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I actually agree with this. If the federal government had closed the borders (I though our President was in favor of this), made isolation at home mandatory for 3 weeks, and paid everyone a UBI for 3 weeks, we'd likely be much better off than we are now, with likely far less deaths, and having paid far less in federal aid.
Vietnam, Singapore, South Korea . . . come to mind.
No country is immune. Just some did/do a much better job. It's leadership. Something that the USA is lacking right now.
Off-topic, but that's a common lament in rural-living. Contrary to popular belief, it's quite the common situation, that neighbors rarely meet. .
I grew up in a small town in northern Arizona, and I remember it being that way in my neighborhood.
My family's home was outside the main areas of town, we didn't have a large amount of neighbors, and for the ones we did have, I couldn't have told you what they looked like.
The one exception being a family who lived around the corner, and then, only because the oldest boy was in my class at school.
And that's YOUR fear, one that I find completely unfounded as it pertains to making masks something permanently required and punishable by law. You see how that goes both ways?
Let's stop here before going further; I wonder why this misunderstanding persists. The two potential "new abnormals" that we want to avoid would be (1) past-the-point-of-necessity municipal mask mandates and (2) past-the-point-of-necessity cultural expectations around safety (i.e. maskless = unsafe).
While #1 may vary depending on where you live (e.g. most cities will probably persist in mask mandates for at least 6-12 months even after the first widely available vaccine) #2 is powerful enough to drive #1 at times, and even when it isn't, it's still a factor that can dwarf actual facts. Masks indoors where there may be vulnerable people makes sense as a temporary measure, but we did not stop there. The revolution in how masks are looked at (a cultural revolution, if you will) has transformed them into a savior relic prone to data attribution errors (more on that later). This may be hard to appreciate if you haven't been living someplace where outdoor, socially-distanced mask wearing is at least 90% and no less than 1 out of every 5 drivers masks up in their car.
Society elevating a helpful, but limited DIY tool into a holy grail and a safety blanket is something that has precedent for persisting past the point of sanity and certainly past the point of legal mandates and fines.
Quote:
Originally Posted by DubbleT
How long? Maybe when the risk of catching the virus are substantially lower, whether that's through some kind of herd immunity, a vaccine, or a mutation in the virus itself. Maybe when treatment improves to the point that a high risk patient who becomes infected can go to the hospital and have a good chance of coming home. Maybe when we know more about the after effects of Covid19 and how serious/long lasting those complications are, and whether that's actually a bigger problem we need to protect against than we realize right now.
So you tell me, what's a good number for those? What's acceptable? Do we say that if one of every ten patients admitted to the hospital survives we're good to go? If fewer than sixty percent of hospitalized patients develop lasting, debilitating complications we declare that as the magic number and decide that taking further precautions is pointless? How far into the future do you think we might hit whatever the magic numbers are, and can you estimate a date for me on that?
I'll blend the "maybe when"s with the "what do you think" pointers.
1) Community Spread. We overstate the importance of this metric in a vacuum when it's high, and understate the importance of it by itself when it's low. Let's say that 5% test positivity is what we'd like to see. (I don't find the R calculations terribly useful as they require the full breadth of infections, not just confirmed cases, which is generally not knowable until the pandemic is over, and at any rate they fluctuate wildly once low numbers have been reached.)
If testing % positivity is over that 5% threshold, what else do we know about how much harm the virus is doing? We can look to hospitalization data, which tends to lag by a week or less, and deaths, which lag by 2-4 weeks. A virus that spreads in the community without causing much harm, we can agree, is not worth months of lingering restrictions.
We're obviously not at that point with COVID-19 - but we're going to arrive there at some point. With or without a vaccine, the "end state" of the virus is to become endemic. Like the flu and the common cold, it will stay around and spike seasonally but cause very little harm in aggregate.
If we refuse to accept this because we believe we can control it into extinction (we can't), we'll be stuck with masks longer than we need. If we reach a point where the virus truly is doing little harm like the flu and cold, but we fail to incorporate this positive information because we are obsessed with case counts, we'll be stuck with masks longer than we need.
If community spread is persistently low, on the other hand, it's a sign that we may be at a point where we can begin returning to normal. Most states in the northeast have been under 5% case positivity for several months now. They should drop all outdoor mask requirements except for events where crowds will persist (e.g. public protests) and allow businesses to make their own decisions about mandates. Grocery stores in cities will likely maintain mandates longer than grocery stores in small towns, and this makes sense: data proves that this is a virus that rises and falls according to urban density.
Why are we unable to make that happen? Well, we got hit hard in March and April. We're traumatized. We're petrified that any growth - even the natural noisy fluctuation that happens when numbers are very low - marks the return of exponential growth. We can't sally forth without an artifact that makes us feel safe.
And then there is the attribution error fallacy. If societal numbers haven't done what we like, we conclude that it can only be because mask mandates are lacking, or else not being adequately followed. If the numbers do get better, we conclude it can only be because of the mask mandates. This creates a catch-22 trap: once we decide that masks, and only masks, are what have salvaged us, we'll be unable to let go of them for fear the scary numbers will return.
Some examples to illustrate this point: the outbreaks in AZ/FL/TX are now in free-fall after spending a month climbing - just like we've seen in the vast majority of European countries, regardless of what level of interventions they chose. But it must be because the mask mandates (implemented 2-4 weeks prior to peak) finally started working!
But NY/NJ/MA/CT only started mandating masks broadly once the numbers had turned the corner from the peak and were heading down. Well, that must be because the morally superior citizens of those states masked up voluntarily! But CA and HI have had mask mandates for months and their numbers only started spiking recently. It must be because people stopped wearing masks!
It's a vicious cycle of logical fallacies - and it's inescapable - but only if we allow it to be.
2) Hospitalizations and Mortality Outcomes. If we want these to "get lower" it's important to baseline our starting point.
I'll be using Youyang Gu's model for most of this, since his projections have been better than the others' and since it avails the data in an intuitive way.
Right now, we're at an even 170,000 deaths off a known 5.4m cases and an estimated 44.5m total infections. That would give you about a 3.15% CFR and a 0.38% IFR.
Not to get sidetracked, but while I think Gu's estimate of total infections is credible (and possibly an undercount if non-antibody-producing T-cell survivors are widespread) let's build in some error and create a range. The lower bound of his # total infections is 32.8m. Now we can say that the IFR is somewhere between 0.38% and 0.52%.
So the survival rate is somewhere between 99.48% and 99.62% in the U.S. Good info to start with. But we should clarify that, because we've really had two different waves so far: the Northeast in April/May, where treatments and protection of LTC facilities were poor, and the South/Southwest in June/July.
Let's show the difference by bifurcating these waves at May 26, the point at which the first wave's infections bottomed out.
Wave 1: Total deaths = 101,843; Infections = 12.0m - 16.4m; IFR = 0.62% - 0.85% Wave 2: Total deaths = 68,206; Infections = 20.8m - 28.1m; IFR = 0.24% - 0.33%
You can contest these results a little depending on whether you believe deaths have been over- or under-counted (IMO it's both and both are marginal) but there's really no denying that the second wave has had a wildly better outcome than the first.
If this trend persists even if cases climb again due to the fall/winter and/or schools reopening, and if the IFR range starts to drop into the high teens, IMO it's time to cut the umbilical cord and start getting back to life without masks.
(If those criteria don't pan out? Then keep them for a little longer! No argument from me.)
The one metric that, unfortunately, I can't wave-split is hospitalizations, since the only time tracker I can find for the cumulative count seems to be down. But the CDC has us right now at 144 hospitalizations per 100,000, a cumulative total of 475,000.
That's a hospitalization:infection ratio (range) of 1.0% - 1.4% and a survival:hospitalization rate (assuming all deaths passed through the hospital first) of 64.2%. I think most people would be surprised at how low the first measure is, while feeling like the second measure still needs improvement.
The only sensible thing here that I can think of is to see how extant seasonal colds compare and aim to look more like them (if we don't already).
3) Long Term Effects. Oh boy, have you heard that people are getting all sorts of weird symptoms? Have you heard about the hashtag long coviders? Have you heard that 50% of everyone who gets this will have lifelong brain damage?
This is where we really need to be careful to acquire information rationally (rather than through anecdotes) lest we poison our 'exit criteria' with baseless fears and insatiable end-goals.
I think there's rational common ground: on the one hand, there will absolutely be some degree of recovered cases who take weeks or months to heal, and some subset of them who will have lifelong effects. We know this because every disease, from strep to mononucleosis to the flu, acts the same way. Such cases are real - and rare.
On the other hand, we have overactive imaginations and a tidal wave of collective stress. It's tempting to brainstorm fanciful ideas about how COVID-19 - a disease whose relatively small and rapidly shrinking IFR you just saw above - doubles as a sleeper cell that will endanger the lifespans of the young and healthy who almost always have no idea they even had it.
At the extreme (and by no means do I represent this as 'all' or any stated portion of self-diagnosed suffering) the mind is a powerful thing and mass anxiety is often the explanation for strange effects that persist even while all physical health indicators are normal. If you look up studies of SARS-CoV-1 sequelae, psychosomatic results tend to crop up just as often as real long-term damage.
And so at the other end of the reasonableness spectrum, while we can acknowledge the importance of learning more about long-term recovery, we should also agree that we can't wait 20 years to see what the virus does and keep the masks on the whole time. We should ground our ideas about what the virus might and might not do over the "long haul" in comparisons to similar pathogens (of which we have several 'cousin' coronavirii including the significantly more lethal SARS-CoV-1) and avoid straying into the medical version of apocalypse films.
Very early on, we had a study of 300 patients in China who recovered from severe cases and were encumbered with lung damage and abnormalities. Some of these are probably attributable to the use of ventilators (which universally hurt the body). Some might be pre-existing conditions (studies like these rarely are able to compare the condition of the body prior to the disease: how do we know that severe cases weren't severe because they were already in poor health?). Regardless, all of the abnormalities were gone by the end of month 3. (87 days IIRC, I can dig up a link for the curious.)
A more recent study that's fed the social media panic over "long COVID" has been purported to show that 75% of everyone who gets it will have lasting heart damage. I'll use this as a sample case for why we need to avoid jumping to conclusions - and maintaining a high "burden of proof" for bad news just as much as we do good news.
A: Low sample size of the cohort (60 patients).
B: Cohort was disproportionately comprised of severe cases. Hospitalizations IIRC were about 33% - you can check the numbers up yonder and see for yourself that this is 2350% to 3300% worse than the general population.
C: Results (magnetic scans) were not performed on the cohort prior to COVID illness. They do manage to account for this somewhat through the use of a control group, but...
D: Actual cardiologists find the data unreliable.
E: The chief scary finding reporting (myocarditis) refers to inflammation that is known to be caused by similar infections and is known to heal over time in all but the rare tragic cases.
This whole issue is so important because we presently are over-calibrated towards specious theories and outlier results. The "rare tragic cases" that I mentioned happen with all illnesses but are getting special press attention with COVID-19 alone.
It takes a lot of energy to contextualize (and, sometimes, debunk) stories and theories of long-term damage, but not a lot of energy to spit them out into the deep blue sea. If we treat every single worst-case outcome, no matter how remote, as a "tollgate" for returning to normal, then yes, the question asked by this thread is legitimate and we will be wearing masks forever.
You asked what I think: the evidence today does not suggest COVID-19 is more remarkable than similar illnesses where long-term "damage" is concerned and does not (by itself) justify prolonging mask usage. Remember those numbers, above, that show how total infections lag known cases. We've had something on the order of 30 to 40 million people get this in the U.S. and the worldwide number is likely up to 9 digits. The disruption to society that would've occurred if this truly was a first-of-its-kind mass organ decayer would be not just noticeable in our day to day lives but unavoidable.
Let's stop here before going further; I wonder why this misunderstanding persists. The two potential "new abnormals" that we want to avoid would be (1) past-the-point-of-necessity municipal mask mandates and (2) past-the-point-of-necessity cultural expectations around safety (i.e. maskless = unsafe).
While #1 may vary depending on where you live (e.g. most cities will probably persist in mask mandates for at least 6-12 months even after the first widely available vaccine) #2 is powerful enough to drive #1 at times, and even when it isn't, it's still a factor that can dwarf actual facts. Masks indoors where there may be vulnerable people makes sense as a temporary measure, but we did not stop there. The revolution in how masks are looked at (a cultural revolution, if you will) has transformed them into a savior relic prone to data attribution errors (more on that later). This may be hard to appreciate if you haven't been living someplace where outdoor, socially-distanced mask wearing is at least 90% and no less than 1 out of every 5 drivers masks up in their car.
Society elevating a helpful, but limited DIY tool into a holy grail and a safety blanket is something that has precedent for persisting past the point of sanity and certainly past the point of legal mandates and fines.
I'll blend the "maybe when"s with the "what do you think" pointers.
1) Community Spread. We overstate the importance of this metric in a vacuum when it's high, and understate the importance of it by itself when it's low. Let's say that 5% test positivity is what we'd like to see. (I don't find the R calculations terribly useful as they require the full breadth of infections, not just confirmed cases, which is generally not knowable until the pandemic is over, and at any rate they fluctuate wildly once low numbers have been reached.)
If testing % positivity is over that 5% threshold, what else do we know about how much harm the virus is doing? We can look to hospitalization data, which tends to lag by a week or less, and deaths, which lag by 2-4 weeks. A virus that spreads in the community without causing much harm, we can agree, is not worth months of lingering restrictions.
We're obviously not at that point with COVID-19 - but we're going to arrive there at some point. With or without a vaccine, the "end state" of the virus is to become endemic. Like the flu and the common cold, it will stay around and spike seasonally but cause very little harm in aggregate.
If we refuse to accept this because we believe we can control it into extinction (we can't), we'll be stuck with masks longer than we need. If we reach a point where the virus truly is doing little harm like the flu and cold, but we fail to incorporate this positive information because we are obsessed with case counts, we'll be stuck with masks longer than we need.
If community spread is persistently low, on the other hand, it's a sign that we may be at a point where we can begin returning to normal. Most states in the northeast have been under 5% case positivity for several months now. They should drop all outdoor mask requirements except for events where crowds will persist (e.g. public protests) and allow businesses to make their own decisions about mandates. Grocery stores in cities will likely maintain mandates longer than grocery stores in small towns, and this makes sense: data proves that this is a virus that rises and falls according to urban density.
Why are we unable to make that happen? Well, we got hit hard in March and April. We're traumatized. We're petrified that any growth - even the natural noisy fluctuation that happens when numbers are very low - marks the return of exponential growth. We can't sally forth without an artifact that makes us feel safe.
And then there is the attribution error fallacy. If societal numbers haven't done what we like, we conclude that it can only be because mask mandates are lacking, or else not being adequately followed. If the numbers do get better, we conclude it can only be because of the mask mandates. This creates a catch-22 trap: once we decide that masks, and only masks, are what have salvaged us, we'll be unable to let go of them for fear the scary numbers will return.
Some examples to illustrate this point: the outbreaks in AZ/FL/TX are now in free-fall after spending a month climbing - just like we've seen in the vast majority of European countries, regardless of what level of interventions they chose. But it must be because the mask mandates (implemented 2-4 weeks prior to peak) finally started working!
But NY/NJ/MA/CT only started mandating masks broadly once the numbers had turned the corner from the peak and were heading down. Well, that must be because the morally superior citizens of those states masked up voluntarily! But CA and HI have had mask mandates for months and their numbers only started spiking recently. It must be because people stopped wearing masks!
It's a vicious cycle of logical fallacies - and it's inescapable - but only if we allow it to be.
2) Hospitalizations and Mortality Outcomes. If we want these to "get lower" it's important to baseline our starting point.
I'll be using Youyang Gu's model for most of this, since his projections have been better than the others' and since it avails the data in an intuitive way.
Right now, we're at an even 170,000 deaths off a known 5.4m cases and an estimated 44.5m total infections. That would give you about a 3.15% CFR and a 0.38% IFR.
Not to get sidetracked, but while I think Gu's estimate of total infections is credible (and possibly an undercount if non-antibody-producing T-cell survivors are widespread) let's build in some error and create a range. The lower bound of his # total infections is 32.8m. Now we can say that the IFR is somewhere between 0.38% and 0.52%.
So the survival rate is somewhere between 99.48% and 99.62% in the U.S. Good info to start with. But we should clarify that, because we've really had two different waves so far: the Northeast in April/May, where treatments and protection of LTC facilities were poor, and the South/Southwest in June/July.
Let's show the difference by bifurcating these waves at May 26, the point at which the first wave's infections bottomed out.
You can contest these results a little depending on whether you believe deaths have been over- or under-counted (IMO it's both and both are marginal) but there's really no denying that the second wave has had a wildly better outcome than the first.
If this trend persists even if cases climb again due to the fall/winter and/or schools reopening, and if the IFR range starts to drop into the high teens, IMO it's time to cut the umbilical cord and start getting back to life without masks.
(If those criteria don't pan out? Then keep them for a little longer! No argument from me.)
The one metric that, unfortunately, I can't wave-split is hospitalizations, since the only time tracker I can find for the cumulative count seems to be down. But the CDC has us right now at 144 hospitalizations per 100,000, a cumulative total of 475,000.
That's a hospitalization:infection ratio (range) of 1.0% - 1.4% and a survival:hospitalization rate (assuming all deaths passed through the hospital first) of 64.2%. I think most people would be surprised at how low the first measure is, while feeling like the second measure still needs improvement.
The only sensible thing here that I can think of is to see how extant seasonal colds compare and aim to look more like them (if we don't already).
3) Long Term Effects. Oh boy, have you heard that people are getting all sorts of weird symptoms? Have you heard about the hashtag long coviders? Have you heard that 50% of everyone who gets this will have lifelong brain damage?
This is where we really need to be careful to acquire information rationally (rather than through anecdotes) lest we poison our 'exit criteria' with baseless fears and insatiable end-goals.
I think there's rational common ground: on the one hand, there will absolutely be some degree of recovered cases who take weeks or months to heal, and some subset of them who will have lifelong effects. We know this because every disease, from strep to mononucleosis to the flu, acts the same way. Such cases are real - and rare.
On the other hand, we have overactive imaginations and a tidal wave of collective stress. It's tempting to brainstorm fanciful ideas about how COVID-19 - a disease whose relatively small and rapidly shrinking IFR you just saw above - doubles as a sleeper cell that will endanger the lifespans of the young and healthy who almost always have no idea they even had it.
At the extreme (and by no means do I represent this as 'all' or any stated portion of self-diagnosed suffering) the mind is a powerful thing and mass anxiety is often the explanation for strange effects that persist even while all physical health indicators are normal. If you look up studies of SARS-CoV-1 sequelae, psychosomatic results tend to crop up just as often as real long-term damage.
And so at the other end of the reasonableness spectrum, while we can acknowledge the importance of learning more about long-term recovery, we should also agree that we can't wait 20 years to see what the virus does and keep the masks on the whole time. We should ground our ideas about what the virus might and might not do over the "long haul" in comparisons to similar pathogens (of which we have several 'cousin' coronavirii including the significantly more lethal SARS-CoV-1) and avoid straying into the medical version of apocalypse films.
Very early on, we had a study of 300 patients in China who recovered from severe cases and were encumbered with lung damage and abnormalities. Some of these are probably attributable to the use of ventilators (which universally hurt the body). Some might be pre-existing conditions (studies like these rarely are able to compare the condition of the body prior to the disease: how do we know that severe cases weren't severe because they were already in poor health?). Regardless, all of the abnormalities were gone by the end of month 3. (87 days IIRC, I can dig up a link for the curious.)
A more recent study that's fed the social media panic over "long COVID" has been purported to show that 75% of everyone who gets it will have lasting heart damage. I'll use this as a sample case for why we need to avoid jumping to conclusions - and maintaining a high "burden of proof" for bad news just as much as we do good news.
A: Low sample size of the cohort (60 patients).
B: Cohort was disproportionately comprised of severe cases. Hospitalizations IIRC were about 33% - you can check the numbers up yonder and see for yourself that this is 2350% to 3300% worse than the general population.
C: Results (magnetic scans) were not performed on the cohort prior to COVID illness. They do manage to account for this somewhat through the use of a control group, but...
D: Actual cardiologists find the data unreliable.
E: The chief scary finding reporting (myocarditis) refers to inflammation that is known to be caused by similar infections and is known to heal over time in all but the rare tragic cases.
This whole issue is so important because we presently are over-calibrated towards specious theories and outlier results. The "rare tragic cases" that I mentioned happen with all illnesses but are getting special press attention with COVID-19 alone.
It takes a lot of energy to contextualize (and, sometimes, debunk) stories and theories of long-term damage, but not a lot of energy to spit them out into the deep blue sea. If we treat every single worst-case outcome, no matter how remote, as a "tollgate" for returning to normal, then yes, the question asked by this thread is legitimate and we will be wearing masks forever.
You asked what I think: the evidence today does not suggest COVID-19 is more remarkable than similar illnesses where long-term "damage" is concerned and does not (by itself) justify prolonging mask usage. Remember those numbers, above, that show how total infections lag known cases. We've had something on the order of 30 to 40 million people get this in the U.S. and the worldwide number is likely up to 9 digits. The disruption to society that would've occurred if this truly was a first-of-its-kind mass organ decayer would be not just noticeable in our day to day lives but unavoidable.
Very good data: The only problem that I see is the hospital space with so many numbers wanting hospital services. In some cases, people can't get the medical attention and have died.
When that happens, news tend to focus on that and people get the perception that legislators and hospitals do not care.
You have a great day.
elamigo
Very good data: The only problem that I see is the hospital space with so many numbers wanting hospital services. In some cases, people can't get the medical attention and have died.
When that happens, news tend to focus on that and people get the perception that legislators and hospitals do not care.
You have a great day.
elamigo
Yes, the hospital capacity was the very first thing we were worried about defending. Fortunately, we've done well: while there were people who couldn't get the care they needed in Italy because hospitals were over capacity, I'm not aware of hospitals breaching capacity anywhere in the U.S. other than a single hospital in New York briefly in April. In the states that had "Wave 2" spikes (Arizona, Texas, Florida, California) some hospitals hit capacity (usually smaller ones that have few ICU beds) and had to direct people elsewhere, but I'm not aware of anywhere that the "surge capacity" had to even be activated, let alone filled up. It does make sense since although 475,000 total hospitalizations sounds like a lot, they are spread out over the whole 5 months we've been dealing with this thing (albeit, not evenly).
Thanks for reading and attending to the data, a great day to you too.
Let's stop here before going further; I wonder why this misunderstanding persists. The two potential "new abnormals" that we want to avoid would be (1) past-the-point-of-necessity municipal mask mandates and (2) past-the-point-of-necessity cultural expectations around safety (i.e. maskless = unsafe).
While #1 may vary depending on where you live (e.g. most cities will probably persist in mask mandates for at least 6-12 months even after the first widely available vaccine) #2 is powerful enough to drive #1 at times, and even when it isn't, it's still a factor that can dwarf actual facts. Masks indoors where there may be vulnerable people makes sense as a temporary measure, but we did not stop there. The revolution in how masks are looked at (a cultural revolution, if you will) has transformed them into a savior relic prone to data attribution errors (more on that later). This may be hard to appreciate if you haven't been living someplace where outdoor, socially-distanced mask wearing is at least 90% and no less than 1 out of every 5 drivers masks up in their car.
Society elevating a helpful, but limited DIY tool into a holy grail and a safety blanket is something that has precedent for persisting past the point of sanity and certainly past the point of legal mandates and fines.
I'll blend the "maybe when"s with the "what do you think" pointers.
1) Community Spread. We overstate the importance of this metric in a vacuum when it's high, and understate the importance of it by itself when it's low. Let's say that 5% test positivity is what we'd like to see. (I don't find the R calculations terribly useful as they require the full breadth of infections, not just confirmed cases, which is generally not knowable until the pandemic is over, and at any rate they fluctuate wildly once low numbers have been reached.)
If testing % positivity is over that 5% threshold, what else do we know about how much harm the virus is doing? We can look to hospitalization data, which tends to lag by a week or less, and deaths, which lag by 2-4 weeks. A virus that spreads in the community without causing much harm, we can agree, is not worth months of lingering restrictions.
We're obviously not at that point with COVID-19 - but we're going to arrive there at some point. With or without a vaccine, the "end state" of the virus is to become endemic. Like the flu and the common cold, it will stay around and spike seasonally but cause very little harm in aggregate.
If we refuse to accept this because we believe we can control it into extinction (we can't), we'll be stuck with masks longer than we need. If we reach a point where the virus truly is doing little harm like the flu and cold, but we fail to incorporate this positive information because we are obsessed with case counts, we'll be stuck with masks longer than we need.
If community spread is persistently low, on the other hand, it's a sign that we may be at a point where we can begin returning to normal. Most states in the northeast have been under 5% case positivity for several months now. They should drop all outdoor mask requirements except for events where crowds will persist (e.g. public protests) and allow businesses to make their own decisions about mandates. Grocery stores in cities will likely maintain mandates longer than grocery stores in small towns, and this makes sense: data proves that this is a virus that rises and falls according to urban density.
Why are we unable to make that happen? Well, we got hit hard in March and April. We're traumatized. We're petrified that any growth - even the natural noisy fluctuation that happens when numbers are very low - marks the return of exponential growth. We can't sally forth without an artifact that makes us feel safe.
And then there is the attribution error fallacy. If societal numbers haven't done what we like, we conclude that it can only be because mask mandates are lacking, or else not being adequately followed. If the numbers do get better, we conclude it can only be because of the mask mandates. This creates a catch-22 trap: once we decide that masks, and only masks, are what have salvaged us, we'll be unable to let go of them for fear the scary numbers will return.
Some examples to illustrate this point: the outbreaks in AZ/FL/TX are now in free-fall after spending a month climbing - just like we've seen in the vast majority of European countries, regardless of what level of interventions they chose. But it must be because the mask mandates (implemented 2-4 weeks prior to peak) finally started working!
But NY/NJ/MA/CT only started mandating masks broadly once the numbers had turned the corner from the peak and were heading down. Well, that must be because the morally superior citizens of those states masked up voluntarily! But CA and HI have had mask mandates for months and their numbers only started spiking recently. It must be because people stopped wearing masks!
It's a vicious cycle of logical fallacies - and it's inescapable - but only if we allow it to be.
2) Hospitalizations and Mortality Outcomes. If we want these to "get lower" it's important to baseline our starting point.
I'll be using Youyang Gu's model for most of this, since his projections have been better than the others' and since it avails the data in an intuitive way.
Right now, we're at an even 170,000 deaths off a known 5.4m cases and an estimated 44.5m total infections. That would give you about a 3.15% CFR and a 0.38% IFR.
Not to get sidetracked, but while I think Gu's estimate of total infections is credible (and possibly an undercount if non-antibody-producing T-cell survivors are widespread) let's build in some error and create a range. The lower bound of his # total infections is 32.8m. Now we can say that the IFR is somewhere between 0.38% and 0.52%.
So the survival rate is somewhere between 99.48% and 99.62% in the U.S. Good info to start with. But we should clarify that, because we've really had two different waves so far: the Northeast in April/May, where treatments and protection of LTC facilities were poor, and the South/Southwest in June/July.
Let's show the difference by bifurcating these waves at May 26, the point at which the first wave's infections bottomed out.
Wave 1: Total deaths = 101,843; Infections = 12.0m - 16.4m; IFR = 0.62% - 0.85% Wave 2: Total deaths = 68,206; Infections = 20.8m - 28.1m; IFR = 0.24% - 0.33%
You can contest these results a little depending on whether you believe deaths have been over- or under-counted (IMO it's both and both are marginal) but there's really no denying that the second wave has had a wildly better outcome than the first.
If this trend persists even if cases climb again due to the fall/winter and/or schools reopening, and if the IFR range starts to drop into the high teens, IMO it's time to cut the umbilical cord and start getting back to life without masks.
(If those criteria don't pan out? Then keep them for a little longer! No argument from me.)
The one metric that, unfortunately, I can't wave-split is hospitalizations, since the only time tracker I can find for the cumulative count seems to be down. But the CDC has us right now at 144 hospitalizations per 100,000, a cumulative total of 475,000.
That's a hospitalization:infection ratio (range) of 1.0% - 1.4% and a survival:hospitalization rate (assuming all deaths passed through the hospital first) of 64.2%. I think most people would be surprised at how low the first measure is, while feeling like the second measure still needs improvement.
The only sensible thing here that I can think of is to see how extant seasonal colds compare and aim to look more like them (if we don't already).
3) Long Term Effects. Oh boy, have you heard that people are getting all sorts of weird symptoms? Have you heard about the hashtag long coviders? Have you heard that 50% of everyone who gets this will have lifelong brain damage?
This is where we really need to be careful to acquire information rationally (rather than through anecdotes) lest we poison our 'exit criteria' with baseless fears and insatiable end-goals.
I think there's rational common ground: on the one hand, there will absolutely be some degree of recovered cases who take weeks or months to heal, and some subset of them who will have lifelong effects. We know this because every disease, from strep to mononucleosis to the flu, acts the same way. Such cases are real - and rare.
On the other hand, we have overactive imaginations and a tidal wave of collective stress. It's tempting to brainstorm fanciful ideas about how COVID-19 - a disease whose relatively small and rapidly shrinking IFR you just saw above - doubles as a sleeper cell that will endanger the lifespans of the young and healthy who almost always have no idea they even had it.
At the extreme (and by no means do I represent this as 'all' or any stated portion of self-diagnosed suffering) the mind is a powerful thing and mass anxiety is often the explanation for strange effects that persist even while all physical health indicators are normal. If you look up studies of SARS-CoV-1 sequelae, psychosomatic results tend to crop up just as often as real long-term damage.
And so at the other end of the reasonableness spectrum, while we can acknowledge the importance of learning more about long-term recovery, we should also agree that we can't wait 20 years to see what the virus does and keep the masks on the whole time. We should ground our ideas about what the virus might and might not do over the "long haul" in comparisons to similar pathogens (of which we have several 'cousin' coronavirii including the significantly more lethal SARS-CoV-1) and avoid straying into the medical version of apocalypse films.
Very early on, we had a study of 300 patients in China who recovered from severe cases and were encumbered with lung damage and abnormalities. Some of these are probably attributable to the use of ventilators (which universally hurt the body). Some might be pre-existing conditions (studies like these rarely are able to compare the condition of the body prior to the disease: how do we know that severe cases weren't severe because they were already in poor health?). Regardless, all of the abnormalities were gone by the end of month 3. (87 days IIRC, I can dig up a link for the curious.)
A more recent study that's fed the social media panic over "long COVID" has been purported to show that 75% of everyone who gets it will have lasting heart damage. I'll use this as a sample case for why we need to avoid jumping to conclusions - and maintaining a high "burden of proof" for bad news just as much as we do good news.
A: Low sample size of the cohort (60 patients).
B: Cohort was disproportionately comprised of severe cases. Hospitalizations IIRC were about 33% - you can check the numbers up yonder and see for yourself that this is 2350% to 3300% worse than the general population.
C: Results (magnetic scans) were not performed on the cohort prior to COVID illness. They do manage to account for this somewhat through the use of a control group, but...
D: Actual cardiologists find the data unreliable.
E: The chief scary finding reporting (myocarditis) refers to inflammation that is known to be caused by similar infections and is known to heal over time in all but the rare tragic cases.
This whole issue is so important because we presently are over-calibrated towards specious theories and outlier results. The "rare tragic cases" that I mentioned happen with all illnesses but are getting special press attention with COVID-19 alone.
It takes a lot of energy to contextualize (and, sometimes, debunk) stories and theories of long-term damage, but not a lot of energy to spit them out into the deep blue sea. If we treat every single worst-case outcome, no matter how remote, as a "tollgate" for returning to normal, then yes, the question asked by this thread is legitimate and we will be wearing masks forever.
You asked what I think: the evidence today does not suggest COVID-19 is more remarkable than similar illnesses where long-term "damage" is concerned and does not (by itself) justify prolonging mask usage. Remember those numbers, above, that show how total infections lag known cases. We've had something on the order of 30 to 40 million people get this in the U.S. and the worldwide number is likely up to 9 digits. The disruption to society that would've occurred if this truly was a first-of-its-kind mass organ decayer would be not just noticeable in our day to day lives but unavoidable.
From one Matt to another--tremendous post, one of the best I've ever encountered on this site.
What I think Americans need is a good dose of math.
As someone who dabbles in gambling, I have a bit better sense of what 97, 98, 99% actually means. If I had 1 out of 100 odds to win at any particular casino game, I'd be RICH and the casino would be bankrupt.
What people don't seem to realize is that 1% across the whole of a population is a huge number. Even .1% is big.
What I've learned about the United States these past 5 months is just how violent a country it is. To an almost pathological degree. I always knew America had a propensity for violence which is evident from its past, but it at least seemed to be directed at some kind of "others." I didn't think they would be so callous to their own.
What's become evident is that, in order to avoid inconvenience, Americans will gladly accept the random deaths of 1% of their own number, and worse, denigrate those who try to put in place measures to protect those people.
It makes me wonder how high the percentage would have to get for them to act differently and actually try to protect each other and work together rather than just callously handwaving hundreds of thousands of deaths. 5%? 10%?
Last edited by redguard57; 08-22-2020 at 12:05 PM..
What I think Americans need is a good dose of math.
As someone who dabbles in gambling, I have a bit better sense of what 97, 98, 99% actually means. If I had 1 out of 100 odds to win at any partiucular casino game, I'd be RICH and the casino would be bankrupt.
What people don't seem to realize is that 1% across the whole of a population is a huge number. Even .1% is big.
What I've learned about the United States these past 5 months is just how violent a country it is. To an pathological degree. I always knew America had a propensity for violence which is evident from its past, but it at least seemed to be directed at some kind of "others." I didn't think they would be so callous to their own.
What's become evident is that, in order to avoid inconvenience, Americans will gladly accept the random deaths of 1% of their own number, and worse, denigrate those who try to put in place measures to protect those people.
It makes me wonder how high the percentage would have to get for them to act differently and actually try to protect each other and work together rather than just callously handwaving hundreds of thousands of deaths. 5%? 10%?
Great post; can't rep you again. It HAS been most disturbing to see this descent into violence. I guess it was always simmering under the surface, who knew. Always cynical, I am still stunned and dismayed at the level of violence and unrest over masks and a few inconveniences to help mitigate the spread.
I am deficient in the math gene, so it is helpful to many of us to spell out the numbers.
For comparison, here in tiny developing-nation of Ecuador, everyone is masked up indoors and outdoors in crowded areas. No one is demonstrating or throwing fits about it. Life goes on almost normally. Most people live with older relatives, so care about the vulnerable population.
Vietnam, Singapore, South Korea . . . come to mind.
No country is immune. Just some did/do a much better job. It's leadership. Something that the USA is lacking right now.
Agree that US could have close the border sooner.
The populous there are more attune to the game of "Simon says".
Any dissension that is interpreted as anti-social and disruptive, will be dealt with swiftly.
It takes all to comply concertedly and not just the leaders alone to hold the bag at a time like this.
Yes, the hospital capacity was the very first thing we were worried about defending. Fortunately, we've done well: while there were people who couldn't get the care they needed in Italy because hospitals were over capacity, I'm not aware of hospitals breaching capacity anywhere in the U.S. other than a single hospital in New York briefly in April. In the states that had "Wave 2" spikes (Arizona, Texas, Florida, California) some hospitals hit capacity (usually smaller ones that have few ICU beds) and had to direct people elsewhere, but I'm not aware of anywhere that the "surge capacity" had to even be activated, let alone filled up. It does make sense since although 475,000 total hospitalizations sounds like a lot, they are spread out over the whole 5 months we've been dealing with this thing (albeit, not evenly).
Thanks for reading and attending to the data, a great day to you too.
I just thought of another angle. For the sake of argument, let us say that hospitals have not reached the point of over capacity. Why? From what I have read and seen in the news, they have not reach that level because they had to put aside other needed services for other people that still have medical issues. I have read that some people had to wait longer and actually got worse or died because of the long wait.
Also, based on the data that you provided, what makes this issue a problem is that we do not have a vaccination to it, and the medical field is still learning about what other problems it causes. Some are long time effects on people of different ages. At first, it seemed it did not affect children much. Now, they are finding out that it does. Also, they are finding out more about long term effects. That is why, to me, it is important that a level of higher priority is required over other viruses because there are vaccinations and doctors have a better understanding on how to treat them.
That is why I think the medical experts and the citizen have validity in paying more attention to it than other diseases. Actually, in some cases, there may be more cases of other viruses but vaccinations and established procedures are in place.
You have a great day.
elamigo
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