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No, it doesn't mean "stop sheltering in place," unless cases of COVID-19 have peaked. In order to tell whether they've peaked, you need testing in place, as we

No, it doesn't mean "stop sheltering in place," unless cases of COVID-19 have peaked. In order to tell whether they've peaked, you need testing in place, as well. Even if they have peaked, it could mean "relax some of the restrictions, but not fully end SIP, while monitoring cases." Opening things back up prematurely, without sufficient testing, is just going to get people killed.

manigandham 7y ago
Why do cases matter? It should be the death rate that peaks, and that's measurable without testing. In fact it seems to be over-attributed since many deaths are now being classified to Covid even if there are many other factors.
- pmiller2 7y ago
  Death rate is the proxy for cases. What matters when attempting to contain the disease is prevalence of the disease.
  - jfnixon 7y ago
    I think this is backwards. We have been using infection rates as a proxy for death rates, since deaths are a lagging indicator. It is certain we are missing a huge percentage of cases, and expanding testing will uncover those. It is completely unclear that uncovering more mild and asymptomatic cases will result in more deaths, so new cases are a bad proxy for future deaths.
    - pmiller2 7y ago
      Maybe in an ideal world, but we're not actually measuring infection rates. Dead is pretty objective, and easy to measure, and, we know that the number of deaths will roughly track the number of infections. That's why things like deaths and hospitalizations are what the state of California is watching closely.
  - manigandham 7y ago
    Is that the actual goal? Seems like we're well past containment now with infections in the millions. But if death rates are staying low and healthcare has enough capacity, then what does widespread testing accomplish? Might as well save it for the people who actually get sick and need confirmation for treatment or cause of death.
- tdeck 7y ago
  > it seems to be over-attributed since many deaths are now being classified to Covid even if there are many other factors. Citation?
sfj 7y ago
> Opening things back up prematurely, without sufficient testing, is just going to get people killed. But how many will get killed? Allowing people to drive down the street also kills people. What's the limit?
- pmiller2 7y ago
  Well, do you have research on how many excess deaths there would be if states started opening up now? California is taking a cautious approach by only opening in stages after cases have stabilized, and only after testing is present. Do you have a better plan than what a group of public health experts have come up with?
  - umvi 7y ago
    > Do you have a better plan than what a group of public health experts have come up with? As far as I can tell, public health experts (and basically all medical experts) are in over their heads on this one. It's like 1970s computer scientists issuing guidance on a stuxnet-esque infection. Sure, they are the experts in that they know more about computer science than other people, but they also have no experience with something like stuxnet-esque worms and so... how valuable is their expertise? "We recommend turning off all computers until further notice to stop the spread of stuxnet. Meanwhile, we will take 6-12 months or more to try and reverse engineer it and then we will issue further guidance." Except... "turn off your computer for a year" isn't going to fly with the general population. After so many months there will be riots and people will start disobeying.
    - pmiller2 7y ago
      And, what knowledge and/or credentials do you have to base the conclusion that "public health experts (and basically all medical experts) are in over their heads" on? Do you know what contained the outbreak in China, South Korea, and other countries?
      - umvi 7y ago
        > And, what knowledge and/or credentials do you have to base the conclusion that "public health experts (and basically all medical experts) are in over their heads" on? Nobody alive on earth right now has ever experienced anything like this before at this scale. So by definition, there are no "veterans", there is no one with any experience whatsoever, just people who did case studies of past pandemics when air travel didn't exist and people that ran some simulations. Inexperienced people, no matter how expert they are, are terrible at predicting the future (re: the last 20 years of climate change expertise). "Oops, the model was wrong again, but we learned more for next time!" > Do you know what contained the outbreak in China How do we know it's contained? China kicked out all western journalists and nobody can audit any of their numbers. China is not exactly a clean/sanitary place, I wouldn't put it past CCP to simply cover it up to save face. Or maybe they realized it's not really as bad as it seems and they just let it run rampant. How is Japan faring so well despite not sheltering in place and not testing?
umvi 7y ago
> Opening things back up prematurely, without sufficient testing, is just going to get people killed. Yep, some people will die. That's unavoidable. Tens of millions die every year. Hundreds of millions will die per year in a few decades. That's life. If you are at-risk, you should continue to avoid contact with others. But there's currently no cure for covid-19 other than your own immune system. The sooner the disease runs its course, the sooner we can return to normal. Sheltering in place forever means you prolong the propagation of the disease to excruciatingly long timescales.
- fzeroracer 7y ago
  Bold of you to assume that a disease can just run its course and then end. Would you say the same thing about the Chickenpox or some of the earlier flu pandemics we've seen? Are you willing to bet on a far deadlier second wave not occurring?
  - umvi 7y ago
    > Bold of you to assume that a disease can just run its course and then end. Not that bold, since it is how most diseases/viruses work (with a few exceptions like HIV, and there's no reason to assume covid-19 is an exception) > Would you say the same thing about the Chickenpox Yes, chickenpox is one-and-done. Once you've had it, you (basically) can't get it again. > Are you willing to bet on a far deadlier second wave not occurring? Yes - "Survival of the fittest" If there is a second wave, it will only affect survivors of the first wave, and as far as I can tell, the vast majority of first-wave survivors had mild-to-no symptoms. Kids are barely affected at all, it seems.
    - fzeroracer 7y ago
      Okay, I guess I have to explain some things here. > Not that bold, since it is how most diseases/viruses work (with a few exceptions like HIV, and there's no reason to assume covid-19 is an exception) This is objectively wrong and I'll lead into why in the next point. > Yes, chickenpox is one-and-done. Once you've had it, you (basically) can't get it again. Chickenpox is not one-and-done. If you catch chickenpox, the virus remains latent and can manifest itself as Shingles. And to explain a bit of history here: I'm not talking about a second wave of the current strain. I'm talking about a deadlier strain. That was what my reference was to earlier flu pandemics and I highly suggest you do a bit of reading on that. The Spanish flu had mutated to a far deadlier version during the second wave and spread all over the world. For all the comparisons people make with the flu virus, people seem to ignore that viruses can come and go in waves. The flu did not 'end', it mutates every season and the reason why we're able to keep it under control is because of widespread vaccination preventing it from growing exponentially. You claim that's how most diseases work, but that's not how the flu works. The danger of letting the coronavirus run rampant is severely understated by our complete inability to control it right now.

manigandham 7y ago

Why do cases matter? It should be the death rate that peaks, and that's measurable without testing. In fact it seems to be over-attributed since many deaths are now being classified to Covid even if there are many other factors.

pmiller2 7y ago
Death rate is the proxy for cases. What matters when attempting to contain the disease is prevalence of the disease.
- jfnixon 7y ago
  I think this is backwards. We have been using infection rates as a proxy for death rates, since deaths are a lagging indicator. It is certain we are missing a huge percentage of cases, and expanding testing will uncover those. It is completely unclear that uncovering more mild and asymptomatic cases will result in more deaths, so new cases are a bad proxy for future deaths.
  - pmiller2 7y ago
    Maybe in an ideal world, but we're not actually measuring infection rates. Dead is pretty objective, and easy to measure, and, we know that the number of deaths will roughly track the number of infections. That's why things like deaths and hospitalizations are what the state of California is watching closely.
- manigandham 7y ago
  Is that the actual goal? Seems like we're well past containment now with infections in the millions. But if death rates are staying low and healthcare has enough capacity, then what does widespread testing accomplish? Might as well save it for the people who actually get sick and need confirmation for treatment or cause of death.
tdeck 7y ago
> it seems to be over-attributed since many deaths are now being classified to Covid even if there are many other factors. Citation?

sfj 7y ago

> Opening things back up prematurely, without sufficient testing, is just going to get people killed. But how many will get killed? Allowing people to drive down the street also kills people. What's the limit?

pmiller2 7y ago
Well, do you have research on how many excess deaths there would be if states started opening up now? California is taking a cautious approach by only opening in stages after cases have stabilized, and only after testing is present. Do you have a better plan than what a group of public health experts have come up with?
- umvi 7y ago
  > Do you have a better plan than what a group of public health experts have come up with? As far as I can tell, public health experts (and basically all medical experts) are in over their heads on this one. It's like 1970s computer scientists issuing guidance on a stuxnet-esque infection. Sure, they are the experts in that they know more about computer science than other people, but they also have no experience with something like stuxnet-esque worms and so... how valuable is their expertise? "We recommend turning off all computers until further notice to stop the spread of stuxnet. Meanwhile, we will take 6-12 months or more to try and reverse engineer it and then we will issue further guidance." Except... "turn off your computer for a year" isn't going to fly with the general population. After so many months there will be riots and people will start disobeying.
  - pmiller2 7y ago
    And, what knowledge and/or credentials do you have to base the conclusion that "public health experts (and basically all medical experts) are in over their heads" on? Do you know what contained the outbreak in China, South Korea, and other countries?
    - umvi 7y ago
      > And, what knowledge and/or credentials do you have to base the conclusion that "public health experts (and basically all medical experts) are in over their heads" on? Nobody alive on earth right now has ever experienced anything like this before at this scale. So by definition, there are no "veterans", there is no one with any experience whatsoever, just people who did case studies of past pandemics when air travel didn't exist and people that ran some simulations. Inexperienced people, no matter how expert they are, are terrible at predicting the future (re: the last 20 years of climate change expertise). "Oops, the model was wrong again, but we learned more for next time!" > Do you know what contained the outbreak in China How do we know it's contained? China kicked out all western journalists and nobody can audit any of their numbers. China is not exactly a clean/sanitary place, I wouldn't put it past CCP to simply cover it up to save face. Or maybe they realized it's not really as bad as it seems and they just let it run rampant. How is Japan faring so well despite not sheltering in place and not testing?

umvi 7y ago

> Opening things back up prematurely, without sufficient testing, is just going to get people killed. Yep, some people will die. That's unavoidable. Tens of millions die every year. Hundreds of millions will die per year in a few decades. That's life. If you are at-risk, you should continue to avoid contact with others. But there's currently no cure for covid-19 other than your own immune system. The sooner the disease runs its course, the sooner we can return to normal. Sheltering in place forever means you prolong the propagation of the disease to excruciatingly long timescales.

fzeroracer 7y ago
Bold of you to assume that a disease can just run its course and then end. Would you say the same thing about the Chickenpox or some of the earlier flu pandemics we've seen? Are you willing to bet on a far deadlier second wave not occurring?
- umvi 7y ago
  > Bold of you to assume that a disease can just run its course and then end. Not that bold, since it is how most diseases/viruses work (with a few exceptions like HIV, and there's no reason to assume covid-19 is an exception) > Would you say the same thing about the Chickenpox Yes, chickenpox is one-and-done. Once you've had it, you (basically) can't get it again. > Are you willing to bet on a far deadlier second wave not occurring? Yes - "Survival of the fittest" If there is a second wave, it will only affect survivors of the first wave, and as far as I can tell, the vast majority of first-wave survivors had mild-to-no symptoms. Kids are barely affected at all, it seems.
  - fzeroracer 7y ago
    Okay, I guess I have to explain some things here. > Not that bold, since it is how most diseases/viruses work (with a few exceptions like HIV, and there's no reason to assume covid-19 is an exception) This is objectively wrong and I'll lead into why in the next point. > Yes, chickenpox is one-and-done. Once you've had it, you (basically) can't get it again. Chickenpox is not one-and-done. If you catch chickenpox, the virus remains latent and can manifest itself as Shingles. And to explain a bit of history here: I'm not talking about a second wave of the current strain. I'm talking about a deadlier strain. That was what my reference was to earlier flu pandemics and I highly suggest you do a bit of reading on that. The Spanish flu had mutated to a far deadlier version during the second wave and spread all over the world. For all the comparisons people make with the flu virus, people seem to ignore that viruses can come and go in waves. The flu did not 'end', it mutates every season and the reason why we're able to keep it under control is because of widespread vaccination preventing it from growing exponentially. You claim that's how most diseases work, but that's not how the flu works. The danger of letting the coronavirus run rampant is severely understated by our complete inability to control it right now.