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Coronavirus (COVID-19) Discussion

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5 minutes ago, UberRebel said:

Think of it as kind of “paying now” upfront instead of “playing later.” The risk of course is completely overwhelming the healthcare system with an onslaught of hospitalizations 

 

The problem in Sweden isn't hospital capacity, it's that their strategy leaves seniors vulnerable , not only because they don't have enough PPE, but because their lax approach to social distancing creates more opportunities for infections to propagate between homes.  True 100% isolation of the elderly isn't possible, especially if you don't have enough equipment for senior care workers, which they apparently do not.  Any plan that essentially boils down to "front-load the deaths and hope herd immunity happens" but does not account for the need to protect workers and seniors while the virus is spreading uncontrollably is not a very sound plan at all.

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Posted (edited)
28 minutes ago, Dr. Whom said:

It does seem like we have been stuck on 27,000-29,000 new cases per day for a while now...I think it is flattening the curve although the curve is not going down at least here. I think recovered patients has to be greater than new cases each day to see some real progress on the graphs

That would mean it's working because otherwise the cases per day would still be growing, not stabilizing.

Edited by Slatykamora

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Posted (edited)
27 minutes ago, tonycpsu said:

 

The problem in Sweden isn't hospital capacity, it's that their strategy leaves seniors vulnerable , not only because they don't have enough PPE, but because their lax approach to social distancing creates more opportunities for infections to propagate between homes.  True 100% isolation of the elderly isn't possible, especially if you don't have enough equipment for senior care workers, which they apparently do not.  
 

 

Pursuing herd immunity with a lack of PPE does indeed make catching it more likely. Also more opportunities in general to catch it by not locking down by not isolating.

 

But you seem to be implying that by locking down and being adequately outfitted for PPE means one will NEVER get COVID-19.

 

Herd immunity assumes that to an extent it’s almost inevitable that just about everyone will get it in the long run. Again, this is in a long term horizon where treatments and a cure are not factored in. 
 

Seniors are not more “vulnerable” with herd immunity. They are equally as vulnerable to COVID-19 now as they would be when they catch it in the future absent treatments or vaccines. They are just more likely to catch it now instead of later.

 

So this brings me back to herd immunity being mainly about hospital capacity. So if one assumes that one was going to catch it eventually, then catching it now isn’t any better or worse than catching it later so long as there is hospital capacity.


Locking down and social distancing doesn’t cure anything - all it does is lengthen the timeline and precent unnecessary deaths due to lack of capacity. To an extent you want herd immunity eventually.

 

So the best approach may be a balance of Sweden pushing hard for herd immunity sooner and going into total lockdown.

 

At the end of this, IF IF IF Sweden’s deaths per capita were roughly the same as everyone else and their healthcare system wasn’t completely overrun and they reached herd immunity sooner then you can state their approach “worked.”

Quote

 

Any plan that essentially boils down to "front-load the deaths and hope herd immunity happens" but does not account for the need to protect workers and seniors while the virus is spreading uncontrollably is not a very sound plan at all.

 

not sure what you mean by “hope herd immunity happens.” It WILL happen by them doing this and sooner. It’s just a matter of whether it caused more unnecessary deaths as opposed to locking down

Edited by UberRebel
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NYT: 1 in 5 New Yorkers May Have Had Covid-19, Antibody Tests Suggest

Quote

One of every five New York City residents tested positive for antibodies to the coronavirus, according to preliminary test results described by Gov. Andrew M. Cuomo on Thursday, suggesting the virus had spread far more widely than known. [...]

In New York City, about 21 percent, or one of every five residents, tested positive for coronavirus antibodies during the state survey. The rate was 16.7 percent in Long Island, 11.7 percent in Westchester and Rockland Counties, and 3.6 percent in the rest of the state.


However...

Quote

Hours before Mr. Cuomo’s presentation, a top health official in New York City cautioned against making too much of the usefulness of the test results when it comes to critical decisions over social distancing and reopening the economy, particularly in identifying immunity.

The city’s top official for disease control, Dr. Demetre C. Daskalakis, wrote in an email alert on Wednesday that the tests “may produce false negative or false positive results,” pointing to “significant voids” in using the science to pinpoint immunity.

“Given the current lack of evidence” that any blood test for antibodies is indicative of “durable immunity,” Dr. Daskalakis wrote, “it should not be used for that purpose.” [...]

“I’m very ambivalent about these tests, because we don’t really know yet through the science what it means to have an antibody,” said Dr. Joan Cangiarella, the vice-chair of clinical operations at NYU Langone Health’s pathology department.

“We are hoping these antibodies mean you will be immune for some time,” she said. “But I don’t think the data is fully out there to understand if that means that you’re actually immune. And if these antibodies start to decline, what’s that time frame? Does it decline in a year from now?”

 

Hopefully more reliable antibody tests can show whether this is just a blip, or whether there's cause for optimism.

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Just now, UberRebel said:

But you seem to be implying that by locking down and being adequately outfitted for PPE means one will NEVER get COVID-19.


Wasn't saying that at all. Sweden's plan, as they envisioned it, led to more infections and more deaths in the short term, but hoped for fewer deaths in the long term.  Not simply trading the same number of deaths later for the same number of deaths now as you suggested.

As for "hoping herd immunity happens" -- nobody knows when it happens for this particular disease, so Sweden's plan implicitly hopes that it's a lower percentage of the population to avoid excess deaths that could have been prevented by social distancing long enough to get help from a vaccine or effective antiviral treatments.  One of the basic arguments of "flattening the curve" was to allow life-saving things to happen while the process is dragged out.  If their assumption for herd immunity was 50% and it's actually 80%, that means way more fatalities than they envisioned, and insufficient time to get more PPE, develop a better treatment regimen, etc.

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3 minutes ago, Slatykamora said:

That would mean it's working because otherwise the cases per day would still be growing, not stabilizing.

Yeah...I said the curve is flattening meaning we get around 27009-29000 new cases per day. It’s just not going down and this is for the entire country 

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5 minutes ago, UberRebel said:

 

Pursuing herd immunity with lack of PPE making catching it more likely. Also more opportunities in general to catch it by not locking down by not isolating.

 

But you seem to be implying that by locking down and being adequately outfitted for PPE means one will NEVER get COVID-19.

 

Herd immunity assumes that to an extent it’s almost inevitable that one will get it in the long term. Again, this is in a long term horizon where treatments and a cure are not factored in. 
 

Seniors are not more “vulnerable” with herd immunity. They are equally as vulnerable to COVID-19 now as they would be when the catch it in the future absent treatments or vaccines. They are just more likely to catch it.

 

So this brings me back to herd immunity being about hospital capacity. So if one assumes that one was going to catch it eventually, then catching it now isn’t any better or worse than catching it later so long as there is hospital capacity.


Locking down and social distancing doesn’t cure anything - all it does is lengthen the timeline and precent unnecessary deaths due to lack of capacity. To an extent you want herd immunity eventually.

 

So the best approach may be a balance of Sweden pushing hard for herd immunity sooner and going into total lockdown.

 

At the end of this, IF IF IF Sweden’s deaths per capita were roughly the same as everyone else and their healthcare system wasn’t completely overrun and they reached herd immunity sooner then you can state their approach “worked.”

 

not sure what you mean by “hope herd immunity happens.” It WILL happen by them doing this and sooner. It’s just a matter of whether it caused more unnecessary deaths as opposed to locking down

Yeah...this the route they chose to go. Maybe they believed their citizens are more healthy, less stressed, better healthcare, etc...

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1 minute ago, Dr. Whom said:

Yeah...I said the curve is flattening meaning we get around 27009-29000 new cases per day. It’s just not going down and this is for the entire country 

Probably due to America's size. The infection is going to have a slower momentum then in individual European countries.

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Posted (edited)
36 minutes ago, tonycpsu said:


Wasn't saying that at all. Sweden's plan, as they envisioned it, led to more infections and more deaths in the short term, but hoped for fewer deaths in the long term.  Not simply trading the same number of deaths later for the same number of deaths now as you suggested.

As for "hoping herd immunity happens" -- nobody knows when it happens for this particular disease, so Sweden's plan implicitly hopes that it's a lower percentage of the population to avoid excess deaths that could have been prevented by social distancing long enough to get help from a vaccine or effective antiviral treatments.  One of the basic arguments of "flattening the curve" was to allow life-saving things to happen while the process is dragged out.  If their assumption for herd immunity was 50% and it's actually 80%, that means way more fatalities than they envisioned, and insufficient time to get more PPE, develop a better treatment regimen, etc.

 

I don't know if Sweden was envisioning less deaths; my understanding was they expected about roughly the same amount of deaths, so "better to get it over with sooner rather than later" kind of thing. How they would expect less deaths is beyond me. I thought herd immunity was about speed

 

Flattening the curve does allow for life saving things to happen, but even that is an assumption. You're also assuming implicitly it happens sooner rather than later. As a thought experiment, let's assume we know that effective treatments and a vaccine would only come available in 2035. Does that mean we want to "flatten the curve" and live this kind of life for the next 15 years?

 

It may more absolutely ensure that less people than necessary die thanks to an overabundance of caution, but you can only say that's a better alternative than herd immunity if

1. Herd immunity overwhelmed the healthcare capacity

2. AND the timeline of life saving treatments/cures was on a soon enough timeline that was palatable (I know that's a vague standard)

 

Right now it seems flattening the curve is the more cautious approach, but I don't know if we can definitively say that one approach is for sure better than the other without seeing the results and timeline play out. 

 

I kind of see the two approaches as sort of a spectrum where a balance between the two is better than an extreme of either with all of the unknowns being considered

 

 

 

Edited by UberRebel

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9 minutes ago, UberRebel said:

I thought herd immunity was about speed

 

Negative:

Quote

Anders Tegnell, Sweden’s chief epidemiologist and architect of the policy, says the approach, much like the original British one, is to let the virus spread as slow as possible while sheltering the elderly and the vulnerable until much of the population becomes naturally immune or a vaccine becomes available.

 

They were trying to have it both ways.

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Posted (edited)
1 hour ago, tonycpsu said:

 

The problem in Sweden isn't hospital capacity, it's that their strategy leaves seniors vulnerable , not only because they don't have enough PPE, but because their lax approach to social distancing creates more opportunities for infections to propagate between homes.  True 100% isolation of the elderly isn't possible, especially if you don't have enough equipment for senior care workers, which they apparently do not.  Any plan that essentially boils down to "front-load the deaths and hope herd immunity happens" but does not account for the need to protect workers and seniors while the virus is spreading uncontrollably is not a very sound plan at all.

 

While I agree with your statement on PPE, I disagree with the general premise of your post. Seniors homes and seniors in general are always going to be the most vulnerable, even if we’re just talking about a bad flu season. Yes, Sweden should have been taking better precautions in senior living homes earlier. But if you nitpick at any countries response to Coronavirus close enough you can find some flaws. I read your article, and I wouldn’t say being lax with senior homes was their strategy, more of an oversight.

 

Last numbers I saw (I think yesterday) were about 50,000 dead from Coronavirus in the US and 26 million that lost their job because of it. That’s for every 1 death, 520 people that have lost their job due to the shutdown. Think about that ratio for a second. Take a look at these articles.

 

https://www.cnbc.com/2020/04/23/the-us-economy-has-now-erased-all-job-gains-since-the-great-recession.html

 

https://www.cnbc.com/2020/04/23/an-unemployment-rate-of-23percent-the-real-jobless-picture-is-coming-together.html

 

With the early results of the antibody tests coming back showing that 10X as many people have been exposed to the virus as expected, it’s looking like the fatality rate of Covid is more in line with the seasonal flu. Of the number of CONFIRMED cases in NYC, I think I saw 95.1% of the deaths were people older than 45. Most were elderly and/or had underlying conditions. Not to sound insensitive, but many of these elderly or immune compromised people may have died from something else in the not so distant future anyway. Yet the economic sacrifices of the masses (even most people that aren’t losing their job are getting crushed) have been so severe. Despite some of the anecdotal stories you hear, the virus is not life threatening to the vast vast majority of the population. There’s got to be more balance here.

 

I think you’ve got to start opening things up soon, while taking precautions for the elderly and vulnerable. Stores opening up an hour early and allowing only the elderly in as we’re seeing now for example. You’ve got to continue opening more and more, so long as you don’t run the risk of overwhelming the health system and everyone who needs treatment can continue to get it.

 

Sweden, while their handling of the crisis may not have been perfect, has been able to keep their economy open without overrunning their healthcare system. To me that makes it, generally speaking, a success.

Edited by TrueToTheBlue
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1 hour ago, TrueToTheBlue said:

 

While I agree with your statement on PPE, I disagree with the general premise of your post. Seniors homes and seniors in general are always going to be the most vulnerable, even if we’re just talking about a bad flu season. Yes, Sweden should have been taking better precautions in senior living homes earlier. But if you nitpick at any countries response to Coronavirus close enough you can find some flaws. I read your article, and I wouldn’t say being lax with senior homes was their strategy, more of an oversight.

 

Last numbers I saw (I think yesterday) were about 50,000 dead from Coronavirus in the US and 26 million that lost their job because of it. That’s for every 1 death, 520 people that have lost their job due to the shutdown. Think about that ratio for a second. Take a look at these articles.

 

https://www.cnbc.com/2020/04/23/the-us-economy-has-now-erased-all-job-gains-since-the-great-recession.html

 

https://www.cnbc.com/2020/04/23/an-unemployment-rate-of-23percent-the-real-jobless-picture-is-coming-together.html

 

With the early results of the antibody tests coming back showing that 10X as many people have been exposed to the virus as expected, it’s looking like the fatality rate of Covid is more in line with the seasonal flu. Of the number of CONFIRMED cases in NYC, I think I saw 95.1% of the deaths were people older than 45. Most were elderly and/or had underlying conditions. Not to sound insensitive, but many of these elderly or immune compromised people may have died from something else in the not so distant future anyway. Yet the economic sacrifices of the masses (even most people that aren’t losing their job are getting crushed) have been so severe. Despite some of the anecdotal stories you hear, the virus is not life threatening to the vast vast majority of the population. There’s got to be more balance here.

 

I think you’ve got to start opening things up soon, while taking precautions for the elderly and vulnerable. Stores opening up an hour early and allowing only the elderly in as we’re seeing now for example. You’ve got to continue opening more and more, so long as you don’t run the risk of overwhelming the health system and everyone who needs treatment can continue to get it.

 

Sweden, while their handling of the crisis may not have been perfect, has been able to keep their economy open without overrunning their healthcare system. To me that makes it, generally speaking, a success.

Fully agree.. things need to start opening up. End of story.

I agree with your thought process in the sense that stores can be open 1 hour more a day.. small steps.. but steps nonetheless. For example, one of our big grocery store chains here in Canada will be extending their hours starting April 26th. Its only a small step.. but.. it kinda looks like we will start getting the economy up and running again.

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Point of closing life was to provide a tad of relief to healthcare. Mission accomplished. Let er’ buck😂

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Just now, Whitecloud0101 said:

Point of closing life was to provide a tad of relief to healthcare. Mission accomplished. Let er’ buck😂

You're not wrong.. i think that kind of goes over peoples heads a little bit.. myself included at times. The lockdown wasnt intended to be the cure of the disease.. just to buy time and help with the medical systems. I think we here in N.America have achieved that.. and its time to start opening up again.. slowly.. and with restrictions.. but open..

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7 hours ago, brockpapersizer said:

which part?

The added deaths this year in relation to last. 

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8 hours ago, Dr. Whom said:

Latest Worldometer news:

New York State Governor Cuomo said that preliminary findings from an antibody study conducted on 3,000 people at grocery stores across New York State found a 13.9% had coronavirus antibodies, suggesting a 13.9% actual infection rate statewide (21.2% in New York City), which translates to an estimate of about 2,700,000 actual cases in New York State (10 times more than the about 270,000 cases that have been detected and reported officially). Governor Cuomo acknowledged that the official count reported by New York State (which still is not including probable deaths as recommended by the new CDC guidelines) of about 15,500 deaths is "not accurate" as it doesn't account for stay at home deaths. Based on Worldometer's count (which includes probable deaths reported by New York City) of about 21,000 deaths and the 2,700,000 case estimate from the new antibody study, the actual case fatality rate in New York State could be at around 0.78%

That includes ongoing cases that could still end in death. Notice the low recovery rate so far. 

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4 hours ago, Slatykamora said:

That would mean it's working because otherwise the cases per day would still be growing, not stabilizing.

Unless your testing capabilities are essentially the same daily. If you aren’t ramping up tests you won’t get a higher case number daily. 

 

3 hours ago, TrueToTheBlue said:

 

While I agree with your statement on PPE, I disagree with the general premise of your post. Seniors homes and seniors in general are always going to be the most vulnerable, even if we’re just talking about a bad flu season. Yes, Sweden should have been taking better precautions in senior living homes earlier. But if you nitpick at any countries response to Coronavirus close enough you can find some flaws. I read your article, and I wouldn’t say being lax with senior homes was their strategy, more of an oversight.

 

Last numbers I saw (I think yesterday) were about 50,000 dead from Coronavirus in the US and 26 million that lost their job because of it. That’s for every 1 death, 520 people that have lost their job due to the shutdown. Think about that ratio for a second. Take a look at these articles.

 

https://www.cnbc.com/2020/04/23/the-us-economy-has-now-erased-all-job-gains-since-the-great-recession.html

 

https://www.cnbc.com/2020/04/23/an-unemployment-rate-of-23percent-the-real-jobless-picture-is-coming-together.html

 

With the early results of the antibody tests coming back showing that 10X as many people have been exposed to the virus as expected, it’s looking like the fatality rate of Covid is more in line with the seasonal flu. Of the number of CONFIRMED cases in NYC, I think I saw 95.1% of the deaths were people older than 45. Most were elderly and/or had underlying conditions. Not to sound insensitive, but many of these elderly or immune compromised people may have died from something else in the not so distant future anyway. Yet the economic sacrifices of the masses (even most people that aren’t losing their job are getting crushed) have been so severe. Despite some of the anecdotal stories you hear, the virus is not life threatening to the vast vast majority of the population. There’s got to be more balance here.

 

I think you’ve got to start opening things up soon, while taking precautions for the elderly and vulnerable. Stores opening up an hour early and allowing only the elderly in as we’re seeing now for example. You’ve got to continue opening more and more, so long as you don’t run the risk of overwhelming the health system and everyone who needs treatment can continue to get it.

 

Sweden, while their handling of the crisis may not have been perfect, has been able to keep their economy open without overrunning their healthcare system. To me that makes it, generally speaking, a success.

If this had a similar death rate to the flu, it wouldn’t already have more deaths worldwide since December than the flu did the entire last year. 

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3 minutes ago, TrueToTheBlue said:

I read your article, and I wouldn’t say being lax with senior homes was their strategy, more of an oversight.

 

This is a distinction without a difference.  An oversight means a blind spot in the strategy.  If you sold your plan on isolating the vulnerable and failed to take the precautions necessary to save them, then you sold the plan under false pretenses.  They said their plan would would drag it out longer, yet the death rate exploded.  There's nobody to blame but those who chose to implement that plan, who had a responsibility to account for the PPE supply.

14 minutes ago, TrueToTheBlue said:

With the results of the antibody tests coming back showing that 10X as many people have been exposed to the virus as expected,

 

As I mentioned upthread, and as Cuomo mentioned during the press conference these antibody tests aren't gospel.  This article explains some of the problems with extrapolating from a single serology result:

Quote

The many different academic and commercial tests for coronavirus antibodies are still being refined and validated. They can show whether someone’s immune system has encountered the virus. But because no one knows what level of antibodies, if any, confers protection against the new virus, the tests can’t tell whether a person is immune to a future infection. And no one knows how long such immunity might last.

 

The piece goes on to cite other antibody studies that came to wildly different conclusions about the populations they studied, with a range of 2% to 30% having encountered the virus.  Even if we assume that the findings are correct, this alone shows you can't extrapolate from a single result to make projections about how things will go in a different environment.

 

1 hour ago, TrueToTheBlue said:

Last numbers I saw (I think yesterday) were about 50,000 dead from Coronavirus in the US and 26 million that lost their job because of it. That’s for every 1 death, 520 people that have lost their job due to the shutdown.

 

Yeah, my wife is one of the 26 million, so you don't need to sell me on the economic consequences here.  Still, the CARE act is providing emergency support for those who need it, and standard unemployment compensation is there as well.  The federal government has a printing press that it can print money with, and that is offsetting much of the financial hardship of the job losses.  It has thus far done so without significant harm to the country's currency or economic position in the world, which makes sense considering the rest of the world is dealing with this as well.

None of that is to say the job losses don't matter -- our household budget is certainly noticing it -- but to say that there are things we can do -- and are doing, supported by both political parties -- to make up for the losses.  What we can't make up for is lives lost to the disease, so excuse me if I'm unconvinced that there's a specific ratio of job losses to lives lost that we should be targeting.

 

21 minutes ago, TrueToTheBlue said:

Of the number of CONFIRMED cases in NYC, I think I saw 95.1% of the deaths were people older than 45. Most were elderly and/or had underlying conditions. Not to sound insensitive, but many of these elderly or immune compromised people may have died from something else in the not so distant future anyway.

 

It's pretty misleading to conflate "older than 45" with "many of these elderly or immune compromised people may have died from something else in the not so distant future anyway".  Yes, most fatalities had some other comorbidity, but so does most of the adult population.  You're already on shaky ground when you're essentially saying "well, the old geezers didn't have much time left anyway", but when you're counting people in their mid 40s and people who might have a little asthma as expendable so we can get some people back to work, it's clear you've lost the plot entirely.

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25 minutes ago, daynlokki said:

Just read that Trump said something about injecting disinfectants for this? Is that true? I read it in a partisan post so haven’t been able to verify. 
https://www.google.com/amp/s/amp.cnn.com/cnn/videos/health/2020/04/24/trump-disinfectant-inject-town-hall-gupta-wen-vpx.cnn

https://www.rollingstone.com/politics/politics-news/trump-coronavirus-remedies-injecting-disinfectant-989263/

Wait a few seconds and you should be able to play the clip that's included which is from his press briefing today.

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2 minutes ago, MrBrett said:

https://www.rollingstone.com/politics/politics-news/trump-coronavirus-remedies-injecting-disinfectant-989263/

Wait a few seconds and you should be able to play the clip that's included which is from his press briefing today.

You have to love Trump...says whatever is in his mind. He was asking the doctors and then told the press he was not suggesting it was a cure. 
 

It’s sad he has to even suggest if they tried injecting a safe bleach or iv light therapy because there are no therapies backed by science or even any doctors suggesting stuff. At least hook up an iv of vitamin c and nutrients to keep the immune system at optimal 

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1 hour ago, daynlokki said:

That includes ongoing cases that could still end in death. Notice the low recovery rate so far. 

Over 31,000 new cases today and our testing increased by a good number as well.

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1 hour ago, tonycpsu said:

Yeah, my wife is one of the 26 million, so you don't need to sell me on the economic consequences here.  Still, the CARE act is providing emergency support for those who need it, and standard unemployment compensation is there as well.  The federal government has a printing press that it can print money with, and that is offsetting much of the financial hardship of the job losses.  It has thus far done so without significant harm to the country's currency or economic position in the world, which makes sense considering the rest of the world is dealing with this as well.

None of that is to say the job losses don't matter -- our household budget is certainly noticing it -- but to say that there are things we can do -- and are doing, supported by both political parties -- to make up for the losses.  What we can't make up for is lives lost to the disease, so excuse me if I'm unconvinced that there's a specific ratio of job losses to lives lost that we should be targeting.

IMO, the biggest issue economically is not the value of the dollar internationally, or unemployment benefits for individuals (although there are some issues there, see Florida), but the failings of the PPP for small business owners.

https://www.inc.com/cameron-albert-deitch/coronavirus-small-business-closures-layoffs-survey.html

Small business has fueled most of the innovation in this country at one point or another.  They keep the enterprise sized folks honest in their hiring and labor practices.  We need to do a better job taking care of these folks.

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Hopefully those antibodies tests are faulty like our other tests with false negatives. It would be awesome if 80% already have the antibody.

 

I wonder if the Asian countries have more antibodies or can recover quicker due to previous exposure to the other SARS. This along with their rigorous hygiene and containment could explain their ridiculous numbers

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13 minutes ago, Dr. Whom said:

Over 31,000 new cases today and our testing increased by a good number as well.

4.774m tests in the US. Yesterday it was at 4.696. Testing is up but even then 31k positives out of less than 100k total tests with a large false negative rate still in those test. 

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