As a stand alone, California could shut down for quite some time. That would limit deaths. Think about it this way: the state has huge resources many of which come from IT and entertainment - a lot of which can be perpetuated virtually.
So shut down, have self-driving cars (safe on streets without people or human drivers) deliver everything. Have very limited numbers of people packing stuff. You can limit human to human exposure for a few weeks and knock cases right down. Basically, send every person in the state food and suspend all rent and mortgage payments.
Then open up again, wait for cases to rise, and then do it again.
Rinse and repeat until vaccination rescues you.
The longer-term effects of this would be terrible. The economic malaise would have big impacts on mortality within the state - although they are far harder to measure. Some studies have suggested unemployment doubles mortality for the unemployed over the following two years - people like to live for a purpose. Then you have the effects on less rich places.
Finally you have the really broad question: At what point is saving lives worth taking away living? I wrote a dystopian short story on that one...
In terms of viral load I'd suggest spitting in their mouth or sneezing in their face would be very high. Having a few particles waft in from 20 feet away would be very low.
I used the wrong term in the comment. Higher viral load is how much you have, not how much you got hit with. As expected. high viral loads are bad... academic.oup.com/.../5865363
The right term is infection dose and it is a well-established concept.
I had a harder time finding formal papers. They tend to need to do animal studies to understand this better because it is hard to trace infection dose otherwise. Animals aren't exactly human, so there are very real limits. That said, here is a relevant study...
"Only high- and mid-dose animals developed mild multifocal bronchopneumonia alongside liver inflammation. "
In a way, I think this was first used with early innoculations. Before cowpox was discovered, they used to take pustules from those who had smallpox and insert them under the skin of the healthy. This brought on smallpox, but fatality rates were much lower as a result of the nature of exposure (not breathed in in a systemic exposure). It was a more limited exposure.
Sweden has faired POORLY. They didn't isolate or protect the old and they got hit hard before there was much of any medical mitigation. Not as bad as mainstream Europeans, but far worse than other Scandanavians. Given that we know there are hereditary risk factors they didn't do well - just like the Haredi community in NY which got HAMMERED.
That said, despite all of that, rates are falling in Sweden and have collapsed in Ultra-Orthodox NY - suggesting that there is some sort of community immunity being estabished.
They trace to find those who were near them who tested positive earlier, I presume. Standard contact tracing. I'm sure the change is gradual. But I'm also sure it is weird. Perhaps the onset of puberty (adult in some respects but with far less risk aversion than 30-year-olds) provides the shift and it actually occurs a little older than 10 :)
Of course, I don't think you could do it for long enough. I'd suggest draconian mask compliance to allow for moderated exposure. But, again, as I said in the article, I'm not an expert. My goal is to stimulate thoughtful conversation.
I think the FDA is probably the least important part of this. Doctors are figuring out what works and using it. It is an organic, tribal-knowledge, process that moves far faster than formal studies and approvals.
They do test the dead and in many cases classify cases of death "with" COVID as being "from" COVID. It has become clear that COVID can cause fatal strokes, for example.
The biggest studied impact has come from Dexomethazone, but it did next to nothing for mild cases and only helped 1/5th of critical cases. it can't be enough to explain our improvement in outcomes.
Mask compliance in Israel 2 weeks ago, from my unofficial walking around, was very low. People had them on their chins. Nose covering was quite rare. It has shot up more recently.
There is a newly discovered age distinction. 10-19s are awesome transmitters. 0-9 don't transmit much at all... Thus the suggestion to reopen younger education but keep kids 10-19 at home.
Lots of people are at "higher" risk. It appears indo-Europeans are at far higher risk than east Asians. But an obese 30 year old is at lower risk than an otherwise healthy 70 year old.
Those who feel they are at particular risk can isolate themselves more. For example, they don't have to send their kids to school.
Where we can identify clear demographic classes with significant boosts in risk, we can enable isolation. Checks for the pregnant or those with medically diagnosed hypertension etc... But we should aim to limit the isolation somewhat so we can spread the virus well in less vulnerable areas.
(As an aside, I'm following this within the established rules. I'm mostly indo-European, my blood pressure is a bit high and my BMI is 27.5, I sent my youngest two kids to kindergarden this week despite significantly increased spread in my community. One got exposed to a special ed assistant and another diagnosed kid. I'm in isolation now but I do not regret the exposure and will not even if I get very sick. I am at slightly higher risk but my possibly exposure could actually limit risk for those at much higher risk and perhaps hasten the reopening of the economy. To paraphrase a poker player I know, you don't regret the hands you lose - you regret those you played wrong.)
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Changing The Way We Fight Covid-19
As a stand alone, California could shut down for quite some time. That would limit deaths. Think about it this way: the state has huge resources many of which come from IT and entertainment - a lot of which can be perpetuated virtually.
So shut down, have self-driving cars (safe on streets without people or human drivers) deliver everything. Have very limited numbers of people packing stuff. You can limit human to human exposure for a few weeks and knock cases right down. Basically, send every person in the state food and suspend all rent and mortgage payments.
Then open up again, wait for cases to rise, and then do it again.
Rinse and repeat until vaccination rescues you.
The longer-term effects of this would be terrible. The economic malaise would have big impacts on mortality within the state - although they are far harder to measure. Some studies have suggested unemployment doubles mortality for the unemployed over the following two years - people like to live for a purpose. Then you have the effects on less rich places.
Finally you have the really broad question: At what point is saving lives worth taking away living? I wrote a dystopian short story on that one...
https://medium.com/me/stats/post/268cb891e075
Changing The Way We Fight Covid-19
In terms of viral load I'd suggest spitting in their mouth or sneezing in their face would be very high. Having a few particles waft in from 20 feet away would be very low.
Changing The Way We Fight Covid-19
I used the wrong term in the comment. Higher viral load is how much you have, not how much you got hit with. As expected. high viral loads are bad... academic.oup.com/.../5865363
The right term is infection dose and it is a well-established concept.
Here's some tribal knowledge on this: www.latimes.com/.../masks-help-avoid-major-illness-coronavirus
I had a harder time finding formal papers. They tend to need to do animal studies to understand this better because it is hard to trace infection dose otherwise. Animals aren't exactly human, so there are very real limits. That said, here is a relevant study...
www.immunology.ox.ac.uk/.../dose-dependent-response-to-infection-with-sars-cov-2-in-the-ferret-model-evidence-of-protection-to-re-challenge
"Only high- and mid-dose animals developed mild multifocal bronchopneumonia alongside liver inflammation. "
In a way, I think this was first used with early innoculations. Before cowpox was discovered, they used to take pustules from those who had smallpox and insert them under the skin of the healthy. This brought on smallpox, but fatality rates were much lower as a result of the nature of exposure (not breathed in in a systemic exposure). It was a more limited exposure.
Changing The Way We Fight Covid-19
Sweden has faired POORLY. They didn't isolate or protect the old and they got hit hard before there was much of any medical mitigation. Not as bad as mainstream Europeans, but far worse than other Scandanavians. Given that we know there are hereditary risk factors they didn't do well - just like the Haredi community in NY which got HAMMERED.
That said, despite all of that, rates are falling in Sweden and have collapsed in Ultra-Orthodox NY - suggesting that there is some sort of community immunity being estabished.
Changing The Way We Fight Covid-19
They trace to find those who were near them who tested positive earlier, I presume. Standard contact tracing. I'm sure the change is gradual. But I'm also sure it is weird. Perhaps the onset of puberty (adult in some respects but with far less risk aversion than 30-year-olds) provides the shift and it actually occurs a little older than 10 :)
Changing The Way We Fight Covid-19
Of course, I don't think you could do it for long enough. I'd suggest draconian mask compliance to allow for moderated exposure. But, again, as I said in the article, I'm not an expert. My goal is to stimulate thoughtful conversation.
Changing The Way We Fight Covid-19
I think the FDA is probably the least important part of this. Doctors are figuring out what works and using it. It is an organic, tribal-knowledge, process that moves far faster than formal studies and approvals.
They do test the dead and in many cases classify cases of death "with" COVID as being "from" COVID. It has become clear that COVID can cause fatal strokes, for example.
The biggest studied impact has come from Dexomethazone, but it did next to nothing for mild cases and only helped 1/5th of critical cases. it can't be enough to explain our improvement in outcomes.
Changing The Way We Fight Covid-19
Mask compliance in Israel 2 weeks ago, from my unofficial walking around, was very low. People had them on their chins. Nose covering was quite rare. It has shot up more recently.
Changing The Way We Fight Covid-19
There is a newly discovered age distinction. 10-19s are awesome transmitters. 0-9 don't transmit much at all... Thus the suggestion to reopen younger education but keep kids 10-19 at home.
www.nytimes.com/.../...virus-children-schools.html
Changing The Way We Fight Covid-19
Lots of people are at "higher" risk. It appears indo-Europeans are at far higher risk than east Asians. But an obese 30 year old is at lower risk than an otherwise healthy 70 year old.
Those who feel they are at particular risk can isolate themselves more. For example, they don't have to send their kids to school.
Where we can identify clear demographic classes with significant boosts in risk, we can enable isolation. Checks for the pregnant or those with medically diagnosed hypertension etc... But we should aim to limit the isolation somewhat so we can spread the virus well in less vulnerable areas.
(As an aside, I'm following this within the established rules. I'm mostly indo-European, my blood pressure is a bit high and my BMI is 27.5, I sent my youngest two kids to kindergarden this week despite significantly increased spread in my community. One got exposed to a special ed assistant and another diagnosed kid. I'm in isolation now but I do not regret the exposure and will not even if I get very sick. I am at slightly higher risk but my possibly exposure could actually limit risk for those at much higher risk and perhaps hasten the reopening of the economy. To paraphrase a poker player I know, you don't regret the hands you lose - you regret those you played wrong.)