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spartansaver

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At the risk of sounding misanthropic:

 

I think the lesson here is that, this WILL happen again (could be next year, next decade, next century - but viruses do not go away) ; and we will NOT be prepared, we will not learn from this, and to think otherwise is to grossly overestimate the ability for a bunch of tribal nations and populist leaders to "do what is right".

 

Look at China and the US to see what the world powers are doing: totalitarian misinformation vs. egotistical misinformation. Nonsense all around.

 

This is a really great point, but for some reason I'm still hopeful. I think a few good leaders could reverse this trend.

 

Trump and most Republicans have abandoned good faith efforts to rule, but I still believe that people in aggregate are intrinsically good, and most people who get into politics really do want to do what they believe is best for the country. The only question is whether this phase in USA politics is a short-term thing, or if the system has been broken to the point where it's impossible for good leaders to be elected.

 

If the latter, then I'd expect to see American power to continue to plummet in the world, as it drives away its allies and its anti-science/anti-education mentality dramatically weakens the country's competitive position. Just as happened with the Soviet Union, I think it's very hard to sustain (for much more than a century) a system whose values don't match reality.

 

But I still think it's more likely that USA will pull out of this descent and remain a superpower. (Or that the blue states separate and become the new superpower, producing 2/3rds of the USA GDP--effectively the same thing. Secession isn't likely today, but after a few elections where the majority is repeatedly thwarted through tricks like voter suppression and gerrymandering, I think it becomes more likely.)

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I'm trying to ask this uncontroversially mostly medical professionals here: assuming a gradual relaxation of the lockdown with no vaccine, no treatment, and no (or minimal) testing/tracking. Would you say going out is acceptable or too risky? Let's assume a medium-high risk state like MA. Let's assume not super vulnerable person.

 

If we want to talk concrete "going out" categories, let's say going to parks, general shopping, meeting friends/family, going to office/work, going to a restaurant (I tried to order this from least risk to most risk).

 

Outcome of "severe" infection sounds very scary. That has to be balanced with infection risks though.

 

I know this is a bit theoretical and uncertain, but since there's a talk of "relaxation" even in NY state, maybe this could be useful.

 

I could open a new topic... but probably not worth it.

 

Thanks

 

Today, yes, I think the risk is acceptable, based on general reports of curve flattening and general lack of overwhelmed local ERs and ICUs.

 

The "re-opening" of local economies should be conditional on:

 

1. universal mask usage

2. maintaining 6-ft social distancing

3. no large crowds

 

This can allow many businesses, restaurants, maybe some schools to re-open.

 

The decision regarding timing, pace, and extent of re-opening will be left to state governors and local authorities, who can fine-tune the above conditions, based on local factors.  If a surge of serious cases start to show up in ERs and ICUs, they'll have to clamp down again. 

 

The federal government level can mostly give permission to states and localities to open up around April 30 (maybe even before), when they feel ready.  They can veto crazy decisions that might happen in some regional southern areas, such as large church services, movie theaters, sports arenas. 

 

As you say, there is no good medical treatment/vaccine, and testing has been disappointing.  (Whenever you rush out with new tests for a new disease, being unable to evaluate accuracy and reliability systematically, we really can't trust the results.)  But you don't need testing or treatment in new pandemics, since the only effective measure is various levels of quarantine and travel restrictions.  (If South Korea had no testing but had only lockdowns, they would have still been fine.)

 

Today, I think the risk of economic recession/depression (deaths, suicides, depressions, lack of confidence in authorities) is greater than the risk of swamping the medical system, especially if the heavy lockdown extends beyond April 30.  I think this feeling is widespread, and is percolating from the bottom-up.  Any heavy handed top-down governmental restrictions will be answered by spontaneous bottom-up rebellion - so in a way, I think your question is moot.

 

Improvement in testing should go on, but their utility will primarily be in retrospective analysis for future outbreaks.  We don't need precise knowledge from test results to know what to do now (again, the only thing to do is isolation with masks and some form of quarantine).  And even if a vaccine is developed, I don't have confidence that it will be effective or safe enough, especially if it comes earlier rather than later.

 

+1

 

If once testing becomes available by all means get tested to see if you have antibodies right? Already being exposed verified with an eventual reliable test will relieve a lot of concerns. Wear a mask as the virus typically enters through mouth/nose. Wearing goggles may not be the most fashionable but glasses should help if want to be extra vigilant.

 

As cobafdek says worst case if you do need ICU care it likely will be more available. I cant help but think if you are of the genetic make up (obesity, CVD, CA, DM) or have medical conditions that put you at risk your at risk regardless. How would you (hypothetical you) plan to out run this for 12-18-24 months? If your medical make up predestines you to a severe case with this virus that will be the case now, in July, Sept, Dec etc.

 

Losing weight, stopping smoking, vaping, getting cholesterol down may go a long way to helping with comorbidities too which outside of getting the virus puts you most at risk. Cant change your age though.

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I'm trying to ask this uncontroversially mostly medical professionals here: assuming a gradual relaxation of the lockdown with no vaccine, no treatment, and no (or minimal) testing/tracking. Would you say going out is acceptable or too risky? Let's assume a medium-high risk state like MA. Let's assume not super vulnerable person.

 

If we want to talk concrete "going out" categories, let's say going to parks, general shopping, meeting friends/family, going to office/work, going to a restaurant (I tried to order this from least risk to most risk).

 

Outcome of "severe" infection sounds very scary. That has to be balanced with infection risks though.

 

I know this is a bit theoretical and uncertain, but since there's a talk of "relaxation" even in NY state, maybe this could be useful.

 

I could open a new topic... but probably not worth it.

 

Thanks

 

Today, yes, I think the risk is acceptable, based on general reports of curve flattening and general lack of overwhelmed local ERs and ICUs.

 

The "re-opening" of local economies should be conditional on:

 

1. universal mask usage

2. maintaining 6-ft social distancing

3. no large crowds

 

This can allow many businesses, restaurants, maybe some schools to re-open.

 

The decision regarding timing, pace, and extent of re-opening will be left to state governors and local authorities, who can fine-tune the above conditions, based on local factors.  If a surge of serious cases start to show up in ERs and ICUs, they'll have to clamp down again. 

 

The federal government level can mostly give permission to states and localities to open up around April 30 (maybe even before), when they feel ready.  They can veto crazy decisions that might happen in some regional southern areas, such as large church services, movie theaters, sports arenas. 

 

As you say, there is no good medical treatment/vaccine, and testing has been disappointing.  (Whenever you rush out with new tests for a new disease, being unable to evaluate accuracy and reliability systematically, we really can't trust the results.)  But you don't need testing or treatment in new pandemics, since the only effective measure is various levels of quarantine and travel restrictions.  (If South Korea had no testing but had only lockdowns, they would have still been fine.)

 

Today, I think the risk of economic recession/depression (deaths, suicides, depressions, lack of confidence in authorities) is greater than the risk of swamping the medical system, especially if the heavy lockdown extends beyond April 30.  I think this feeling is widespread, and is percolating from the bottom-up.  Any heavy handed top-down governmental restrictions will be answered by spontaneous bottom-up rebellion - so in a way, I think your question is moot.

 

Improvement in testing should go on, but their utility will primarily be in retrospective analysis for future outbreaks.  We don't need precise knowledge from test results to know what to do now (again, the only thing to do is isolation with masks and some form of quarantine).  And even if a vaccine is developed, I don't have confidence that it will be effective or safe enough, especially if it comes earlier rather than later.

 

I agree at most people will  get tired of this lockdown. I believe the economy will have to be opened up in May, possibly in baby steps.

 

One concern I have is that you can’t really open up the economy without opening up the schools,which isn’t exactly a baby step. Perhaps open up kinder gartens first, then middle schools etc. This would still take a lot of time and I incur quite a bit of risk.

 

Without schools being open, parents with kids are screwed.

 

Then,what you describe interns of going out with mask, social distancing ET still doesn’t really help any service business like restaurants, hairdressers, bars, sports venues etc. Maybe they could operate,but at much reduced capacity. There is another can of worm with liabilities. What happens when there is an outbreak that can be traced at a business. Trial lawyers will go after this, show that some protocols weren’t followed and here we go with huge number of lawsuits. I don’t think it will be possible to buy insurance for this unless the government creates one.

 

 

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I'm trying to ask this uncontroversially mostly medical professionals here: assuming a gradual relaxation of the lockdown with no vaccine, no treatment, and no (or minimal) testing/tracking. Would you say going out is acceptable or too risky? Let's assume a medium-high risk state like MA. Let's assume not super vulnerable person.

If we want to talk concrete "going out" categories, let's say going to parks, general shopping, meeting friends/family, going to office/work, going to a restaurant (I tried to order this from least risk to most risk).

Outcome of "severe" infection sounds very scary. That has to be balanced with infection risks though.

I know this is a bit theoretical and uncertain, but since there's a talk of "relaxation" even in NY state, maybe this could be useful.

I could open a new topic... but probably not worth it.

Thanks

Complement to Cobafdek, in the middle of the (tribal) fight.

Your question is difficult to answer (it feels like: What's the risk of shorting Tesla stock?) and it includes the evaluation of tail risk.

Since my background has some relevance and since i need to address this question now, here's a tentative answer.

 

It seems that the opening will be gradual and the rate of opening will be inversely proportional to virus resurgence. So you'll need to adjust your risk management for your area and with the evolving picture. I work with a scenario of localized and limited resurgence activity during the opening with no second or third wave although this could become low-grade seasonal. I'd say testing will be useful for certain areas of concern but it's hard to see how testing at large will be useful for local decisions. I would also add that herd immunity is not a black or white concept. Relative herd immunity may be much lower than the often 60-70% quoted.

 

1st risk: risk that you become a spreader without being sick

This is a population-level risk but also an individual risk as you may bring the disease to loved ones who may be susceptible (known risk factors or even rarely idiosyncratic).

Then, your cumulative (i share DocSnowball's realism about molecules and timeline) individual risk is likely lowish (and will evolve over a fairly long time), especially if you take basic precautions (basic distance, washing hands, and avoiding social contacts with older (or frail) friends or family members). The concept of position sizing (extent of your social participation along the activity risk spectrum you describe) could be applied as a degree of conviction that your area is safe (from publicly announced statistics, hospital activity level etc).

 

2nd risk: risk that you become significantly sick

Apart from idiosyncratic risk, which is very low, your risk will be proportional to risk factors (age, lung disease, obesity, diabetes etc) with individual risk factors being likely more than additive and serious event risk going up exponentially with the overall level of frailty. Assuming not super vulnerable means no major risk factors, it seems that your risk of becoming significantly sick is very low (do your own work  :) ).

 

What you do as an individual is also tied to your risk personality. If you used to go for the flu vaccine every year versus not even worrying about becoming sick will have an influence on future behavior vs CV. It's possible CV becomes old news very rapidly especially if other events take eyeballs off the bug (and its consequences).

 

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Allright, I was having a beer an playing with numbers. I saw that somewhere in Israel they were actually doing group testing instead of individual ones. Basically they had 64 persons spit and then if the group was positive they would test 32, etc...

 

I tough it was an interesting concept, just like a DB works you can find a value much quicker by splitting the pile in halves over and over again.

 

I then went to take Quebec numbers (I live there). Assuming there is 0.3% of the population that has Covid, you don't want the group to be so large that 100% will test positive but you don't want the group so small that it's a waste of resources.

 

If I want about 25% of the initial test to turn out positive, how big should I make the initial group test? Well it turns out it's about 8000. For a population of 8M that is 1 000 tests (Quebec has a capacity of 12K/ test per day). So easily we can test all groups of 8000 on day 1, the next day, the groups that turned positive are split into 4 and so on.

 

Within 11 days we would have tested 8M people, found out the individuals, and we could repeat the process again. 22 days and we would be done with it. Quebec has a capacity of 12K tests per day, so that would not even interfere with the screening of the symptomatic persons.

 

Besides scaling 8000 persons per group what else am I missing here?

 

BeerBaron

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https://www.bloomberg.com/news/articles/2020-04-16/south-korea-plans-emergency-handouts-to-households-hit-by-virus?utm_content=business&utm_medium=social&utm_source=twitter&cmpid=socialflow-twitter-business&utm_campaign=socialflow-organic

 

"The amount is larger than the 7.1 trillion won initially planned, underscoring the government’s determination to offer relief to households. The handouts will be distributed to 14.8 million middle and lower-income households via electronic cash, gift certificates, and other methods,"

 

 

 

 

 

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Allright, I was having a beer an playing with numbers. I saw that somewhere in Israel they were actually doing group testing instead of individual ones. Basically they had 64 persons spit and then if the group was positive they would test 32, etc...

 

I tough it was an interesting concept, just like a DB works you can find a value much quicker by splitting the pile in halves over and over again.

 

I then went to take Quebec numbers (I live there). Assuming there is 0.3% of the population that has Covid, you don't want the group to be so large that 100% will test positive but you don't want the group so small that it's a waste of resources.

 

If I want about 25% of the initial test to turn out positive, how big should I make the initial group test? Well it turns out it's about 8000. For a population of 8M that is 1 000 tests (Quebec has a capacity of 12K/ test per day). So easily we can test all groups of 8000 on day 1, the next day, the groups that turned positive are split into 4 and so on.

 

Within 11 days we would have tested 8M people, found out the individuals, and we could repeat the process again. 22 days and we would be done with it. Quebec has a capacity of 12K tests per day, so that would not even interfere with the screening of the symptomatic persons.

 

Besides scaling 8000 persons per group what else am I missing here?

 

BeerBaron

 

I think the tests are not perfect and only pick it up if there's a certain amount? So 1/8000 people or whatever would be too diluted. Otherwise that's kind of genius. I am a chemistry & science layman so take it fwiw.

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Without schools being open, parents with kids are screwed.

 

How many of these parents take the summer off when their kids don't have school?

 

Not many take the entire summer of, but most do some vacation. Which won’t happen this year. Also most activities like summer camps /soccer won’t happen. Staying with friends/family/in-laws won’t happen.

 

My sons does now school via Zoom. I don’t think this works LT either, but this probably depends on the kid. He now need to organize himself to make sure he doesn’t miss any classes if none of us is at home, which sometimes fails. My wife usually works only half time as a Nurse but since this virus popped up in our area too, she works more hours than I do.

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I was hoping Sweden would be the "control" here, so we would see what the effects of no lockdown could be.

 

But I don't see much material difference in Sweden's mobility versus Denmark or Norway. People everywhere are going out less. Yes there is some differences, but they all are minor when compared to Italy, where you can see an extreme drop in people going out.  As an effect of this, their economic numbers should also be pretty bad. Anyone from the region who can shed any light on the movement of people, shops and economic impacts in Sweden? Thanks in advance.

 

Sweden: https://www.gstatic.com/covid19/mobility/2020-04-11_SE_Mobility_Report_en.pdf

Other Nordic Countries:

https://www.gstatic.com/covid19/mobility/2020-04-11_DK_Mobility_Report_en.pdf

https://www.gstatic.com/covid19/mobility/2020-04-11_NO_Mobility_Report_en.pdf

 

Italy:

https://www.gstatic.com/covid19/mobility/2020-04-11_IT_Mobility_Report_en.pdf

 

 

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Lol. Please point to me where I was wrong Dick?

 

Sure.  It's pretty simple.  You were saying early on that hundreds of thousands or millions of people in the USA probably had it, and that testing was pointless.  Then, hundreds of thousands of people in NYC actually got it and more than 10K died, which wouldn't have happened if all those people were infected already. And the countries that have done the best have been the ones who were good at testing and tracing.

 

That said, I have come down more harshly on you than others simply because you're dishonest, and because--if you are actually a doctor--I think that dishonesty makes you dangerous. (I would have no problem whatsoever with you if you were simply wrong and adjusted your beliefs as the evidence changed. In fact, I'd have a whole pile of respect for you, if that were the case.)

 

I also think that anyone who makes the argument that the worst case didn't arise so the worst case scenario couldn't possibly be true--after there was a massive, month-long lockdown to prevent the worse case scenario--is either disingenuous or stupid or both.

 

Can you please show data to prove that?

 

I am looking at worldometer

 

Country      Deaths/1M population    Tests/1M population

Spain                  402                          13,908

Italy                    358                          18,481

France                263                            5,114

UK                      190                            5,876

Switzerland        143                          22,993

USA                      86                            9,845         

 

As I went down the Deaths/1 Million population of some larger western countries, I faily to see a clear trend with relation to Tests rate.

 

             

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And the countries that have done the best have been the ones who were good at testing and tracing.

 

Can you please show data to prove that?

 

I was mainly talking about Taiwan, Germany, and South Korea. (Full disclosure: a couple of weeks ago, Singapore would've been on my list of test & trace success stories, but it seems to be breaking down.)

 

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And the countries that have done the best have been the ones who were good at testing and tracing.

 

Can you please show data to prove that?

 

I was mainly talking about Taiwan, Germany, and South Korea. (Full disclosure: a couple of weeks ago, Singapore would've been on my list of test & trace success stories, but it seems to be breaking down.)

 

Country      Deaths/1M population    Tests/1M population

Spain                  402                          13,908

Italy                    358                          18,481

France                263                            5,114

UK                      190                            5,876

Switzerland        143                          22,993

USA                      86                            9,845     

Germany              45                          20,629

S.Korea                  9                          10,509

Japan                    1                                745

Taiwan                    0.3                          2,129

 

 

Still no trend.  Taiwan doesnt follow.  Taiwan has one of the lowest testing rates and lowest death rates. 

Next is Japan with lowest testing rates in list above and deaths only above Taiwan.

Richard, please do check my data on Worldometer.

 

It is very difficult to rely on testing when vast majority of infected have no symptoms. 

You have to test most of 340 million in US. Thats not an easy job.

The highest in the list above is Switzerland which tested 2.3% of its population.

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I found this interesting: Dutch bloodbank reports in preliminary discussion antibodies found in ~ 3% of 4208 blood donors they have tested. All blood donors should be symptom free and not have had contacts with anyone with symptoms for 14 days before they are allowed to donate. I'm sure you could argue the people who donate blood by definition are not a perfect representation of a population, but otherwise this seems pretty random to me (and probably underreporting as everyone tested is by definition asymptomatic).

 

Netherlands has a 17 million population, with right now 28K registered cases and 3100 deaths.  3% of 17 million is 500K.  So suggests real number of infected patients compared to patients tested positive could be 18x as large. 3100 deaths is surely underreported as it is everywhere (nursing home deaths etc), but let's make it 5000-10000, you get a mortality rate of 0.1%-0.2%.

 

So, based on this report, herd immunity seems far away, except maybe in regions that have been hit particularly hard.  On the other hand, death rate does seem much, much lower than initial stats (and some people) were saying . And number of asymptomatic patients are many times the number of patients that get sick (as more and more research is now suggesting).

 

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I'm trying to ask this uncontroversially mostly medical professionals here: assuming a gradual relaxation of the lockdown with no vaccine, no treatment, and no (or minimal) testing/tracking. Would you say going out is acceptable or too risky? Let's assume a medium-high risk state like MA. Let's assume not super vulnerable person.

If we want to talk concrete "going out" categories, let's say going to parks, general shopping, meeting friends/family, going to office/work, going to a restaurant (I tried to order this from least risk to most risk).

Outcome of "severe" infection sounds very scary. That has to be balanced with infection risks though.

I know this is a bit theoretical and uncertain, but since there's a talk of "relaxation" even in NY state, maybe this could be useful.

I could open a new topic... but probably not worth it.

Thanks

Complement to Cobafdek, in the middle of the (tribal) fight.

Your question is difficult to answer (it feels like: What's the risk of shorting Tesla stock?) and it includes the evaluation of tail risk.

Since my background has some relevance and since i need to address this question now, here's a tentative answer.

 

It seems that the opening will be gradual and the rate of opening will be inversely proportional to virus resurgence. So you'll need to adjust your risk management for your area and with the evolving picture. I work with a scenario of localized and limited resurgence activity during the opening with no second or third wave although this could become low-grade seasonal. I'd say testing will be useful for certain areas of concern but it's hard to see how testing at large will be useful for local decisions. I would also add that herd immunity is not a black or white concept. Relative herd immunity may be much lower than the often 60-70% quoted.

 

1st risk: risk that you become a spreader without being sick

This is a population-level risk but also an individual risk as you may bring the disease to loved ones who may be susceptible (known risk factors or even rarely idiosyncratic).

Then, your cumulative (i share DocSnowball's realism about molecules and timeline) individual risk is likely lowish (and will evolve over a fairly long time), especially if you take basic precautions (basic distance, washing hands, and avoiding social contacts with older (or frail) friends or family members). The concept of position sizing (extent of your social participation along the activity risk spectrum you describe) could be applied as a degree of conviction that your area is safe (from publicly announced statistics, hospital activity level etc).

 

2nd risk: risk that you become significantly sick

Apart from idiosyncratic risk, which is very low, your risk will be proportional to risk factors (age, lung disease, obesity, diabetes etc) with individual risk factors being likely more than additive and serious event risk going up exponentially with the overall level of frailty. Assuming not super vulnerable means no major risk factors, it seems that your risk of becoming significantly sick is very low (do your own work  :) ).

 

What you do as an individual is also tied to your risk personality. If you used to go for the flu vaccine every year versus not even worrying about becoming sick will have an influence on future behavior vs CV. It's possible CV becomes old news very rapidly especially if other events take eyeballs off the bug (and its consequences).

 

@Jurgis: personally I wait for one incubation period to start to trust the data - cases in your state have gone down and stayed down for 14 days; and for two incubation periods for giving the all clear - cases are in single digits or zero in your state for 28 days. Try to phase your return back towards activities in that way. The most essential activities come first, and the lowest risk will be where you're not within 3-6 feet of others and are outdoors. The highest risk will be going to healthcare facilities and crowded indoor gatherings. One thing I've learned is this virus is 2 SD beyond what I've expected of it in spreading, so better to be safe than sorry. The fact that it spreads so easily in healthcare facilities (10k healthcare workers infected in the US!!! cities with public transport really hit hard) tells me there is effective transmission beyond droplets, perhaps it lives well on surfaces + asymptomatic/presymptomatic people spread it early on...(you fill in your thoughts)

 

Maybe a smart idea to build a checklist of do's and don't to follow before, during and after going out and test-drive/refine it when you start going out. I'll try to get it started.

 

Is this activity essential?

What is the risk in this activity? How can it be substituted or minimized?

Hand sanitizer - check. Wipes - check. Mask - check.

Keeping social distance, minimizing touches, minimizing time spent/risk incurred in the activity

Sanitize when done, dispose mask and take footwear off safely on return

Hand washing when home

Dispose clothes for washing later, hand washing again

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FWIW my prediction is that we'll try to do it the right way (tracking, testing etc), fail miserably, and then the destruction will be so great we'll just go "Fuck it" and go back to work anyway and tell grandma to stay home and order groceries online.

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I found this interesting: Dutch bloodbank reports in preliminary discussion antibodies found in ~ 3% of 4208 blood donors they have tested. All blood donors should be symptom free and not have had contacts with anyone with symptoms for 14 days before they are allowed to donate. I'm sure you could argue the people who donate blood by definition are not a perfect representation of a population, but otherwise this seems pretty random to me (and probably underreporting as everyone tested is by definition asymptomatic).

 

Netherlands has a 17 million population, with right now 28K registered cases and 3100 deaths.  3% of 17 million is 500K.  So suggests real number of infected patients compared to patients tested positive could be 18x as large. 3100 deaths is surely underreported as it is everywhere (nursing home deaths etc), but let's make it 5000-10000, you get a mortality rate of 0.1%-0.2%.

 

So, based on this report, herd immunity seems far away, except maybe in regions that have been hit particularly hard.  On the other hand, death rate does seem much, much lower than initial stats (and some people) were saying . And number of asymptomatic patients are many times the number of patients that get sick (as more and more research is now suggesting).

This is interesting. Netherlands used policies more or less intermediate compared to places like Austria on one side and Italy on the other with, as expected, more or less intermediate results. Netherlands has also produced interesting work on influenza vaccine effectiveness and is a good relative European student in terms of historical flu vaccinate rates.

It looks like (picture developing) that the CV does behave (intrinsic features) similarly to the influenza virus, with the main difference being that the population tends to have a much lower natural immunity to it and there is no vaccine, not even a partially effective one. Reasonable extrapolation of data in the Netherlands suggests that the eventual death rate from CV (with some social distancing and other basic measures) will look like (compare to a reasonable degree) the typical death rate for influenza, had there been a 0% rate of vaccination.

What society is doing is basically trying to adapt (with various levels of 'success') to this new and evolving reality.

 

@LC

Thank you for supplying the link for the European monitoring of mortality with seasonal variations.

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