4 ms·

It’s so hard to see that happening though, and if it doesn’t, we’re in trouble. We still don’t have scalable testing in the US, which is absolutely vital to re

It’s so hard to see that happening though, and if it doesn’t, we’re in trouble. We still don’t have scalable testing in the US, which is absolutely vital to reopening the economy safely. Without that, we risk losing all of the progress we’ve made flattening the curve. Then all of these businesses have to open back up and hope they’re able to generate income quickly enough to stay afloat, which isn’t a guarantee. There are also a growing number of experts saying that we’ll be in flux for the rest of 2020 unless we establish that survivors can’t be reinfected, which hasn’t been confirmed yet. Even if some areas are able to open up early, the economy will continue to suffer to its global nature. We’re just in no way able to say it’s going to be normal in 2 months.

mlyle 7y ago
> Without that, we risk losing all of the progress we’ve made flattening the curve. I personally believe that the worst could be done in many places. New York was too slow to institute controls and stopped just short of catastrophe. But, it's likely (based on extrapolation from serological data elsewhere), that 15% of people in NYC are immune and 20% will be soon. A disease with an Rt of, say, 1.8 is still scary and still requires controls and distancing, but it's a whole different ballgames from one with an Rt of 2.5. (-0.5 Rt for reduced susceptibility, -0.2 Rt for seasonal effects, say). > There are also a growing number of experts saying that we’ll be in flux for the rest of 2020 unless we establish that survivors can’t be reinfected, which hasn’t been confirmed yet. The case reports we have and clinical experience suggest reinfection is very rare. The bigger question is lasting immunity. Will most people be totally protected for 3 years like with a typical cold coronavirus? Or can we expect more like the 5+ years seen with SARS-CoV-1? And even if people become susceptible again, will the disease be less severe? I also believe that in the long run, 2019-nCoV will become "just another" endemic common cold virus, and will kill small numbers of people every year just like the other endemic respiratory coronaviruses (229E, OC43 etc) do. I bet those would be pretty fearsome introduced into an immunologically naive population. Which really sucks-- say, 10% more severe respiratory illness forever is not good. But I think it's the path we're on unless we get a truly terrific vaccine, and I don't think we can bet on that.
- the_mitsuhiko 7y ago
  There is no way that 15% of NY had the virus.
  - mlyle 6y ago
    I said 15% of New York City, and now we have the data -- no preprint yet, but... https://www.npr.org/sections/coronavirus-live-updates/2020/04/23/842818125/coronavirus-has-infected-a-fifth-of-new-york-city-testing-suggests https://www.npr.org/sections/coronavirus-live-updates/2020/0...
  - therealcamino 7y ago
    One recent report: Two hospitals in NYC did universal screening of 215 pregnant women admitted for delivery between March 22 and April 4th. 15.4% tested positive. Most of those testing positive (87.9%) had no symptoms at the time they were admitted. https://www.nejm.org/doi/full/10.1056/NEJMc2009316 https://www.nejm.org/doi/full/10.1056/NEJMc2009316
    - yread 7y ago
      Pregnant women go to hospitals for the antenatal appointments a lot though. And hospitals are full of the virus. You would expect pregnant women to be more likely to be infected than general population
      - therealcamino 7y ago
        Without other data I'm not sure I find that convincing. In the US, a lot of obstetrical care takes place at offices away from hospitals.
        mlyle 7y ago
        Less so in NYC, but I agree. In any case, I think the interesting things are: A) the share of infected people who will never have symptoms, and B) the share of infected people that have minor symptoms and will not be diagnosed. There's reason to believe that both A and B are significant. If they reach 90%-- which there's reason to believe they likely do-- it means that with a 1.5% cumulative case count you have more like 15% of the population having been exposed.

mlyle 7y ago

> Without that, we risk losing all of the progress we’ve made flattening the curve. I personally believe that the worst could be done in many places. New York was too slow to institute controls and stopped just short of catastrophe. But, it's likely (based on extrapolation from serological data elsewhere), that 15% of people in NYC are immune and 20% will be soon. A disease with an Rt of, say, 1.8 is still scary and still requires controls and distancing, but it's a whole different ballgames from one with an Rt of 2.5. (-0.5 Rt for reduced susceptibility, -0.2 Rt for seasonal effects, say). > There are also a growing number of experts saying that we’ll be in flux for the rest of 2020 unless we establish that survivors can’t be reinfected, which hasn’t been confirmed yet. The case reports we have and clinical experience suggest reinfection is very rare. The bigger question is lasting immunity. Will most people be totally protected for 3 years like with a typical cold coronavirus? Or can we expect more like the 5+ years seen with SARS-CoV-1? And even if people become susceptible again, will the disease be less severe? I also believe that in the long run, 2019-nCoV will become "just another" endemic common cold virus, and will kill small numbers of people every year just like the other endemic respiratory coronaviruses (229E, OC43 etc) do. I bet those would be pretty fearsome introduced into an immunologically naive population. Which really sucks-- say, 10% more severe respiratory illness forever is not good. But I think it's the path we're on unless we get a truly terrific vaccine, and I don't think we can bet on that.

the_mitsuhiko 7y ago
There is no way that 15% of NY had the virus.
- mlyle 6y ago
  I said 15% of New York City, and now we have the data -- no preprint yet, but... https://www.npr.org/sections/coronavirus-live-updates/2020/04/23/842818125/coronavirus-has-infected-a-fifth-of-new-york-city-testing-suggests https://www.npr.org/sections/coronavirus-live-updates/2020/0...
- therealcamino 7y ago
  One recent report: Two hospitals in NYC did universal screening of 215 pregnant women admitted for delivery between March 22 and April 4th. 15.4% tested positive. Most of those testing positive (87.9%) had no symptoms at the time they were admitted. https://www.nejm.org/doi/full/10.1056/NEJMc2009316 https://www.nejm.org/doi/full/10.1056/NEJMc2009316
  - yread 7y ago
    Pregnant women go to hospitals for the antenatal appointments a lot though. And hospitals are full of the virus. You would expect pregnant women to be more likely to be infected than general population
    - therealcamino 7y ago
      Without other data I'm not sure I find that convincing. In the US, a lot of obstetrical care takes place at offices away from hospitals.
      - mlyle 7y ago
        Less so in NYC, but I agree. In any case, I think the interesting things are: A) the share of infected people who will never have symptoms, and B) the share of infected people that have minor symptoms and will not be diagnosed. There's reason to believe that both A and B are significant. If they reach 90%-- which there's reason to believe they likely do-- it means that with a 1.5% cumulative case count you have more like 15% of the population having been exposed.