Good critique of the herd immunity strategy

Herd Immunity sounds promising for a once-in-a-lifetime disease. But if immunity only lasts 12 to 24 months, that’s a, several time per decade disease, which sounds like a less attractive deal.

Let’s say the Infection Fatality Rate is just 0.5% per run to Herd Immunity, which would be achieved at, say, 60% of the US population of 330 million or about 1,000,000 deaths each time.

Let’s say it takes one year of widespread illness and dying to reach herd immunity and then the whole process starts over again 18 months later. That’s four times per decade. But it could be even more frequent than that.

That raises the question of how bad the next several runs to herd immunity would be. My guess is the IFR would decline because you are progressively killing off the the most vulnerable so the disease faces diminishing returns the next several times through. Perhaps people even get more resistant to the disease each time they have it.

Plus, obviously huge resources will be devoted to improving therapy each time. If a million plus people die in America the first run to herd immunity, we will attain a huge sample size of data of how to treat people, which should prove useful in lowering the death toll in subsequent waves.

But then again maybe not. Maybe people get progressively more worn down each time they catch it?

Now it could be that the timing of a vaccine works out perfectly and we get to Herd Immunity the first time about a year before a vaccine arrives so we don’t have to do it all over again and again.

But then again, how do we know herd immunity will happen all that fast? You want it to arrive slowly enough that the hospitals aren’t overwhelmed, but not so slowly that the economy never gets to revive from most people being (briefly) immune. But what if lots of people want to hunker down and avoid being a sacrificial lamb? This sounds like a Herd Immunity strategy might blunder into a worst of both worlds, with huge numbers being made deeply ill but the economic downturn dragging on for several years as scores of millions hunker down and don’t spend a lot of money pursuing an active social life.

Advocates of a Herd Immunity strategy really need to get out their spreadsheets and do the math of how this would turn out to be a good thing. Perhaps it is the best alternative, but, please, show your work.

Here is the link from Steve Sailer.  Via Kyle.

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The proper term is endemic.

"Darwinian natural selection" is a more honest name because it implies serious consequences including death. "Herd immunity" sounds like fake cheery marketing BS where everybody gets a participation trophy and nobody dies.

+1

Add in a little innumeracy and a belief in luck.

Herd immunity is real and works. But the real issue here is that we may be faced with a new and continuing threat that will take a toll of the population into the future and perhaps forever.

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It’s not lockdown = life, herd immunity = death. Look at the numbers, the lockdown countries have many deaths too. In fact the highest relative death toll may be NYC, a locked down city

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Not even flu is endemic except for in some tropical regions (https://www.who.int/immunization/diseases/influenza/en/), unless you are misusing the term "endemic" and mean something else (https://www.medicinenet.com/script/main/art.asp?articlekey=3234). The chances of coronavirus becoming endemic seem quite low. For those on both sides of the herd immunity debate, the key question is what is the natural reservoir of this coronavirus and would it actually become a seasonal epidemic. If the jump from the natural reservoir to the human population doesn't occur that often (maybe people will stop eating bats), then the probability is also very low that this becomes a seasonal epidemic. I am disappointed to have seen little to no discussion of this question (which I feel virologists should have something to say about).

We do have this https://www.discovermagazine.com/health/could-we-be-living-with-covid-19-forever

" There's precedent for a coronavirus becoming endemic in the human population. Actually, there are four of them:: 229E, NL63, OC43 and HKU1. All four of these coronaviruses cause symptoms of the common cold, and infections are most often fairly mild.

“We do know about other coronaviruses, it’s not like this is a virus that’s completely out of a new category,” says Amesh Adalja, a senior scholar at the Johns Hopkins Bloomberg School of Public Health’s Center for Health Security. “I think this will join those four other coronaviruses and have a similar pattern [of recurrence] after this first wave.”

Keep in mind too that there has never been a human vaccine for a coronavirus.

These are benign coronaviruses. Together they cause 1/5 of all colds. They’re not problematic enough to warrant getting a vaccine.
If a vaccine was developed for one of them, who would take it ?
There’s a vaccine for a feline Coronavirus FCoV

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"I think this will join those four other coronaviruses and have a similar pattern [of recurrence] after this first wave". But why does he think that? Since he "knows about other coronaviruses", how many other coronaviruses are there that have infected humans and not become recurring epidemics or endemic? I'm not saying that C19 can't become seasonal or endemic, but I haven't seen any reason to think that it would. Also, why would we think it would infect 60% of the population each time? With herd immunity, the probability of it becoming widespread every season (if in fact it becomes seasonal) seems rather low.

Suppression seems to be not a viable option. I don't know why Tyler thinks Sailer's critique is a good one, since Tyler thinks the lockdowns can't be sustained, and the only way to get the spread of the disease under enough control to make a test and trace strategy work would be an even more severe and longer lockdown. So this critique should be DOA if Tyler follows his beliefs about the actual sustainability of lockdowns.

If suppression is not on the table and if there is pessimism about a vaccine, what other choice is there besides herd immunity? Perhaps if the virus flares up again, a better disease monitoring mechanism will be in place so that test and trace will be easier.

There is also this: "The transition from pandemic to seasonal circulation is well established for influenza, wherein, following an influenza pandemic, the novel virus becomes the new seasonal virus, replacing the previous A subtype [34]. The 4 current HCoVs have been circulating for decades, and it is unclear how they initially emerged or whether they replaced previously circulating viruses [35]. Contrary to influenza, MERS and SARS have not become a fixed presence in seasonal respiratory illness circulation on a global scale. Only time will tell if SARS-CoV-2 will become a continuing presence in the seasonal HCoV landscape, continue with limited circulation as with MERS, or, like SARS, disappear from humans altogether."
https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiaa161/5815743

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Herd immunity is just the latest tactic to continue flattening the economy. In Boston, a preliminary study shows approximately 10% have or are infected with minimal or no symptoms. Per the illustrious mayor: “Mayor Martin Walsh said the still-high number of people who haven’t been exposed to the virus — more people than the city expected, he said — means any reopening needs to be done very carefully. Mayor Martin Walsh said the still-high number of people who haven’t been exposed to the virus — more people than the city expected, he said — means any reopening needs to be done very carefully.” So, we’ll reopen when I say so.

As of yesterday, the Case Fatality Rate (deaths divided by positive cases) is around 5.7%. But a number of studies have indicated that asymptomatic cases range from 2-15%. Taking the Boston study for example, would project that there are roughly 33,000,000 additional cases, which gives you an Infection Fatality Rate (IFR) of 0.24%. Then there are the possibilities that fatalities are overstated due to financial incentives and the existence of comorbidities that impair health yet the cause of death is listed as Wuhan virus. The seasonal flu is estimated to have caused 12-61K deaths in the last ten years, with an estimated IFR averaging around 0.1%. And we have a (variably effective) vaccine for the flu. Several recent epidemics e.g, the Hong Kong flu of 1968-69 were estimated to have killed 100k in the US.

Add in the fact that the current outbreak is largely focused on the elderly and those nursing home residents unfortunate to be under Democrat governors, tell me again why I should be cowering in fear in my house?

New York City population - 8.4 million
Deaths from covid-19 in NYC - 14,000
Implied infected population in NYC, assuming IFR of 0.24% - 5.8 million

What evidence is there, Rich, that 5.8 million New Yorkers have been infected? Cite your sources and show your work.

+1 Thank you Ricardo. Challenges those who fail to link to sources. You can stop disinformation that way or improve the discussion.

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"On Wednesday, a study of 60,000 people was published by the Spanish government. It suggested only five per cent of the country's population has been infected, so far. The results did vary massively across the country: Madrid has a prevalence rate of 11.3 per cent; but in provinces in the south, east and north-west of the country, the rate is much lower. In Seville, for example, 2.3 per cent of people have contracted COVID-19.

Yesterday, a survey of 11,000 households in England suggested one in four hundred is currently infected with the virus - that’s only 0.27 per cent of the population. And in France, a study led by the Pasteur Institute says 4.4 per cent of France (2.8 million people) has been infected. Researchers say the rate even in the worst-hit parts of the country - in the east part and in and around Paris - is still only between nine and ten per cent on average. These same researchers go on to explain that “around 65 per cent of the population should be immune if we want to control the pandemic by the sole means of immunity”.

Clearly, we are a long way from that, except for in Sweden where Johan Giesecke, an epidemiologist advising the authorities there, says Stockholm could reach herd immunity by June. Sweden, though, already has a death rate three times higher than that of its neighbour, Denmark, and seven times that of Finland." https://www.euronews.com/2020/05/15/analysis-how-close-are-we-to-covid-19-herd-immunity

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Not 5.8M, but in that range. NY ran an antibody test on 15K people in the state, and found 12.3% had antibodies. NY state is 20M, so roundish number is that suggests 2.4M in that state have the antibodies and thus have had covid. NY has 28K deaths, so perhaps a IFR of 1.1%

https://www.usnews.com/news/national-news/articles/2020-05-02/new-york-gov-andrew-cuomo-says-15-000-tested-for-coronavirus-antibodies

You just flipped from NYCity figures to NY state figures, and called 2.5 million in the range of 5.8 million.

Your math failures are catching up with your policy analysis failures.

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330,000,000 in US, 8.4 Million in NYC, 14k deaths, therefore 550k deaths in US. Way to cherry pick, a state with Cuomo and DeBlasio.

Florida, 22 million, 2,020 deaths. You have to control for the quality of the government.

https://covidtracking.com/data
https://www.bostonherald.com/2020/05/15/coronavirus-in-boston-10-of-bostonians-have-covid-antibodies/

https://www.cdc.gov/flu/weekly/fluactivitysurv.htm

You’re welcome.

You are using a deaths to date statistic.

Actually, Rich, if you allow it to burn through, any government is irrelevant unless you plan to social distance all your life. It's just the rate of diffusion. t.

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the boldest claim we saw from the boston study was that
1 out of 40 bostonians are currently infectious with the sars2 virus

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This nonsensical, Infection Fatality Rate will (and has ) vary greatly in various locations. The age of those infected and the dosage they receive are both now known to be important factors . Not to mention how they are tallying both the numerator and denominator. Odds are good that New York will be a vary extreme case for the United States.
Really, all the silliness from Tyler and Alex is just rhetorical fun. Herd immunity will be the way forward for the vast majority of US States and countries, simply because there is no other option available that both keeps people working and protects the most vulnerable.

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So I guess boomer Steve wants to crash the economy by shuttering everything so he doesn't die of some flu?

Steve is scared of his own mortality. For a eugenics fan, what a wuss.

There is no herd immunity from death.

Or, don't ask for whom the bell tolls, it tolls only for the genetically inferior.

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Steve is pussy. But he's tough talker against the Mexican who produces shit, unlike himself who is just blowhard.

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Steve is financially capable of hiding the from the virus as long as it takes.

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How are you supposed to achieve herd immunity fast enough when you're distancing and sheltering in place? Steve is hyperventilating again. He's been terrible on this topic.

What happened to Corona Virus from 2003 (Sars-Covid 1)? It returns every 3-4 years, so what, are people in danger? No, people developed immunity and they have immunity now. Others have it at lower levels not detectable or they don't have symptoms.

Is there cure for common cold? What about seasonal flu? No and No. So what? 99% of people have no serious issues with it. People who are very sick to begin with and 80 years old have problems, but they are dying anyway.

I sometimes wonder what the hell is going on and did aliens hijack the world? Who are you people going against nature's cure, it's everywhere, be afraid. If my dad were alive, he would slap your shit.

I am hardly a fan of Steve on race, I don't see an error in this math.

If it really costs a million lives what are you saying?

Accept that loss faster?

"What happened to Corona Virus from 2003 (Sars-Covid 1)? It returns every 3-4 years,"

No, it has not returned to the US.

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"What happened to Corona Virus from 2003 (Sars-Covid 1)? It returns every 3-4 years,"

It had an R0=<1 so it fizzled out.

Covid 19 has an R0 of at least 2:

https://www.businessinsider.com/coronavirus-contagious-r-naught-average-patient-spread-2020-3

https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article

> It had an R0=<1 so it fizzled out.

If it had an Ro < 1, then it would never have gotten a foothold. It would have been a non-issue week 1. Sars-cov-1 (the orginal sars) was much more lethal, but symptoms showed up very early, 2-3 days. With Sars-cov-2, the symptoms take much longer to appear AND in most cases are mild or do not show at all--you just spread it.

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There isn't anything wrong with Steve's math, it is his assumptions which are questionable. Will immunity really be so short lived? Nobody knows yet. Do you really need 60% infection rate to achieve herd immunity? Maybe, maybe not, depends on how infectious the next round turns out. If R is naturally 2.0, then if 50% immunity drops that to 1.0 and it will not take-off. Steve does point out that each round kills off the most vulnerable and so there are fewer in that class the next round.

If the immunity acquired from actually contracting the disease turns out to last only 2 -3 years, why should we expect immunity derived from a vaccine to last longer (assuming a vaccine can be developed)?

Exactly! But even worse, a lot of vaccine candidates which "should" work, don't, which is why vaccine development can take a very long time. And definitely, you can't know how long they will last.

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Even if vaccine induced immunity only lasts two years, having to get revaccinated every two years is quite acceptable. People get annual flu shots now.

-dk

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"What happened to Corona Virus from 2003 (Sars-Covid 1)? It returns every 3-4 years, so what, are people in danger? No, people developed immunity and they have immunity now. Others have it at lower levels not detectable or they don't have symptoms."

You need to cite some evidence for this claim.

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I agree with you. Crashing economy much much worse than virus in terms of deaths and suffering long term, despite full effort to misclassify the Covid deaths.

Boomers learned to use the internet and hijacked the political system in one last hurrah!

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You assume that millions dead lifts the economy.

Or that hospitals overrun with covid patients do not deny care to others who will die from healthcare being unavailable

Or that we will not run out of death certificates and morgues.

> You assume that millions dead lifts the economy.

Well, millions of excess deaths among those that have retired would actually help the economy, morbid as it may be. Smoking was actually a net win for the economy because we have lifetime smokers that got to the age of 65 or 70, and went downhill really, really fast (COPD, heart attack, lung cancer). They never took their SS payments that they'd paid into, and their deaths were relatively quick and didn't required years of expensive assisted living.

I'm not saying let old people die. I'm just saying your initial premise is wrong.

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Again with the hospitals being overrun?

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Your point about hunkering down is supported by Swedish evidence.

The Swedish Economic Focus Group are forecasting a 2020 drop in GDP of 4.9% despite a Government stimulus of 13.8% of GDP. So an average GDP drop and an above average support package.

The health outcome in Sweden looks reasonable compared globally but if you then factor in Sweden ranks 159th in the most densely populated list (less than 10% Germany or the UK) and has high health care expenditure it looks much less good. When you compare Sweden with its Baltic and Nordic neighbours, the numbers are horrible.

https://ourworldindata.org/grapher/total-covid-deaths-per-million?tab=chart&year=2020-04-27&country=DNK+EST+FIN+LVA+LTU+NOR+SWE

Note the trend line going up consistently in Sweden when all the other neighbours have flattened their's.

FT Covid tracking show Swedish excess deaths have peaked. Compared to we Aussies their second wave risk is much lower and fear of it is less of a burden on their economy.

It is crazy to compare some of the predictions of doom for Sweden to the reality - https://twitter.com/HaraldofW/status/1261376362364821504

Let's consider the case if all the Western European states who were hit hard by this and locked down, if they'd stuck to the Swedish strategy: social distancing, handwashing, self isolation, contact tracing, household quarantine, shelter the elderly, but no crude, shotgun blast lockdowns - not in any sense "go for herd immunity", as it was characterised by what can only be described as idiots then (and complete f**king idiots if they persist with the same terminology now). Which is the established science.

It seems very probable they would have been hit about equally as hard, neither much harder or softer, and peaked in death rates about as quickly, with less damage to the economy and much higher immunity among the young population (because all those young, low risk people would still be out and about).

It seems reasonably probable that lockdowns do the opposite of what their proponents claimed they would do, on the basis of these models which have achieved very poor prediction.

The claim was that they cost very little extra, while limiting spread a lot more, but it seems probable to me that they cost a lot more, while limiting spread very little compared to what the other measures already do...

+ 1
Yes, they want to convince us that Sweden is a disaster because they’re higher than Norway.
They’re not saying France, Italy the UK, Spain, Belgium or New York are disasters.
In addition we hear their economy will be just as bad, as though lockdown or no lockdown is irrelevant to the economic outcome.
In NY 84% of the hospitalizations came from people who were locked down ( Cuomo presentation). He called it shocking. The lockdown didn’t help them.

Further down the page there is a Nature link that compares all the European responses.

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My impression is that when a virus mutates, the antibodies to the previous version of the virus are still effective, but to a lesser degree. So the mutated virus is less deadly than otherwise. If this impression is correct, then herd immunity is still valuable.

That depends on the mutation. it might not make any difference or it might render you completely non-immune. And people's response will vary

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You're absolutely right, but even more protective than you realize. Immunity to 2003 SARS-Corona protecting people today, as 7-15% tested positive to Covid-19 antibodies in serum before new virus widespread. The other roughly 90% may also be immune from 2003 but not detectable or virus doesn't penetrate to receptors for any symptoms.

Compare to new flu vaccine which is maybe 30% effective, but with danger of side effects and unknown contamination.

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I think there is way too much uncertainty and unknowns about things like risk of reinfection to start breaking out spreadsheets and math...

In the face of this much uncertainty, the best ethical principle to follow is "first, do no harm." So policy should be relatively laissez-faire (as the coercive restrictions are doing extreme amounts of harm and clearly have not been successful at containing the virus and are not sustainable), while on a personal level, I am still taking a high degree of precautions around what I do to minimize my own risk of catching the virus or spreading it to others.

+1 for the sanity in recognizing the uncertainty

Whether the herd immunity/endemic approach is optimal is not the question. The question is not whether the disease gives long lasting immunity either.

The only question is whether the US will stumble into a Sweden approach by default.

The answer is, obviously, yes. We’re all Swedes now, some of us are just still in denial.

None of the Sweden's neighbors are in denial, and America's response represents failure. Including armed protesters in state capitals demanding the right to not socially distance like the Swedes currently are.

None of the Sweden’s neighbors are? Top kek prior_approval, showing off that GMU education, aren’t you? Six words and two of them are incorrect.

The logic doesn’t even stand on its own, aside from the grammar errors.

Obviously the protestors are in denial, hence the protesting.

As to the neighbors, we won’t know for another year or so.

Are you still planning on running off to Taipei where they did it right?

Dude opposes things like universal healthcare in the United States, but where does he run?

https://www.cnn.com/2020/04/04/asia/taiwan-coronavirus-response-who-intl-hnk/index.html

Seems like you two should quit trolling each other. making you both look dumb. especially you of course anonymous, because your comments particularly are silly "We must do something! What, I don't know!" ism and shoehorning of dopey progressive talking points, e.g. single payer, Trump. But both looking a bit dumb.

My argument has been very simple:

Use successful countries as models, and do what they do.

Skeptical fights that, and then says since the US is hopeless, he wants to go off to Taipei, where they do things right.

Doesn't that strike you as a rather fundamental hypocrisy?

There have been two small successful countries so far: Finland where the virus was contained quickly and Norway, which was probably similar and had the benefit of small nursing homes, unlike Sweden.

Japan, South Korea, Taiwan and Australia can't be compared since obviously something fundamentally different has been happening there with coronavirus. Australia had 100 deaths in 2009/10 from H1N1 and did no special test and tracking nor did Australia have a lockdown while the U.S. had between 9,000 and 18,000 H1N1 deaths. Note the uncertainty. How did that happen?

Japan did almost no social distancing beyond almost never shaking hands and never kissing strangers yet they have had 710 deaths or 50 times fewer per capita that the U.S. with 97% of the population under lockdown. How do you explain Japan?

I thought I asked you, but perhaps it was someone else, where this myth about Japan came from?

Japan’s northern island of Hokkaido offers a grim lesson in the next phase of the battle against COVID-19. It acted quickly and contained an early outbreak of the coronavirus with a 3-week lockdown. But, when the governor lifted restrictions, a second wave of infections hit even harder. Twenty-six days later, the island was forced back into lockdown.

And no, I'm not sure that the "fundamental difference" is not a policy difference. They jumped on it fast.

Japan did not jump on the virus fast. What myth are you talking about. Please be specific.

Sorry, that was two concepts.

There is the myth the Japan never locked down.

And there is the correlation between fast action and fewer cases.

And in terms of "fast" that has to be relative to the initial case count.

Japan never locked down as it can't according to its constitution. It did have an emergency in Hokkaido for a while then lifted and finally declared a national emergency in April 16 that was the same as what Sweden did early on: encourage not going out much and social distancing.

Your second point on speed of the spread is too vague to understand as a "myth."

Don't get hung up on words. Their change in behaviour was dramatic.

The goal was ambitious, with authorities seeking a 70-80 percent reduction in social interaction. The data suggests they got close to that figure and also managed to keep people from their usual annual pilgrimage home during the early May “Golden Week” holidays. Japan Rail said its high-speed train network operated at around 5 percent of capacity over the holiday period, compared with the typical 105 percent. Getting people to work from often cramped apartments was less successful, showing just an 18 percent reduction, but in the streets of central Tokyo, crowds have fallen by around 60 percent, according to mobile phone data. Masks are in use by almost everyone, a request that has invoked few complaints since people here regularly wear masks when ill or to avoid spring pollen.

In addition, Japan closed schools and banned large gatherings and concerts by the end of February. It wouldn't surprise me that much if these actions along with a high degree of voluntary compliance with government requests was enough to make a difference. Singapore's early success may have been due to similar factors, although I don't think Singapore even closed schools.

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For a little compare and contrast:

"'Illinois is closed and we’ve been wanting to get out,' said Castano Penn, a Chicagoan who works at a senior living center and was not wearing a mask Saturday as he strolled the streets of Lake Geneva [Wis]."

"I know it’s probably bad," he said. "I’m just kind of done with it all.”

https://amp.jsonline.com/amp/5207558002

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I'd be very open to just doing the Taiwanese plan, here.

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> Dude opposes things like universal healthcare in the United States, but where does he run?

Taiwan's strength in this wasn't universal health care. It was closing the borders on Jan 23, and aside from a few weeks, keeping them closed for the entire duration.

Pick a country with a solid response and tell me their border policy. I'll bet there's a lot of similarity.

I have never once complained about anyone closing a border for this pandemic. Nor have I complained about mask-wearing. I just don't think you can pick one here either.

I provided a link for Taiwan's response. A universal healthcare definitely helped, but as you say it wasn't the only factor.

I'll just do one response, feel free to troll away after. I'd rather play with my kids.

1 - I don't recall ever opposing the concept of universal healthcare. I suppose this is just random trolling.
2 - I said we would move to Taipei if the US starts to hit the fan. That would be things like 60% unemployment, indefinitely closed schools, 1992 style riots, hyperinflation, etc. Anyone would if they could, if it does get that bad. If it does, it won't have much to do with the virus
3 - Japan closed schools and large gatherings, that was pretty much it (not including Hokkaido). This is much, much less than Sweden and nothing even close to the US. Check out their packed subway lines (they have a unique subway set up, they're all privately run and tickets don't transfer iirc)

4 - Spaced for the attention it deserves:

a) the Taiwan plan, this is strictly enforced quarantines. There's an electronic fence, if you leave the electronic fence under mandatory quarantine you're hit with a $33,000 US (not NT$). This would (Very roughly, I'm not going into PPP) be the equivalent of about a $70,000 (per capita GDP basis) fine for leaving your house under quarantine.
b) the Taiwan plan works because their case count is so low they're able to enforce this. The US is at 1.5 million known cases, which means anywhere from 7.5 million to 30 million cases. Taiwan has 45 active cases. Not 45 thousand. Not 4500. 45 total

4- tldr: even if you could get the US public to do a 180 and agree to mandatory electronic monitoring and fencing, with a $70,000 fine for leaving the electronic fence, it's about 3 months too late for that plan

You're living in a fantasy

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Universal Health Care didn't help Great Britain, who has about twice the per capita death rate as the US.

-dk

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Well said Zaua. If we don't get "sufficient" immunity from this thing, it is hard to see it ever dying out. Which means we will have to live with it. So the lock down strategy makes no sense either in this scenario. Even if you could eradicate it within a country, there is no way we can eradicate it in the world. So unless you want to shut down most travel into your country, eventually it will happen again.

Is that a pragmatic belief or an ideological one?

That is, is there nothing government could do in this situation, or is there just nothing you want government to do?

Remember, for every essay on "there's nothing we can do," there is an example of a country who did something.

All those countries pushing down to zero new cases per week.

"All those countries pushing down to zero new cases per week."

Not any that are comparable. The closest is Germany with 700 new cases a day and they began to open three weeks ago.

You might have to explain more carefully why no other country matches, other than they are successes and so don't count.

Scroll up. I already explained it.

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FWIW, here is the coverage at Nature:

https://www.nature.com/articles/d41586-020-01248-1

That article left out Japan and doesn't inform the reader that as with Japan, South Korea managed to have only 170 N1H1 deaths in 2009/10 (Australia had 100) without major testing or imploring people to stay home yet the U.S. had 12,500 deaths. This isn't string theory. Something very different is happening in Asia than in the West.

Isn't it a fairly consistent difference between the East and West that the East had the fresh lesson of SARS and acted quickly?

No. Australia barely had SARS and as I've repeated Japan wasn't taking much action until eight weeks into coronavirus and tested less than that U.S. That is learning the lesson of SARS?
Taiwan - 85%+ wore masks
Korea - 85%+ wore masks
Japan - 67% wore masks
Australia - very few wore masks

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Not to say mask wearing isn't also important.

I need a little experiment with hamsters and masks here:

https://www.bangkokpost.com/world/1919628/hamster-tests-show-masks-reduce-coronavirus-spread-scientists

Masks work. It's really too bad that so many of us have to rely on homemade.

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Yes, agree, this is what most don't get. We either learn to live with this as the economy crashes around us, or we learn to live with this as the economy limps back and more get sick and die. There is no scenario in the near terms (6 months) were this is eradicated and we get back to normal.

WHO said this week a vaccine might never come. Remember, HIV is a virus we've been fighting for 30 years with enormous resources. And still there's no vaccine. Only therapeutics.

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I think it is odd for you to start from a belief that public health ever had anything to do with laissez-faire.

I mean, going into deep history, it has not.

What is "deep history" for public health? What about charitable hospitals?

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Officially going for herd immunity would still be better than the current half assed approach where we're stuck in perpetual soft lockdowns.

It's much easier to shut an economy down than it is to open up.

And repeat lockdowns will increase the lasting damage on a logarithmic scale.

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48 states open or opening. Care to guess the 2 holdouts?

It's not obvious to me that every state should do the same thing here. Or, that "state" is even the right level at which to implement policy (e.g., NYC vs upstate NY)

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You say:

"Officially going for herd immunity would still be better than the current half assed approach where we're stuck in perpetual soft lockdowns."

But the numbers might be:

"Let’s say the Infection Fatality Rate is just 0.5% per run to Herd Immunity, which would be achieved at, say, 60% of the US population of 330 million or about 1,000,000 deaths each time."

Seriously? Are you buying into a million unnecessary deaths? Is that the American political reality we face?

(Unnecessary because nothing about our response has to be half assed, just get on board.)

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There's no need to "go for herd immunity" like people are intentionally infecting themselves or the gov wants people to get infected as fast as possible or anything.

Just end the "shelter in place" orders and compulsions that probably causes excess damage without much more reducing R, provide some financial support to people in very high risk groups (who aren't already on a pension) and continue with advice of voluntary social distancing, and protecting the elderly.

Is that actually the plan that has returned the best results world-wide?

Or have countries been able to drive their new cases per week down, way down, with national government initiative?

You would have to be able to control for all pre-existing conditions. Sweden is following the settled science.

What is clearly the case that those who asserted that cases would explode in Sweden, on the basis of non-peer reviewed models that were frankly often just some overconfident armchair blogger with no epidemiological background, were just wrong.

Whether Sweden is most optimal will not be known for some time. And to some degree there will be a value judgment of how much extra driving down cases is worth how much sweeping extension of government powers and closing of the economy.

Sorry, no. I regard that as hand-waving and bullshit.

Denmark has bested Sweden, but you won't look at it, not because it down't have better results, but because it is ideologically off limits.

You don't know about the initial differences in conditions; Denmark is small, Sweden is large, etc. Evidence is not "Sweden and Denmark are both Scandinavian, Denmark has had fewer fatalities, so...".

I regard simply conflating Denmark and Sweden as the action of one who has already ideologically decided that he is for lockdowns, because he is in the culture war against anti-lockdown protestors, and then is continuing down that road under the veil of being purely evidence based and neutral. (This is, admittedly, informed by your frequent claims to be a neutral centralist followed by advocacy of whatever the "progressive" preference happens to be at any given time).

Sweden is actually an outlier relative to its neighbors, and not just Denmark. And I think it's pretty clear that you (and many conservatives) are picking it for a reason. It has a plan you *want* to win.

You aren't doing a full global search.

And finally, it's pretty sick after you make that ideologically driven choice to call it "culture war" when you are called on it. It's where you started. You picked a plan compatible with *your* culture.

For redundancy, you did not scour the world for the country with the best results, you *picked one* with the plan you wanted to follow.

I mean if you want to prove that wrong, go ahead, describe some performance metrics, and show to me how Sweden is actually beating the world, making it your hero.

Your comments about "full global search" and "scour the world for the country with the best results" make no sense.

I could say that tiny islands which immediately closed their borders but had no lockdown had the best results (and they do), but it obviously provides no guide for what we should do now.

You can't just copy the "best performing" other country with no reasoning behind your choice to support and then shout down any objections to your lack of reasoning as a fatalism. You have to design a strategy appropriate for your country, based on the facts.

And the facts include (but are not limited to) the claims about lockdowns having the strong effects on growth of cases which was originally claimed, being essentially falsified, and Sweden (and perhaps place like Belarus and certainly other state level examples within the USA) showing this.

So you take that new information, and then you think about a new strategy, that weights the tradeoffs you're happy to make.

Sweden is not important because I am advocating "copying" if, but because it supports the mainstream approach (before people went mad and started advocating scientifically unsupported, extreme, high cost, civil liberty wrecking, approaches) and refutes a falsity.

From there we start, but there is no need to "copy" any other country.

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From the Nature link above:

Meanwhile, Germany and Austria stand out as nations that adopted aggressive and early control strategies compared with Italy, France and Spain, which implemented similar measures, including lockdown, but later in their epidemics, she says. So far, Germany and Austria have, per capita, seen a fraction of the deaths from COVID-19 of these other countries.

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Again, for triple redundancy:

From day one I have been agnostic on plans, other than to say "do what works." That is, whatever can be shown to work world-wide.

I "fight" people who aren't that open. Who instead are matching to ideological partners in the world, and *not* performance partners.

Why is your only focus on world wide plans? Hawaii, Alaska, Wyoming, Utah and Montana have the lowest deaths on a per capita basis. What are some of their plans that succeeded and why aren’t you advocating any of those?

We can certainly compare states or smaller regions in the United States.

But we have to be careful about looking at a level versus a rate of change.

Everyone has a small count when the virus first touches down. The best performers tamp things down, and keep the growth in check.

https://www.npr.org/sections/health-shots/2020/03/16/816707182/map-tracking-the-spread-of-the-coronavirus-in-the-u-s

Indeed, DeBlasio has so much to answer for.

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Herd immunity is US defacto strategy because lack of investment in testing. But herd immunity will take a long time, especially as folks are more cautious. We’re looking at 12 months+ Of economic Armageddon before everyone has had it.

If I recall correctly Tyler's early prediction was that we would go back and forth, open, close, open, close.

That has been looking more likely in the last month. Places like Wisconsin will open until they feel some pain and then close again.

I don't think we'll ever get to a million deaths, but certainly thousands more than we have to.

People want to say stuff like this is off-limits, but come on guys admit that it is a core part of the problem:

https://twitter.com/realDonaldTrump/status/1261993163188830210?s=19

The leader of the nation is not treating it as an epidemiological problem.

>If I recall correctly Tyler's early prediction was that we would go back and forth, open, close, open, close.

Which *is* the correct policy if you are trying to "flatten the curve."

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The EU Spring forecast for Sweden is a decline of 6.1% in Sweden compared with a decline of 6.5% in Germany and 5.9% in Denmark both of which had total lock downs.
https://ec.europa.eu/info/sites/info/files/economy-finance/ecfin_forecast_spring_2020_overview_en_0.pdf

Very significant in that forecast is the the relative 7.5% swing in GDP performance in 2020 between China and the USA and 9% swing in China's favour compared with the EU. Not crunched the numbers but that must bring the date China overtakes the US on all measures into the mid 2020s.

The torch of civilization has passed indeed, whether the Econ metrics have recorded it or not. But the West was only borrowing the torch anyways.

It is the 中国, after all.

Do you mean those folks with the Universal Health Care?

Alas, we up North have universal health care, and we're basically playing "USA results"-lite (maybe half the fatality).

Honestly, this crisis has so many unknowns and unexplained phenomena that its simply a litmus test for our priors. For any direction one leans ideologically, you can find a supporting case, and 3 that make it clear that's it's wrong.

Perfect for endless debates.

I look forward to the post-mortem in about a decade to see what was really going on.

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> I look forward to the post-mortem ...

Ugh. Poor choice of words. Too much software development.

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> Do you mean those folks with the Universal Health Care?

The UK has universal health care. Do you like their numbers?

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I'm not saying anything outlandish here:

Universal healthcare helps you with universal testing and a national plan for isolation and quarantine.

If you don't have one system, if you don't even have a cross-match database for SSN to insurance no, you have to cobble something together.

And people are pointing it that universal health care doesn't seem to affect the results. Which suggests that the factors you cite don't either.

I'm not sure the UK is really that centralized; you have a patchwork of local authority response and others across devolved governments of the nations of the United Kingdom. Germany's response is also heavily federalized, and there are probably many others.

This is not to say that centralization does help or doesn't, but it is mainly the case here that anonymous has decided in past posts that massively more centralization and single-payer healthcare are what the US should have and then asserts reasons for why they help, as if this were fact, to support this.

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In what way do these critiques also not apply to a vaccine strategy? Only good for one season then rinse repeat. Except we also have to crater the economy for 12-24 months on the front end while researching a vaccine.... The solution is to not try to solve covid, but to solve pneumonia, the way covid (and a bucketload of other viruses and conditions) kills. 12 - 24 months could be more than enough time bought by herd immunity to research better pneumonia treatments.

If only we'd thought about working on pneumonia treatments before this.

Seriously... the low hanging fruit is long picked. It's very unlikely that anything quick and affordable is still out there

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Exactly. If herd immunity wears off due to mutations, the vaccine will also cease to be effective (as far as I understand anyway). We can't solve flu, why will we be able to solve this one? These suggestions of immunity wearing off in short order strike me as simple suggestions that we face an apocalypse. A significant fraction of our population will be culled and life expectancy will drop.

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COVID-19 appears to have the following side effects:

Stroke, blood clots in younger patients
https://www.nytimes.com/2020/05/14/health/coronavirus-strokes.html

Heart attack, heart failure
https://medicalxpress.com/news/2020-05-heart-failure-covid-dangerous-cardiovascular.html

Lung damage
"People who survive ARDS and recover from COVID-19 may have lasting pulmonary scarring."
https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/what-coronavirus-does-to-the-lungs

Acute kidney injuries
https://www.reuters.com/article/us-health-coronavirus-kidney/kidney-injury-seen-in-more-than-a-third-of-hospitalized-covid-19-patients-u-s-study-idUSKBN22Q0U7

I like to play a little poker now and then (when cardrooms were open!) but there's no way I'm gambling my health on this thing. I love all my organs. Every one of them.

Then stay in your bomb shelter and don't come out for a year. Nobody owes anything to your love of your organs besides yourself.

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Sure but the numbers are trivial outside of the aged. Lockdown has multiple mortality effects for the young. Very few less Covid deaths, more suicides maybe less deaths from driving and more from drug abuse.

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> COVID-19 appears to have the following side effects:

For people under 40 or 50, COVID is far less dangerous to you than cars. The US loses 34K in car crashes every year. Most aren't alcohol related. NY has lost just 1100 people under the age of 50 to covid, and they have 1/3 of the US deaths. You might extrapolate their data to say nationwide the US has lost under 4000 people age 50 and below to covid.

Car crashes are far more lethal to your average person aged 50 and below.

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Good critique of the herd immunity strategy?

1) Even if one does get re-infected, the severity of the symptoms are a fraction of what one experiences in the initial infection

2) Why don't health authorities and gov'ts stress the importance of losing weight, lowering hypertension, reducing abdominal fat and developing a better insulin response? 90% of the fatalities in NYC involved these co-morbidities.

"Even if one does get re-infected, the severity of the symptoms are a fraction of what one experiences in the initial infection"
Yeah, actually you have zero idea if this is true.

https://www.moonofalabama.org/2020/05/covid-19-links.html#more

This link doesn't support your assertion at all.

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Those are valid questions but what does Steve Sailer suggest we do in those various gloomy scenarios?

If humans never do develop long-lasting immunity nor a vaccine to the coronavirus, and if it's lethality increases, we may be looking at a situation like the one in Catherine L. Moore and Henry Kuttner's classic SF story "Vintage Season". Time travelers from the future arrive at the present so they can witness a beautiful spring, the last one before the planet gets ravaged by a new plague. Maybe that's what those flying Tic Tabs and other UFOs are about!

Bingo. In the scenarios where herd immunity "doesn't work", i.e., no vaccine or effective treatment before herd immunity wears off, what is the alternative --- lockdown for years on end awaiting non-existent vaccine or effective treatment?

Herd immunity isn't a strategy to be pursued --- it's the natural outcome absent any other interventions. We have a variety of interventions that could help people avoid Nature's outcomes, which indeed seems to involve death for about 0.5% or so of infected persons (even if it's not clear how premature those deaths really are): vaccines, drugs and other treatments, voluntary quarantines, health regulations, widespread government shuttering of economic activities, and involuntary quarantines. So, the only question is which of these interventions are worth pursuing in a free society to alter Nature? Vaccines, drugs/treatments, voluntary quarantines, and non-intrusive health regulations seem like no brainers. Throwing healthy, uninfected, innocent civilians in prison or heavily fining them to enforce prolonged business shutdowns and involuntary quarantines? I wouldn't think so myself, although this may or may not be an area of disagreement.

"In the scenarios where herd immunity "doesn't work", i.e., no vaccine or effective treatment before herd immunity wears off, what is the alternative --- lockdown for years on end awaiting non-existent vaccine or effective treatment?"

Eliminate the disease through non-pharmacological measures. That includes masks, tracking your every move, centralized quarantine (forced if necessary) and intermittant geographical lockdowns in cases of outbreaks.
Still an order of magnitude better than the alternative.

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"Advocates of a Herd Immunity strategy really need to get out their spreadsheets and do the math of how this would turn out to be a good thing. "

The one thing I learned from this whole pandemic is that nobody with any authority knows any math.

Boomers think math is done in Excel.

It’s cringe-tastic

One of the greatest and most public failures in modern economics was the infamous Excel spreadsheet of Reinhart and Rogoff revealing an amazing degree of incompetence and possible corruption. It took 3 years(!!) to find out. From now on, everybody needs to show their work ASAP. Post your data on Github. Let the replicators replicate.

"The most serious was that, in their Excel spreadsheet, Reinhart and Rogoff had not selected the entire row when averaging growth figures ...... When that error was corrected, the “0.1% decline” data became a 2.2% average increase in economic growth."

https://theconversation.com/the-reinhart-rogoff-error-or-how-not-to-excel-at-economics-13646

https://www.bloomberg.com/news/articles/2013-04-18/faq-reinhart-rogoff-and-the-excel-error-that-changed-history

Lmfao, I had forgotten about that.

Makes the Imperial model look almost respectable, in a “tallest retard” kind of way

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Calling people 'boomers' is a cringe-tastic attempt at ad hominem.

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But the math isn't the hard part. The hard part is getting reliable data to feed into the model. There are no good numbers to crunch.

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Who just might know a tiny bit of math to go along with her PhD in quantum chemistry.

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Advocates of the "vaccine immunity strategy" need to do their homework too.

If you asked experts six months ago to estimate how long it would take to create a coronavirus vaccine suitable for human use, they would have said anywhere from several years to more than a decade.

It is really putting all our eggs in one basket to cross our fingers and anticipate a vaccine in record time.

Even record time is too long, because extreme economic crises also have an alarming death toll.

The debate is becoming moot. All over the US and Europe, shutdowns are being phased out by necessity, ready or not. It'll be all dance and no hammers, and hope for the best. All roads lead to Sweden.

Slouching Towards Stockholm

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They would have vastly underestimated the scale. A successful vaccine will take time (still takes nine months for a baby, regardless of how many pregnant women you have), but the vast effort and resources being devoted right now to vaccine development - including building facilities that may never be used - would not have been considered reasonable 6 months ago.

All roads clearly do not lead to Sweden, where social distancing seems to be much more pervasive than in the U.S.

Sweden, where social distancing seems to be much more pervasive than in the U.S.

He said, from Germany. This is wrong, but hey it’s prior_approval. Being correct isn’t really the point with him

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If "all roads lead to Sweden", you better accept the gradual destruction of our standard of living to 19-century levels which will follow with this virus becoming endemic.

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The Great Potato famine in Ireland killed off over a million people, most of them succumbing to comorbidities of malnutrition rather than to the potato blight itself

My favorite comment from Steve’s post.

Until he points out that many people did not really die from Zyklon B, it was instead other causes that caused their deaths.

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Guns don't kill you. Bullets do.

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Yes, I caught that. Nobody succumbed to the potato blight itself because people aren't potatoes. But in general I like Steve's work.

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Isn't that important information? It indicates something very important. There was as single potato crop, and potatoes were the primary food source. We have crop failures all the time in North America, but it doesn't cause famine because we have many other sources of food. The potato crop failure exposed something about Ireland that would have been exposed by any number of events.

How this virus affects people, who are affected and how it is spread specifically in what environments are the important details. If it kills old people, having young people in lockdown will fail catastrophically unless you have a shoot on sight implementation as well.

So what does this pandemic expose about the specific areas that are affected? What other things could have the same effect as this virus due to the same vulnerabilities?

I said early on that this is the third civilisation level crisis of globalization, one per decade. What will be the fourth?

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What are the choices?

* never let it enter in the first place (some pacific islands appear to have succeeded on this count)
* get on top of this virus and do test/trace/isolate until you reel it in and eradicate it (some countries are doing)
* never even try that, and just let it kill who it's going to kill (maybe try to slow it...), and hope that herd immunity is actually a thing
* react with lockdown of various flavors because it turns that 'not trying' isn't a strategy that people will go along with, but don't have any actual strategy

My view is that the latter 2 will lead to all the same short term economic damage, or probably worse, when essential industries can't function, and also lead to long term economic fall out too. As well as long term health fall out. but at least the swedes have a strategy. OTOH reviewing how some of the countries that are winning he case count, there's another strategy:

* deny that you need any strategy.

This is a particularly chaotic variant of the last 2.

Eventually USA will suck it up and industrialise test/trace/isolate, but you'll need to clean out the stupid first.

The US, like most countries but unlike Australia, doesn't really have an option anymore. The only question is how fast herd immunity will be reached. Or at least I'd love it if someone could tell me a realistic alternative.

Lots of people will die, but on the bright side there's probably less living in fear of a second wave than in countries which handled the first wave much better (or got lucky or both, like Aus). Those will have to have closed borders for a long time.

China has managed 2 to date. Most of China never got it bad, but the Wuhan outbreak is probably not too different from most of the US.

Please give me relevant and reliable evidence for your statements about China and a non-official reference in English with a good description of how China managed "2 to date".

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No one's completely sure how well China did, because everyone's pretty sure they are lying about the numbers. But at a minimum, they welded the secondary doors shut on hundreds (probably thousands) of apartments buildings and posted guards at the front door to limit access. They arrested people in the street without papers to be out. They brought medical authorities in to the police stations and threatened them for publicly posting about the epidemic.

You really can't draw any significant conclusions from China.

The evidence from Wuhan was a major factor in why NZ decided an elimination strategy was feasible. Of course noone believes their stats, but China appears to have contained it even in Wuhan. The rest of the country never really got affected. Its not clear that welding doors was decisive. Centralised quarantine was probably the main difference between the Wuhan lockdown and other countries. That and they were better prepared (fever clinics etc).

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Australia is a small open economy. Tourism is 9% of the economy, education of foreign students is also a huge part, and it has an unsustainable reliance on commodity exports to Asia.
We can't afford to shut our borders infinitely.

Yeah, right, better let 1% of your population die and ~5% become disabled (and that's just in the first wave of infections) than lose 10% of your GDP.

"it has an unsustainable reliance on commodity exports to Asia."
Newsflash: biosafe shipping is a thing and you can organize it so that virus is not imported. So trade can continue.

Yes, I agree with you here. Australia (where I now live) does still have an option. So it's not foolish to stay locked down.

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"Doesn't have an option" because the ideology of lolobertarians like you needs it to not have an option.

Me? I was behind the idea of a lockdown and everything in the beginning, but that ship sailed without us a few weeks ago. My dear fellow citizens were only partly behind it and our elected representatives were incompetent. So we missed our chance. I personally think that's bad. I also dislike it when the sun goes down but have learned to accept that as a fact of life.

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Herd immunity or a vaccine are not the only two options. We never got a vaccine for SARS, nor do we have herd immunity. Many countries have successfully contained the virus to a point caseloads are going down to very low numbers. The endpoint of that is zero.

Swedens new daily death and case numbers are declining. Their R0 is less than 1. If you follow Sweden your R0 will be less than 1. With an R0 less than 1 the epidemic stops and the virus will eventually be contained and eliminated by contact tracing and isolation.

The government strategy in the UK is to keep opening up but only so far as R0 stays less than 1. They are going to start quarantining at the border. They are implementing contact tracing. They are therefore going for elimination.

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"Advocates of a Herd Immunity strategy really need to get out their spreadsheets and do the math of how this would turn out to be a good thing. Perhaps it is the best alternative, but, please, show your work."

Steve, you have some nerve making this statement. Herd immunity is norm since beginning of time. Your people based lockdowns on faulty, non-peer-reviewed models that were crap and garbage code.

We've never isolated the healthy before, so the burden is on your side. Heavy, heavy burden before crashing economy and destroying millions of lives and millions of deaths. Suicides, drug use, abuse, all spiking. Heart disease, cancer, diabetes will skyrocket like never before. If 2008 recession caused approx 280k extra deaths, this will be in the millions.

Britain, British territories and ex-colonies all have lockdown fever. Its' in your blood and DNA. Go back to Europe you descendant of white indentured servants - white slaves.

+1000

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You're a complete moron.
Herd immunity is not a thing for respiratory infections.

Even indefinite lockdown with communism and 30% of the population working in person (surprise, surprise, nobody actually needs 80% of the service sector) will allow for a higher standard of living than this virus becomming endemic.

Those deaths are trivial compared to catastrophe from shutting down healthcare for 99% of patients (so-called "elective" stuff) and forcing businesses to close resulting in 33M or more unemployed past two months. The Bastiat problem. You can see relatively few deaths from virus. What about all future deaths from poverty, stress, and depression from being out of work, without income, and hopeless.

This is 100% man-made depression. We never should have done this. Never again.

There is no compelling evidence that deaths are linked to the business cycle.
There is some evidence they are pro-cyclical and some they are anti-cyclical. The reality is probably there is no large effect.

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>We've never isolated the healthy before, so the burden is on your side.

Presumably, the worry-warts could self-quarentine (more easily, ironically, if everyone else isn't competing for those grocery delivery slots). The big difference is that the worry-warts would have to be more strict than they do under 'social distancing' to achieve the same risk reduction.

tl;dr social distancing transfers some of the cost-for-safety from the worry-warts to everyone else.

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The Swedish scenario. I think is a good model to fight this pandemic. It’s not the only one of course but the economy does matter people.
I think we should assume immunity will last 18 months to 2 years perhaps longer, SARS-CoV-1 has shown 2 years and 99% of people infected develop antibodies to SARS-CoV-2 ( recent study) and there are no credible cases of a significant number of reinfections.
Shoot for an R of 1.5 . This means herd immunity at 33%.. R= 1.5 can be achieved with some social distancing and no lockdown. That’s the Swedish model
R =1.5 was achieved in Sweden ~ 2 weeks after the March 21 announcement (cases doubling every 10-11 days or so)
Each population has a subgroup of effectively immune. That’s the reason the virus has retreated almost everywhere 2-3 months later , lockdown or not.
These people clear the virus quickly with an innate + T cell response. They don’t need antibodies. They’re the asymptomatic, never symptomatic , hardly susceptible and hardly infectious. A lot of them are children. This is not proven but it’s clear I think children are not infectious much. It was hard to find many testing positive in Wuhan according to Chinese papers. Schools are open in Sweden but children and teachers are not especially getting sick. We focus a lot on the deaths and we see there are more in this country less in that one. This is not so much the virus' doing , it depends not just on infection rates but on what subgroup gets infected most. If we are careless the old and vulnerable get over represented in the infections, you want them under represented.

I estimate the ( quasi immune) group at 15%. In Sweden the under 20 are ~ 22% of the population
Get 20% of the population infected over 3 months using the almost open model.. Protect the elderly. People self distance but still go to work and engage in most economic activities. They’re just not clueless and irresponsible.
You can keep the IFR at 0.3% by being careful with the elderly. That’s the most important part of the strategy . After 6 -7 doublings ( 64 x to 128 x) or 2-3 months you can get to 20% infected ( Stockholm currently according to Swedish epidemiologists is there or beyond).
If you add the 15% immune you’re already at 35%. And that’s why the cases have peaked on April 24. After this the new cases will slow and become manageable and you can do contact tracing and spot quarantining and it’s all controllable. You want to keep infection below 40% and extinguish the virus if at all possible , your total fatality rate is 0.4 * 0.3% = 0.12%.or 1200 per M
I believe Stockholm reached herd immunity already. The new infections peaked April 24. The rest of the country has not and each area has to be dealt separately with different restrictions.
The other model is of course extinguish the virus like NZ or Taiwan did. It helps to be an island , to be good at testing/tracing but it can work. After you extinguish the virus you have to stay vigilant and monitor infections and travel carefully.
By the same token, I think NYC reached herd immunity also but at a higher cost of lives and a higher economic cost.
The virus does not come back for 2 years or only sporadically. By then you have built up so much preparedness and clinical experience that it becomes a second order effect. There is nothing to worry about. All the what if, each infection makes it worse etc. are just needless unfounded worries..
When it’s over you have a toast and sing the song.
“ I herd it though the grapevine, not much longer, Covid would you be mine” 😊

You're helping redefine "Stockholm Syndrome." It now means "having feelings of trust or affection towards made up statistics and misunderstanding of infectious disease dynamics."

try to make a serious critique. Is it that hard ?

Cat, You have not provided any data to support your position, nor have you linked to any scientific support.

That is a signal of Stockholm Syndrome, as explained by Kevin.

It is not what you feel that matters, it is what you think and can prove with evidence.

Bill, I have already linked to it in other threads and I am tired of linking for your benefit. do your own research read the bulletins of the public health agency of Sweden ( Folkhalsomyndigheten) or don't believe it, that's your prerogative.

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ok. you seriously sed
"I believe Stockholm reached herd immunity already. The new infections peaked April 24."
we think its a little early for you to claim that stockholm has achieve herd immunity!

That was a prediction of the Swedish public health center( their CDC) for early May. ( 26%), not mine. The epidemic peaked in a non lockdown country with little immunity. It should be raging if there's little immunity over there

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The Nature article that Tyler shared last week (https://www.nature.com/articles/d41586-020-01315-7) speculated that immunity might take the form of subsequent infections affecting the upper respiratory tract only, like other Coronaviruses that cause the common cold.

This would obviously be a problem if people on their second or third infection can still pass it on in the initial severe form to the vulnerable.

Someone catching say OC43 for the first time in their 70s might be at risk of severe infection, it just happens to be the case that the elderly have already had the disease multiple times in their youth. That might be the final outcome of Covid-19.

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The equation for Herd immunity seems to be:

X will die out of Y catching the disease in order to achieve herd immunity.

For such a simple equation, both X and Y are incredibly nuanced.

The death rate is affected by treatments, which people catch it and likely the viral load at infection. Y is, AFAICT, almost completely unknown. The mean, median and max values for R0 seem key, but I'm not sure anyone knows what they are. If the median and mean R0 are close to 1, and some superspreaders do all the damage, that changes the herd immunity equation dramatically.

Given herd immunity is the strategy everyone defaults to, I'm not really sure what this post implies?

+1, best response in the thread so far.

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For the nth time, there are no (serious) advocates of "herd immunity strategy".

There are advocates of indefinite and repeated lockdowns being impossible, who believe some level of herd immunity will spread through the population and slow the spread of the disease and allow some normal life to take place.

But none of them advocate purposeful infection, and they advocate voluntary use of social distancing, shielding of elderly, contact tracing, greater voluntary working from home, and the other NPIs that actually work and which are to repeat myself, largely voluntary.

"For the nth time, there are no (serious) advocates of "herd immunity strategy".

I'm serious!

No, you are not serious.

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You notice what is missing from the herd immunity advocates??

They focus only on wishful immunity,
But,
They do not address
Improvements in therapy
That happen during the time
The Virus is put at bay.

How many extra dead that could have been saved with better therapy later?

Test, trace, and isolate is just as wishful.

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Rate from infection to immune is 3 weeks. Immune to infections is 52 weeks. The ratio is 18, there are 18 more neighborhoods immune than infected. Triadic identifies the infected neighborhoods and clamps down to keep infection rate from spreading to another neighborhood.

What is the neighborhood size? That is determined by the tridic response team which likely covers a particular area, counted in units of people. The solution is to find the typical neighborhood size within the capacity of the triadic.

You have a coloring problem, define all stabilized regions to be one of a triadic responders, 18 immune colors, and likely two triadic responders (one for insurance).

There is a bit more to it, but the basic idea remains. When all your regions are colored, then from a distance it should look white.

If any economists wants to know how the economy works, some do, then look up hidden Markov Tree problems.

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Of course this approach would rely on very widespread testing. Perhaps 10x what the US is currently doing. (And the US is running more tests than any other country.)

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Herd immunity doesn’t just appear and disappear – it’s gradual. If 59% of the population are immune instead of 60%, we don’t get what we saw in April and May in NYC. The virus is technically encountering enough warm bodies to spread but at a very slow rate (R is greater than one but just barely).

If immunity lasts a couple years then people will lose immunity more or less continually over that period. Maybe a couple percent per month. The virus will be mostly eliminated by herd immunity but will slowly spread from very low levels once enough people have lost immunity because it will still be encountering mostly immune people.

So a second wave in this scenario is automatically the slow burn we originally said we wanted when we started “flatten the curve”. Healthcare systems won’t be overrun. And most people won’t get reinfected because the virus will spread back to herd immunity before that and then die back again.

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I don't mean to be pedantic, but the term "herd immunity" is often misunderstood because its meaning is misunderstood. Herd immunity happens when so many people in a community become immune to an infectious disease that it stops the disease from spreading. This can happen in two ways: (1) many people contract the disease and in time build up an immune response to it (natural immunity); or (2) many people are vaccinated against the disease to achieve immunity. Many people use the term "herd immunity" when they mean natural immunity. Language, as Cowen indicated in a recent blog post, has taken a back seat to math in the economics community. Now is a good time to give language a higher status in the community. Better communication produces more cooperation and better results. It's natural for the herd.

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https://www.reuters.com/article/health-coronavirus-usa/new-covid-19-cases-in-new-york-coming-from-people-leaving-home-cuomo-idUSKBN22S0S3
(Reuters) - New York’s new confirmed COVID-19 cases are predominantly coming from people who left their homes to shop, exercise or socialize, rather than from essential workers, Governor Andrew Cuomo said on Saturday.

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Compared to what?

In 18-24 months a vaccine is more likely be be available or if not surely by THEN governments will have more capacity for TII. And even if not, the second wave will have to be more spread out as not everyone's immunity will disappear at the same time.

Whether there even CAN be a vaccine is still unknown. It depends not at all on science, but on the composition of the human immune system. There are diseases for which it does not hold immunities.

Since we already know that antibodies and t-cells are produced and the infection is cleared, we can be pretty certain that a vaccine is possible.

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What is the herd, and whose herd are you a member of.

Herd immunity is based on the inability of the disease to reach susceptible individuals because there are persons who have had the disease and are presumably unable to pass it on, so the r goes down.

But, all of this presumes the "herd" is fixed and is defined by a geography where people do not come in or go out from the territory defined as the herd.

For example, if Stockholm or Sweden were to acquire herd immunity with 60% previously exposed, during the tourist season foreigners who had not acquired immunity would be visiting, lowering the percentage of uninfected, increasing the odds that uninfected Swedes get a disease.

And, there are border effects as well. Say a state in the US were to try herd immunity, what would be the effect in adjoining states.

If you lived in a border community next to Wisconsin, what are your chances.

Herds are political boundary defined, not isolates.

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The presumption (though COVID-19 hasn't been with us long enough to test this) is that once we hit 'herd immunity' (that is, once we have R0 < 1), two things happen. For this seasonal cycle, the number of infected starts to drop. (Starts to drop, though if growth is strong enough, momentum may carry us well past herd immunity numbers.)

And in future cycles, enough people retain immunity that R0 starts at a lower value. Furthermore, as immunity weakens, it does not go away entirely; the immune system often mounts a stronger defense in future infections, which means future returns once we have herd immunity has a lower IFR rate, and for most people, if they catch it at all it's more like an annoying flu bug.

Fun trivia fact: the Spanish Flu never went away, either. It's the H1N1 virus which is now just one of a bunch of other flu viruses that come back year after year.

Herd immunity, by the way, can also be delivered via a vaccine, assuming one is developed. (And I think a vaccine is extremely likely.) So we don't have to think of herd immunity as a Darwinian process.

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Assume herd immunity.
There, now isn't everything better?
(By the way... the Navy is now up to 13 re-positive tests on the Roosevelt)

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What's the alternative to herd immunity? Isn't every strategy at this point just a herd immunity strategy, just with different ways to get there?

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Why is this a good article?

Its main criticisms of "herd immunity strategy" (which is somewhat a misnomer) are that it is likely to take years and it will last for 12-24 months only.

Reasonable estimates of herd immunity threshold given effect of superspreaders are somewhere between 20% and 50%, depending on underlying R. In NYC and Stockholm we already have 30% immunity. It took only 2.5 months of infection to get here, even given lockdown in NYC. With some curve-flattening efforts, herd immunity seems achievable within 4-5 months in most places.

While it seems reasonable to assume that natural immunity lasts for 12-24 months, I do not see why this is a problem. If vaccine can be easily developed (Case 1) , then it is most likely to be distributed sometime between summer 2021 and winter 2021-2022. So even under low estimates of immunity duration it will be enough to cover the period before vaccine arrival.

If somehow the infection does not grant lasting immunity (Case 2, unlikely) , then there will never be vaccine by definition, so the world is screwed no matter what we do.

If infection grants lasting immunity, but vaccine can not be developed rapidly (Case 3), then natural immunity is the only viable option, since nobody knows when (if ever) vaccine will be available.

The bottom line is that there is no scenario under which lockdown is better than "herd immunity strategy". Properly implemented test-and-trace can beat herd immunity in certain cases. The sad thing is that there is little hope left that Western governments and rational and competent enough to properly implement test-and-trace.

Given all this, adopting "herd immunity" strategy seems like no-brainer.

Post your source for the claim that Stockholm has already had 30% immunity. If that were the case, the rate would still not be increasing.

"On Wednesday, a study of 60,000 people was published by the Spanish government. It suggested only five per cent of the country's population has been infected, so far. The results did vary massively across the country: Madrid has a prevalence rate of 11.3 per cent; but in provinces in the south, east and north-west of the country, the rate is much lower. In Seville, for example, 2.3 per cent of people have contracted COVID-19.

Yesterday, a survey of 11,000 households in England suggested one in four hundred is currently infected with the virus - that’s only 0.27 per cent of the population. And in France, a study led by the Pasteur Institute says 4.4 per cent of France (2.8 million people) has been infected. Researchers say the rate even in the worst-hit parts of the country - in the east part and in and around Paris - is still only between nine and ten per cent on average. These same researchers go on to explain that “around 65 per cent of the population should be immune if we want to control the pandemic by the sole means of immunity”.

Clearly, we are a long way from that, except for in Sweden where Johan Giesecke, an epidemiologist advising the authorities there, says Stockholm could reach herd immunity by June. Sweden, though, already has a death rate three times higher than that of its neighbour, Denmark, and seven times that of Finland." https://www.euronews.com/2020/05/15/analysis-how-close-are-we-to-covid-19-herd-immunity

https://www.usatoday.com/story/news/world/2020/04/28/coronavirus-covid-19-sweden-anders-tegnell-herd-immunity/3031536001/.
Tegnell estimated 25% immunity in Stockholm as of some date before April 28. It is reasonable to assume that now it is at least 30%.

Herd immunity threshold is a function of R. R is a function of many variables, including population density. Naturally, this threshold will be much higher in large cities with high population density (e.g., European cities or NYC). So I would guess that the threshold for Stockholm and NYC is somewhere around 40-50%.

We are long way from herd immunity in the places you mentioned precisely because of lockdowns.

Aaron,

You should do better research.

Sweden withdrew the report on which the article was based:

"The Swedish Public Health Agency made international headlines yesterday by estimating that one-third of Stockholm residents would be infected with the coronavirus by May 1. Less than 24 hours later, the Agency has taken a dramatic u-turn and withdrawn the report.

The decision was announced via Twitter: "We have discovered an error in the report and so the authors are currently going through the material again. We will republish the report as soon as it is ready."

From the same report: "Another Swedish report on the coronavirus spread in the capital has also been withdrawn by its authors. The preliminary findings by researchers at Karolinska University Hospital and the Karolinska Institute estimated that at least 11 out of 100 blood donors in Stockholm had already developed antibodies to the coronavirus."

Here is the link: https://www.forbes.com/sites/davidnikel/2020/04/22/sweden-health-agency-withdraws-controversial-coronavirus-report/#27f709d34349

The report you are referring to initially suggested 1/3 immunity in the population. After the error was corrected, the revised number is 26%. That`s why Tegnell later mentioned 25%.
Source: https://www.bbc.com/news/world-europe-52395866

The Forbes article is dated by April 22. At some point between April 22 and April 25 the error was corrected as reported in BBC article above, dated by April 25.

Thank you. It is important to be accurate.

Now, given that herd immunity needs to be between 60 to 76% , how many more deaths with Sweden have for this achievement. (I realize there may a demographic composition element, but also recognize that those who may have been the most active (younger folks) may have gotten it at a higher rate than those who, so far, have stayed inside).

Take Italy and Spain and England and their current rates of having had covid and project the number of deaths in each country to achieve herd immunity.

60%-76% estimates ignore the effects of heterogeneity in population (i.e., superspreaders). The fact that superspreaders are more likely to infect other people and to be infected themselves pushes the threshold down. I am not sure whether assuming that superspreaders perfectly comply with lockdown is a good idea. The models, accounting for this heterogeneity, suggest threshold between 10% and 60% (several papers with such estimates were linked by Tyler in the recent month, unfortunately I can not find them fast).

The vaccine will not be here for at least 1 year. Even countries with highly efficient test-and-trace system (Korea, Singapore) can not completely stop epidemic. Obviously, lockdown can not be maintained for more than 2-3 months. So the infection will be spreading no matter what we do. The alternatives are either to try to reach herd immunity (or near-herd immunity) by mid-autumn or have constant closing-reopening for the next 1-2 years. The total number of deaths over the period is likely to be comparable (early deaths under herd immunity strategy vs late deaths under lockdown strategy), but economic cost of lockdowns will be huge.

Talking about deaths, do you realize the effect of economic collapse on public health and life expectancy for the subsequent years? How many people, who lost their jobs during economic collapse will die because of worsening health or inability to pay for healthcare? And this is even without taking into account possible political consequences of economic collapse (think of what happened in Germany or Spain after Great Depression).

1. Provide a link to your claim about super spreaders reducing the threshold limits. There should be scientific support if you claim it is true.

2. States have brought down covid without letting the virus run wild. As you pointed out, Singapore, Korea, Taiwan, New Zealand with tracing and testing. There economies have not suffered for that. Yet, countries which have let the virus run wild, and then changed, have had their economies affected.

3. You cannot argue that economies that shut down spread are not to be followed because the threat of the virus has not been eliminated. That is a facetious argument. You don't apply that argument to your let it rip alternative, do you.

4. You have not answered the number of deaths questions posed above as to other countries, or as to Sweden.

1. https://www.medrxiv.org/content/10.1101/2020.04.27.20081893v1.full.pdf.

2. Singapore, Korea and Taiwan succeeded with test, trace, isolate (TTI) because they have rational and competent governments. No single Western country or US state was able to implement TTI or is going to implement it in near future. While there is finally decent testing, no politician in the West is willing to support location-data-based tracing and isolation of infected people. Bluetooth-based apps are just diversion, which even if implemented, will be close to useless. Manual contract tracing is just ridiculous. Multiple research, including Acemoglu et al (2020) show that efficient tracing and isolation is absolutely crucial. Without them TTI will fail as current lockdowns showed.

3. The countries, which used lockdown to decrease (but not eliminate) spread, will see surge soon after reopening. Unless they stop following shutdown strategy, they will implement lockdown again after surge will become large enough. In 99% places in the US, locked down in March, there was no immediate threat of overwhelmed health care system. Given that they locked down then at not very high infection levels, I assume they will do it in the future at comparable infection levels. The whole point of herd immunity strategy is that we can tolerate infection unless it overwhelms health care system. On the other hand, lockdown strategy is based on the premise that we stop everything when there is some infection and deaths, but long before there is any threat of overwhelmed health care system.

4. I wrote several posts, answering number of deaths questions. It is not my fault if you refuse to see it. So let me repeat. We count number of deaths over the whole infection period before vaccine becomes massively available (18-24 months most likely). Sweden have more deaths now, because probably half of infections, needed for herd immunity, are reached now. Other countries have less deaths now, but will have more of them later. In winter, Sweden will have herd immunity and few deaths, while the countries, following lockdown strategy, will have large number of death and lockdown simultaneously. When you count the number of deaths over this 2-year period, numbers are likely to be comparable.

If you are unwilling to change your mind when you get new evidence, inconsistent with your prior, what is your reason to argue? For people, unwilling to update their priors and arguing for the sake of showing that their point is right, such behavior is pure waste of time. Can not you see that?

I cannot believe what you posted in response to number 1.

What the document says is that the sick and the frail will be removed from the population, and that will increase herd immunity.

Here's from the summary: "

Individuals that are frailer, and therefore more susceptible or more exposed, have higher probabilities of being infected, depleting the susceptible subpopulation of those who are at higher risk of infection, and thus intensifying the deceleration in occurrence of new cases. Eventually, susceptible numbers become low enough to prevent epidemic growth or, in other words, herd immunity is attained."

You obviously do not know what the SIR model is: that is the description of it.

Second, they say they don't know: \
"Supported by existing estimates across infectious diseases, we argue that 𝐶𝑉 is generally higher and prognostics more optimistic than currently assumed. However plausible, this needs to be confirmed for the current COVID-19 pandemic and, given its relevance to policy decisions, it should be set as a priority." There, they say they DON"T KNOW.

So, they don't know. They do know the SIR model takes out the weakest first, and they want to study the coefficient of variability. And, they don't know.

2, Item 2 can be summarized by asserting no on wants to do testing, and know one wants to use data to do so. Your opinion.

3. You do not like lockdown and assume that opening up cannot be done at all to minimize risk so don't do it at all..

4. You have not provided evidence. The paper you cited clearly said they needed research to find evidence and test their hypothesis, which is not the same as having the evidence. I have an open mind, all you have provided is your opinion of what governments will or won't do, an opinion that controlled reopening won't work.

I form my opinion based on evidence and change it based on evidence. No evidence provided by your link. Remember what it said: "Supported by existing estimates across infectious diseases, we argue that 𝐶𝑉 is generally higher and prognostics more optimistic than currently assumed. However plausible, this needs to be confirmed for the current COVID-19 pandemic and, given its relevance to policy decisions, it should be set as a priority."

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The supposed 70% number for herd immunity is an idiotic number that flies in the face of common sense.
1. People are not equally sociable.
2. Very few viruses have ever reached this penetration.

It likely closer to 40-50%, and the drop off in the Stockholm death rate backs this up. The obvious answer worldwide is the Swedish strategy, with some improvement around protecting the vulnerable like the elderly.

Since you claim to have common sense, please assume that scientists have it too. Yet, your claim of common sense has no scientific support.

Is that common sense.

Post your support for the claim that 40-50% is sufficient for herd immunity below.

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"But if immunity only lasts 12 to 24 months"

There's absolutely nothing to suggest that. The world isn't dealing with repeated waves of SARS, or any other virus with comparable fatality rate. There is some research suggesting that not everyone remains 100% immune, but the general effect is clear. "please, show your work" - works both ways.

Isn't the burden is on those who assert the proposition of herd immunity to come forward with the data.

How far do you want to push the precautionary principle? This is a new virus, there's no evidence that it doesn't turn all infected people into giraffes after 36 months.

When challenged, you retreated, like a squid throwing up the ink to confuse while it slips away.

Challenge is still on.

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"The world isn't dealing with repeated waves of SARS, or any other virus with comparable fatality rate. "

Ah, yes, the inductivist argument (here spiced up with a false analogy) "it hasn't happen before therefore it will never happen".
Too bad it is just as invalid now as it was in David Hume's time.

Don't be childish it is no such thing. It's historical experience which is actually one of the most useful tools we have in determining the outcomes of any course of action.

"Historical experience" pretty much means an inductivist argument, maybe you should read up on it before you embarrass yourself further.

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meanwhile the American media elite have somehow constructed & reported two completely different narratives - covid 19 cases are both bigly spiking/not increasing in states that have started to restart their economies with precautions while trying to limit spread of the disease!

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Sweden has a much higher death rate than its lock down neighbors, now — meaning it could just going through the infection faster — just not flattening the curve. Meantime everybody over there will have the same country to come back to when it’s over.

The bottom 40% of our workforce, small business owners, even landlords are going to end up out on the street. Back to 1946 on the good side of town (starting from scratch); children out in the street with empty bowls begging for food on the poor side of town — Calcutta!

Peggy Noonan has written the most knowing piece on the blindness of the powerful classes on this tragedy. I’m 76 — if some of us oldies got to go, we got to go (only a matter of time anyway); I just want the same America to be there for everybody else when it’s over.

https://peggynoonan.com/scenes-from-the-class-struggle-in-lockdown
********************

On a completely different angle: wouldn’t we be much more likely to go out and participate in the consumer market place again (department stores, etc.) if everybody else were wearing n95 masks?

What would the US transmission rate drop to if we all wore n95s everywhere we went? Would we feel safer on airliners if everybody was wearing n95s? (An MSNBC doctor/analyst thinks he caught the bug on the airplane even though he was wearing the best breathing protection because he got the virus in his eyes. Of course if the rest of the flight were wearing his level of protection he would have been very unlikely to have been infected).

Can America be saved economically/socially/medically (almost forgot the latter) by $1 a piece masks? If so, when are we going to start producing tens of billions of them?

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Sweden. No shelter in place orders. Social distancing encouraged. Large gatherings not happening.

British Columbia. No shelter in place orders. Social distancing encouraged. Large gatherings not happening.

Sweden has a bit more than twice the population, but both have a large metropolitan area with the rest of the country sprinkled with smaller communities.

The death and case numbers are very different. Why?

I'd venture, timing and introduction vectors, particularly with hidden cases at outset. And probably a bunch of behavioural differences that spin off from how people in the world are acting at that time.

It seems like ultimately we can only compare these places to what was thought to happen, and to models; international comparisons to each other just introduces so many more uncontrolled variables?

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Likely recovered patients will retain partial immunity. So these numbers will be lower.

We are also racing for a therapeutic just as much as a vaccine. And that road is easier in two ways:

1. We can tolerate a higher negative side effect rate in a therapeutic than in a vaccine, because we only give them to people who have serious cases and who would tend to fair poorly without the treatment.

2. Many Therapeutics will be more general than vaccines. Eg. We expect the virus to mutate, defeating some vaccines, but we don’t expect it to change its mode of attack from ACE2

Recovered patients didn't die the first time; probably can be counted as safe for policy reasons because won't likely die next time.

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I still haven't figured out what the problem with crashing the economy is, at least until we start having actual shortages rather than dislocations. Is anyone going hungry or lacking a safe place to live for anything other than ideological reasons? Not in the US. We even have food to export and small cities full of empty homes.

For most Americans, the crash started forty years ago when wages stopped rising while productivity increased. Look at the increasingly long recession recovery times.

Besides, it is out of our hands. That's the problem with globalization. Sweden may have stayed open and accepted a high death rate, but its trade partners shut down. Those candy asses just didn't want to kill as many people.

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If immunity lasts 12-24 months, the virus continues through the population. Which also means it's likely that you'd get the same virus within the same 12 month period and gain immunization again. If you get the same virus 3-4 times I would imagine immunity is greatly increased. I would imagine herd immunity is a still valid approach.

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With 12-24 month immunity, the entire population isn't starting the clock at the same time. There would presumably be some rolling immunity that would be fading in one person while picking up in another. Seems like this would put more downward pressure on spread than if the entire herd lost immunity around the same time.

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