are not service-oriented.

I hope I'm wrong, but when you look at data in the hot spots, the body count is predictably following the infection rate as a leading indicator, and it seems reasonable to believe it will get worse. Four months in, I'm not sure why people keep acting surprised when the forecasts and models actually play out as predicted.

All I know is that after 4 months, tons of discussion and lots of changing information, that regardless of all of us looking at and sharing the same stuff, nothing has changed.

If you were fearful and cautious in the beginning, you still find and interpret info to back that stance.

If you were less concerned and and more cavalier in your take at the beginning, you still find and interpret info to back that stance.

We see what we want to. We're all so predictable.

The problem is that when the things people want to see are not grounded in reality, in this case they have a negative effect on others. I never really appreciated how selfish Americans could be prior to this year.

Well, I for one am actively trying to re-evaluate my position whenever new data calls for it. That's why I'm trying to understand why I was/am/might be wrong in predicting that exponential deaths would follow exponential case numbers (and I will claim credit for predicting exponential case growth).

So another thing I thought of:
It may not be the case that beach bro Brad is actually insulated from great aunt Mae. We normally think of deaths as lagging 14 days behind cases, but in this case, if the death will actually come when beach bro Brad goes to the grocery store, infects the clerk, who then infects a nursing home worker, who then infects great aunt Mae, it may be a much more than 14 days before we see the death count follow the case count. We are seeing hospitals filling up, so maybe even with the better capacity and more effective treatments, it's still only a matter of time?

I'd love to be wrong here, but I just have a really hard time reconciling the extreme number of new cases for two weeks with literally no noticeable difference in deaths.

Jeff said:
I never really appreciated how selfish Americans could be prior to this year.

Right? All those "Do what I say because I'm afraid you'll kill me!" people are the worst.

(I'm just trolling 😄)

ApolloAndy said:
Well, I for one am actively trying to re-evaluate my position whenever new data calls for it. That's why I'm trying to understand why I was/am/might be wrong in predicting that exponential deaths would follow exponential case numbers (and I will claim credit for predicting exponential case growth).

Well, I think we've touched on all the possibilities. Who knows when (if?) it will hold up and if it does when/if we'll get a conclusive answer.

But that doesn't mean hypotheticals aren't valuable. What possible reasons could there be if cases take off again, but death stays low in comparison?

I think the four we've hit are the most likely (and realistically, it's probably a combination of those in some ratio):

1. New infections are happening disproptionately among the least vulnerable.
2. We're better learned how to protect the most vulnerable.
3. Prevention and treatment methods have improved enough to change the trajectory of those infected and at risk.
4. The threat was overstated early on in some way. (for instance, because with limited and equal spread among the population the most vulnerable were skewing the data or because testing has improved enough that we're getting better mortality rate numbers or something like that.)

I can't think of another reason we'd see cases rise disproportionately to deaths when compared to earlier - assuming we do. And exactly how long do we have to wait to start making that call? What date are using for the beginning of the new surge in cases?

I'm just putting this here for a visual. I understand the two week lag and I probably should have shifted the bottom graph to account for that, but we're not morons - you can visualize it pretty easily.

Daily cases bottomed out on June 15 with 18,307. There's no date after that with a lower number. I'd call that the beginning of the latest surge.

Two weeks is June 29th - which is literally the valley just before that cute rounded off wave at the end of the death chart. A perfect match.

In theory, that chart should take off any second now.

We normally think of deaths as lagging 14 days behind cases, but in this case, if the death will actually come when beach bro Brad goes to the grocery store, infects the clerk, who then infects a nursing home worker, who then infects great aunt Mae, it may be a much more than 14 days before we see the death count follow the case count.

But how's that different than before? Beach Bro Brad was at spring break in March. The patterns shouldn't have changed unless he's now actively worried about Great Aunt Mae. And if they have, I would think that would lead to the clerk, the nursing home worker and Aunt Mae herself changing their behaviors as well (in general) meaning less deaths, not a longer lag. (reasons #1 and #2 above)

I guess I'm not sure why there'd suddenly be more stops between A and B than before...and if there is, that could mean more places for the chain to break before Aunt Mae as much as it could mean a longer ride to Aunt Mae.

And then, right on cue, this story comes across my feed:

Dr. Anthony Fauci says the average age of U.S. coronavirus patients has dropped by 15 years as Sun Belt states gets hit

"The average age of people getting infected now is a decade and a half younger than it was a few months ago particularly when New York and New Orleans and Chicago were getting hit very badly," Fauci said.

While young people are less likely to develop serious illnesses from Covid-19, Fauci warned that the virus could still "put them out of action for weeks at a time."

Which lends itself to what I've been suggesting. Who it is getting sick matters.

Few thoughts:

Deaths may increase given that hospitalizations are lagging of cases and deaths lag further. If that happens, may be a lower proportional increase than the increase in the number of cases. We shall see.

When decisions were made to re-open, increased cases were expected. Goal was to avoid spikes which certain areas have not done. Other states have seen increases but not exponential growth.

Younger people are more likely to be significantly impacted by lockdowns/stay at home orders in terms of economics (loss of income and less in savings as a buffer) and socially. Also less likely to be seriously affected by the virus. Doesn't mean their risk is zero but it is significantly less. Older people are less likely to be significantly impacted by lockdowns/stay at home orders in terms of economics (retired and on a pension/social security will not be materially impacted). More likely to have serious problems with the virus. Creates conflicts as general matter.

If you assume there was a limited time during which lockdowns/stay at home orders would be accepted/followed (and looking at what we see, that appears to be a valid assumption), some states may have shut down too early. Some US states have had curves similar to what are viewed as successful curves. Large spikes initially followed by reductions in cases. Ohio didn't have a huge spike but had cases at a relatively low level which has continued pretty steady and increased recently. Should states have waited a little longer before shutting down to avoid pressures to open up too soon?

Various states took different tacks. Depending on how you want to measure success, its not clear which ones will be more successful. And more time is needed to see how it all works out. NY/NJ are held out as having done things right. But their per capita deaths are still at the top. By a lot. Will other states catch up? Not clear at this point.

On the death rate: I saw an interesting argument that the apparent disconnect between increasing case counts and death rates is at least in part due to lead time bias.

https://twitter.com/EpiEllie/status/1280305393516904448

I also think that the focus on "well it's not really that deadly after all!" is a fig leaf for "I don't want to have to care about how my actions might impact other people that I don't personally know." But I'm a judgemental SOB, so maybe that's just me.

The fatality rates are already headed up in some states, and the national trend I'm sure will reflect that soon.

Let's go back to the economic cost. Remember Sweden that pretty much didn't do anything? Their economy has contracted just as much or more compared to nations that locked down. The only difference in outcome is that they have more dead people per capita. Remember when the research on the 1918 pandemic suggested that's how this might play out?

Brian Noble said:

I also think that the focus on "well it's not really that deadly after all!" is a fig leaf for "I don't want to have to care about how my actions might impact other people that I don't personally know."

That's absolutely me. Why wouldn't it be everybody? Who is having fun locking down, distancing, wearing masks and living a truncated existence - even temporarily? Of course I welcome information that confirms we can get back to normal and I can quit wasting energy on giving a **** about everyone. I'll flat out say it:

"I don't want to have to care about how my actions might impact other people that I don't personally know."

I happen to really like seeing that perhaps the mortality rate might be trending down and maybe through better understanding we're potentially seeing a better situation. What kind of psychopath looks at that and gets angry? "God Dammit! Things could be looking up! That's bull****!"

How "glass half empty" do you have to be? Yeesh.

I think it's entirely reasonable to be realistic, but positive.

I want to do as little as possible and face as little disruption as possible. Who doesn't? If I see a path to that place, I'm going to sniff around it - while wearing a mask and staying six feet away form everyone, of course.

You're welcome.

Lord Gonchar said:

Brian Noble said:

I also think that the focus on "well it's not really that deadly after all!" is a fig leaf for "I don't want to have to care about how my actions might impact other people that I don't personally know."

That's absolutely me. Why wouldn't it be everybody?

[...]

I want to do as little as possible and face as little disruption as possible. Who doesn't? If I see a path to that place, I'm going to sniff around it - while wearing a mask and staying six feet away form everyone, of course.

You're welcome.

Then it's not you. You are wearing a mask, that helps others more than it helps you, so you do care.I know you like to think you don't care, but you do. I see you.

I'd settle for not feeling shamed by people because I've decided to eat in restaurants and visit theme parks rather than hole up at home on social media and post every chart and graph and quote and sound byte that infers that it's either JUST STAY HOME or you are a selfish prick that is determined to kill everyone's grandmother.

I think you need new friends. ;)

It's primarily just two co workers.

Re: Gonch

What’s tricky, as a human, is differentiating between wanting something to be the case and allowing confirmation bias to make us believe it’s the case. Sniffing around for evidence that the world is the way you hope it is doesn’t necessarily lead to correct conclusions about the way the world actually is.

I came into work today. Have been working from home the past 3+ months. Expectation was this week we would be back in the office. Not everyone who was expected has been in this week. Expect that will continue. Coming into the office, I put people at additional risk in terms of the virus. Work has taken a ton of precautions but no doubt people who have to be in the building would be less at risk if I stayed home (came in a couple of times when it was 100% voluntary just because with same issues to those who have to be in the building). I know most of the people in the building but not all. Certainly not on a personal level. I went out at lunch and got a sandwich. Would have been less risk to others I don't personally know had I brought something from home to eat in my office. I have to drive to work (at least based on where I chose to live). Would have been less risky to those on the road had I lived within walking distance. Lots of balances there.

Seems to me there are a lot of decisions we make every day that increase the risk to people we don't personally know (some who we do personally know as well) at least if you look at staying home more (much less all the time). Even staying at home and ordering things online, am I putting people I don't know personally at higher risk? Does it matter if I "need" them or just want them?

There are acceptable levels of risk that we accept or reject every day. Not everyone draws the same lines. People take different approaches when faced with the same risk (or what is perceived to be the same risk).

I understood the Sweden approach to be more about sustainability than saving the economy. And given we are still early in stages of the pandemic, seems like its too early to know which approach will work out better. Though at this point, Sweden has lower per capita deaths than Belgium, UK, Spain and Italy. And if it were a US state, Sweden would be just outside the top 10 for per capita deaths and less than NY/NJ by a factor of about 3 each.

So as Jeff has mentioned, a deeper dive into the data shows that, though the national average for deaths/day is almost completely unchanged there's still a lot of movement in there. Florida and Texas are on growing upwards trends, Arizona is also on an upward trend but had a big dip around the holiday weekend, California has a slight steady downward trend, South Carolina is beginning an upward trend, and everywhere else is on a steady decline or, in the case of the Northeast, a substantial decline.

So again, maybe this is confirmation bias, but it doesn't look like the data is that far off from what I expected (exponential cases would result in exponential deaths) when viewed statewide instead of nationally.