Herd immunity to COVID-19 and pre-existing immune responses

By Nic Lewis

I showed in my May 10th article Why herd immunity to COVID-19 is reached much earlier than thought that inhomogeneity within a population in the susceptibility and in the social-connectivity related infectivity of individuals would reduce, in my view probably very substantially, the herd immunity threshold (HIT), beyond which an epidemic goes into retreat. I opined, based on my modelling, that the HIT probably lay somewhere between 7% and 24%, and that evidence from Stockholm County suggested it was around 17% there, and had been reached.

I then showed in a July 27th update article[1] that mounting evidence supported my reasoning.

It is pleasing to report that the evidence for heterogeneity of susceptibility across the population, arising from variability in both social connectivity and biological susceptibility, has continued to increase. Not least, there have been a number of further papers reporting pre-existing cross-reactive T-cells in a substantial proportion of people, which as I discussed in my July 27th article is likely be a key reason for heterogeneity in biological susceptibility. Mainstream journals are now starting to acknowledge that these factors are significant, with the implication that the herd immunity threshold (HIT) can be expected to be substantially lower than that often quoted by scientists close to governments. Unfortunately, in the UK at least, there is little sign as yet that those scientific advisors are prepared to recognise these facts.[2] [3]

Here I will focus excerpt on statements in a recent, quite hard hitting, feature article in the British Medical Journal by one of its associate editors.[4]

The article points out serological studies have generally indicated that no more than around a fifth of people now have antibodies to SARS-CoV-2, saying:

 With public health responses around the world predicated on the assumption that the virus entered the human population with no pre-existing immunity before the pandemic, serosurvey data are leading many to conclude that the virus has, as Mike Ryan, WHO’s head of emergencies, put it, “a long way to burn.”

As the article says, this has led most planners to assume that the pandemic is far from over:

In New York City, where just over a fifth of people surveyed had antibodies, the health department concluded that “as this remains below herd immunity thresholds, monitoring, testing, and contact tracing remain essential public health strategies.” “Whatever that number is, we’re nowhere near close to it,” said WHO’s Ryan in late July, referring to the herd immunity threshold.

However, the article notes:

Yet a stream of studies that have documented SARS-CoV-2 reactive T cells in people without exposure to the virus are raising questions about just how new the pandemic virus really is, with many implications.

It also points out that the WHO and the CDC has been repeating mistakes that they made and recognised in the past, suggesting a lack of scientific competence (unless explainable by a prioritising of other objectives over scientific ones).

In late 2009, months after the World Health Organization declared the H1N1 “swine flu” virus to be a global pandemic, Alessandro Sette was part of a team working to explain why the so called “novel” virus did not seem to be causing more severe infections than seasonal flu. Their answer was pre-existing immunological responses in the adult population: B cells and, in particular, T cells, which “are known to blunt disease severity.” Other studies came to the same conclusion: people with pre-existing reactive T cells had less severe H1N1 disease. In addition, a study carried out during the 2009 outbreak by the US Centers for Disease Control and Prevention reported that 33% of people over 60 years old had cross reactive antibodies to the 2009 H1N1 virus, leading the CDC to conclude that “some degree of pre-existing immunity” to the new H1N1 strains existed, especially among adults over age 60. The data forced a change in views at WHO and CDC, from an assumption before 2009 that most people “will have no immunity to the pandemic virus” to one that acknowledged that “the vulnerability of a population to a pandemic virus is related in part to the level of pre-existing immunity to the virus.” But by 2020 it seems that lesson had been forgotten.

Regarding pre-existing T-cell mediated immunological responses to SARS-CoV-2, the article quotes Alessandro Sette, an immunologist from La Jolla Institute for Immunology in California and an author of several of the studies:

At this point there are a number of studies that are seeing this reactivity in different continents, different labs. As a scientist you know that is a hallmark of something that has a very strong footing.” It also notes that a paper in Science confirmed its authors’ hypothesis that, because they’re closely related, the origin of these immune responses would be ‘common cold’ coronaviruses.

As the article says, the T-cell evidence suggests that antibodies are not the full story, in relation to which it gives this quotation:

 “Maybe we were a little naive to take measurements such as serology testing to look at how many people were infected with the virus,” the Karolinska Institute immunologist Marcus Buggert told The BMJ. “Maybe there is more immunity out there.”

and comments that studies by Buggert and others have shown that many people who have been exposed to SARS-CoV-2 generate T-cell responses but no antibodies.

The article makes the telling point that:

Taken together, this growing body of research documenting pre-existing immunological responses to SARS-CoV-2may force pandemic planners to revisit some of their foundational assumptions about how to measure population susceptibility and monitor the extent of epidemic spread.

The article also discusses the fact that the classical formula HIT = 1 − 1/R0 (where R0 is the disease’s basic reproduction number) assumes that immunity (the complement of biological susceptibility) is distributed evenly and members mix at random, saying:

While vaccines may be deliverable in a near random fashion, from the earliest days questions were raised about the random mixing assumption. Fox and colleagues wrote in 1971 [that] truly random mixing is the exception, not the rule.

The author quotes  Gabriella Gomes, noting that she and her colleagues wrote:

More susceptible and more connected individuals have a higher propensity to be infected and thus are likely to become immune earlier. Due to this selective immunization by natural infection, heterogeneous populations require less infections to cross their herd immunity threshold.

and points out that

While most experts have taken the R0 for SARS-CoV-2 (generally estimated to be between 2 and 3) and concluded that at least 50% of people need to be immune before herd immunity is reached, Gomes and colleagues calculate the threshold at 10% to 20%.

The article further notes that Sunetra Gupta’s group at the University of Oxford has arrived at similar conclusions of lower herd immunity thresholds by considering the issue of pre-existing immunity in the population.

The author also quotes Ulrich Keil, professor emeritus of epidemiology from the University of Münster in Germany, as saying

the notion of randomly distributed immunity is a “very naive assumption”

that ignores the large disparities in health and social conditions in populations.

As so often, the case of Sweden is brought up, in this quotation:

Buggert’s home country has been at the forefront of the herd immunity debate, with Sweden’s light touch strategy against the virus resulting in much scrutiny and scepticism. The epidemic in Sweden does seem to be declining, Buggert said in August. “We have much fewer cases right now. We have around 50 people hospitalised with covid-19 in a city of two million people.” At the peak of the epidemic there were thousands of cases. Something must have happened, said Buggert, particularly considering that social distancing was “always poorly followed, and it’s only become worse.”

Social distancing will reduce the R0 level of an epidemic and thus, while it continues, with reduce the HIT. The fact that social distancing in Sweden has become relatively minor therefore means that the epidemic’s recent behaviour there should provide a better guide to the HIT in the absence of social distancing than its behaviour in many other countries. Supporting Marcus Buggert’s comments, that in Stockholm (a densely populated region where R0 will be higher than average)  the epidemic  is almost extinct and social distancing is now minor, are these recent comments from a hospital doctor[5] in Stockholm:

In the hospital where I work, there isn’t a single person currently being treated for covid.

I haven’t seen a single covid patient in the Emergency Room in over two and a half months.

My personal experience is that people followed the voluntary restrictions pretty well at the beginning, but that they have become increasingly lax as time has gone on.

When I sit in the tube on the way to and from work, it is packed with people. Maybe one in a hundred people is choosing to wear a face mask in public. In Stockholm, life is largely back to normal. If you look at the front pages of the tabloids, on many days there isn’t a single mention of covid anywhere.

Covid is over in Sweden. We have herd immunity.

In Sweden, the epidemic gradually spread throughout the country from its original centre in Stockholm, with different regions seeing differently timed surges in cases, almost all of which have now tailed off despite national seroprevalence estimates of only 5-6%.[6] However, it looks as if in countries such as the UK lockdowns may have impeded the epidemic’s spread from its original centre to regional metropolitan centres, where the epidemic is growing now that young people in particular no longer fear COVID-19 much. Nevertheless, serious illness and deaths remain rare in the UK; in recent weeks only 1% of death certificates have any mention of COVID-19[7].

Returning to the T-cell immunity issue, the BMJ article further comments:

The immunologists I spoke to agreed that T cells could be a key factor that explains why places like New York, London, and Stockholm seem to have experienced a wave of infections and no subsequent resurgence. This would be because protective levels of immunity, not measurable through serology alone but instead the result of a combination of pre-existing and newly formed immune responses, could now exist in the population, preventing an epidemic rise in new infections.

Although noting that these epidemiologists added the qualification that this hypothesis is currently unproven, the article quotes Daniela Weiskopf (the senior author of the Science paper mentioned earlier) as commenting:

Right now, I think everything is a possibility; we just don’t know. The reason we’re optimistic is we have seen with other viruses where [the T cell response] actually helps you.”

As the paper says, one example is swine flu, where research has shown that people with pre-existing reactive T cells had clinically milder disease.

.

In conclusion, it is encouraging to see an article like this in an medical establishment journal like BMJ. I can only hope that epidemiologists, other scientists and modellers advising governments will now finally take seriously the issues that it raises.

 

Nicholas Lewis                                         22 September 2020


[1] Lewis, N: Why herd immunity to COVID-19 is reached much earlier than thought – update; with further update added on July 31st.

[2] For example: The academy of Medical Sciences 14 July 2020 report “Preparing for a challenging winter 2020/21” appears to rely on modelling by Professor Ferguson and colleagues from Imperial College, whose models make little allowance for population heterogeneity of susceptibility  https://www.gov.uk/government/publications/covid-19-preparing-for-a-challenging-winter-202021-7-july-2020

[3] https://www.bbc.co.uk/news/uk-54234084

[4] Peter Doshi: “COVID-19: Do many people have pre-existing immunity?” BMJ 2020;370:m3563 https://dx.doi.org/10.1136/bmj.m3563

[5] https://sebastianrushworth.com/2020/09/19/covid-19-does-sweden-have-herd-immunity/

[6] https://www.folkhalsomyndigheten.se/contentassets/376f9021a4c84da08de18ac597284f0c/pavisning-antikroppar-genomgangen-covid-19-blodgivare-delrapport-2.pdf  The latest published estimate is 5% for week 22; it may have grown since then but based on disease incidence seems likely to have remained under 10%.

[7] https://www.ons.gov.uk/file?uri=%2fpeoplepopulationandcommunity%2fbirthsdeathsandmarriages%2fdeaths%2fdatasets%2fweeklyprovisionalfiguresondeathsregisteredinenglandandwales%2f2020/publishedweek372020.xlsx

Originally posted here, where a pdf copy is also available

501 responses to “Herd immunity to COVID-19 and pre-existing immune responses

  1. Brian Ketelboeter

    Thank you, Nic. I really appreciate your work and wish I understood it better

    • Thanks, Brian.
      You might like to read the full BMJ article -(endnote 4 has the link) It’s open access, is under 3 pages long, and easy to understand, with almost no jargon.

  2. “Whatever that number is, we’re nowhere near close to it,” said WHO’s Ryan in late July, referring to the herd immunity threshold.

    Haha! I don’t know the answer, but this ain’t it. Hunches trump evidence!

  3. Nic Lewis, thank you for this essay and the others in the series.

    Has “herd immunity” to SARS CoV-2 been “reached” anywhere?

    • worldometers has the daily death rates of Sweden, Netherlands, and Switzerland at or under 5/day recently; can we say that is as “close” to “reaching” the conceptual “herd immunity” as we are likely to get?

      • Sweden has a population of around 10 million. MN about 5 million. MN is around 5 to 10 deaths a day. Which is about 6% of background deaths with a strong bias to old people. Choices are done, not done, kinda done so we have stuff to do we never got to do before and you people have always been ungrateful so take this. MN will go with the 3rd choice.

      • Ragnaar, New York is also down to under 10 per day. Do they have “herd immunity”?

    • The death rate in NYC right now can’t be explained by claiming people are more cautious there now than they were in April.
      A recent Wall Street Journal article had a chart saying the immunity for Covid 19 lasted about 6 months- like many common colds, which is why you can catch the cold again.
      T cells must have a big impact, but can’t be all important or we would see more immunity in older people.

      • I don’t think that follows, since old people generally have relatively weak T-cell activity.

      • how did prior immunity help older people with H1N1?

      • stevefitzpatrick

        Having been exposed to a related virus gives cross-reactive T-cells. But absent earlier exposure to a related virus, resistance appears in large part die to the population of ‘naive’ T-cells. The number of naive T-cells is highest in early childhood, but begins to drop significantly just after puberty, and continues to drop until old age. So in old age, people are far less able to fight a truly new virus, while young children are far more capable of fighting a new virus. It is interesting that the rate of symptomatic infections is very low in young childhood but begins to rise after puberty.

  4. I wrote a guest post back in March over at WUWT postulating this based on the facts of CVN71 (aircraft carrier Teddy Roosevelt), where despite the close quarters only about 20% of the crew came down with COVID-19. There are four common cold corona viruses, collectively responsible for about a third of common colds. Two of the four are beta serotypes same as the Wuhan coronavirus. The ship likely had a recent common cold corona infection.

    • That would be a nice vaccine. Just like a cowpox.

    • The results of the aircraft carrier Teddy Roosevelt scaled up. I don’t know why it would be otherwise.

      • The demographics, diet, health, and behaviors of an aircraft carrier crew are hardly representative of the general population.

      • > The demographics, diet, health, and behaviors of an aircraft carrier crew are hardly representative of the general population.

        And trying to extrapolate from Sweden to the US (or the UK) is bacially an exercise in confirmation bias.

      • An extrapolation from Sweden to the US or UK would be much better than from the aircraft carrier. The age, health, and behaviors would be much closer, and possibly the diet. There are lessons to be learned, but these must be carefully framed.

      • > An extrapolation from Sweden to the US or UK would be much better than from the aircraft carrier

        I agree.

        I said the same about the Princess Diamond.

        Nic ignored it.

        Extrapolating from an unrepresentative sample is a fundamental error of science.

      • But understanding the demographic typically on cruises, more like Florida, the Diamond Princess would be a bit better sample Thant the Presumably young and robust People on the aircraft carrier.
        As to Nic ignoring it — seemed to me to be the correct response. As your comment did not bring any light.

      • Here’s another demographic – Manaus, Brazil. They think it reached herd immunity – with a 66% infection rate, mass death, and overflowing hospital. I suspect its population is a lot younger than the cruise ship demographic.

        https://medicalxpress.com/news/2020-09-amazon-city-manaus-herd-immunity.html

      • I am making a fractal argument. A pandemic is the sum of smaller disease transfers. While environments will differ, the basic transfer is the same everywhere. Assuming an unchanging virus, it just keeps doing the same thing. Effective herd immunity works on a population of 100 or 100,000,000. Vaccine testing is the same. It worked on 1,000. Next 1,000,000,000. Having masks in hospitals and using that knowledge gained, now scales up. Because the virus and its transfer doesn’t change.

      • > While environments will differ, the basic transfer is the same everywhere.

        What are you taking about? What does it mean to say “the basic tranfer is the same everywhere?” There is no “basic transfer.”

        “The” virus is different strains, among people with different immunity systems, with different co-morbidities, of different ages, living in different conditions (including different levels of different levels of exposure and different levels of “viral load” under similar conditions).

  5. Arguably, even absent exposure to swine flu, it may well be that person’s who have a lifetime of experience in various workplaces populated by a large number of workers and diverse ethnic groups with cultural traditions and family backgrounds, probably have been exposed to more coronavirus, aka ‘the common cold,’ over the years and as a result also may have greater resistance possibly immunity to Covid-19.

  6. Thank you for this article. I think you made a prediction. I think it came true.

    I’d like to tell my own story. You have various resistances through the spreading network. It rushes through the network through the easiest paths. At the same time, you think you’re getting a representative sample. You are not. The network has resistant paths which the virus is working through now. Yes, we dropped the resistances some as we are tired of this thing and want to live our lives. The network gets more burnt out the longer we go.

    When you cut the easy paths early, the network does not get burnt out. The pathways are still there waiting for the next Trump peaceful protest.

    You can say the network is wrong and we need to fix it. Or you can accept the network. The network has been around for a long time and it works at the 90% level 90% of the time. Government has no clue what it’s doing and can’t make the network better in normal times or now. We can give the network radiation treatments or cut out parts of it. Which is to say we can kill virus by killing ourselves. We think that will work? We can always blame Trump.

    South Korea. Their easy pathways are still there. They can continue their treatments until they reach effective herd immunity. Can they stamp it out? No one can. They can keep fighting it. Or they can accept it. I do not want their system. Ours is fine if we all calm down. And decide not to tear it apart for non virus reasons.

    • India’s 5.6 million cases are 0.4% of its population, and its 90,000 deaths are only 0.006% of its population, both (especially deaths, a more reliable statistic) a far lower proportion than in most western countries, so one wouldn’t expect it to be near herd immunity yet. But I do note that both cases and deaths have ceased to grow exponentially in India.

      • Meanwhile they add 80,000 cases a day. Those numbers you quote show that what we have now is the tip of the iceberg. Talking about herd immunity in India seems contradictory to me

  7. Thanks Nic.
    .
    I think it has been clear for some time that many places (New York City, Stockholm, etc) long ago passed the HIT. While the details remain to be figured out, it is becoming ever more clear that exposure to related corona viruses does infer a significant measure of protection, and at a minimum, protection from severe illness. I predict that hindsight will not be kind to the many policy makers who made the pandemic far more damaging (both economically and socially) than it needed to be. I think the biggest error, and one that cost far too many life-years, was not recognizing early on that the real risk was borne by those over 65, and especially those over 65 with other serious health issues. Had efforts focused on protecting those people from exposure…. and not on the general lock down of people at virtually no risk… then the total damage, in lives and in economic costs, would have been far lower. Perhaps cooler heads will prevail the next time.

    • Steve: Yes, this summer it sure looks like NYC, NJ, MA, Germany, France and Spain had all reached HIT in the early months of the pandemic. However, GROWING second surges in new cases 250% and 150% as big as their spring surges are now underway right in France and Spain, but not in Germany, Italy and the NE US. During the plateau at the end of the first surge, those four European countries had detected 5,100, 3,800, 2,300 and 2,100 cumulative cases per million, with Spain the highest and France and Germany the lowest. In all cases, the number of new cases had dropped to less than 10% of the spring peak. If you assume the ratio of undetected to detected cases was similar in all four countries, one might have predicted that either all or none of these countries had reached heard immunity. Sweden’s pandemic didn’t have an early surge, but took the lead in confirmed case in early summer and has reached 9,000 cumulative cases/million. Spain recently regained the lead surging to 15,000. I doubt anyone can make sense of this in terms of herd immunity, but confirmation bias allows us to cherry-pick a conclusion about herd immunity.

      This doesn’t mean I’m ignoring the evidence that heterogeneity in susceptibility and transmission modify the classic concept of herd immunity. I’m simply saying that we don’t know how much less than 1-(1/R0) will turn out to be needed and why. The Spanish flu occurred in several waves in most locations over two years. The early waves were halted by changes in behavior and public policy, not by herd immunity. Changing behavior and public policy is always an alternative hypothesis that can explain every slowdown in new cases or deaths is changing behavior and public health policy. That hypothesis can’t be ruled out by anecdotal data about these factors in blog posts and comments.

      To make matters worse, if you look at deaths, there is a clear surge in Spain, but a barely detectable surge in France – 3% the size expected based on experience in the spring. In Spain, the second surge in deaths is 10% that expected from spring and in the US 25%. Sweden had a two-fold surge in new cases in June while the death rate was falling. That shocked me at the time, but not now that I’ve seen a 20-fold surge new cases in France producing a barely detectable surge in deaths. The most vulnerable are clearly a different and changing fraction of the new cases and the death rate per detected infection started at very different places in different countries and has fallen in different ways.

      A recent report shows that 66% of the people in Manaus, Brazil have been infected by COVID. What this means for the rest of the world isn’t clear to me right now. https://www.medrxiv.org/content/10.1101/2020.09.16.20194787v1

      • Frank –

        Where I live in Ulster County, about 1.5 hours from NYC, we had a fairly high level of spread back in March:

        https://covid19.ulstercountyny.gov/dashboard/?

        Now the rate of spread is quite low. I think it’s unlikely we’re anywhere near 20% infection rate.

        Reverse engineering from NYC’s low infection rate to conclude that “herd immunity” is the reason, it seems to me, is highly problematic. NYC is comprised of many different types of communities. The notion that there is some kind of coherent overall infection rate for the entire city likewise seems problematic to me. There are neighborhoods which likely have a low rate of spread but which have a much higher community infection rate than 20%. And there are neighborhoods which likely have a low rate of spread and which have a much lower community infection rate than 20%.

        Seems to me that at this stage, we don’t have good enough data for people to reach conclusions other than those which are driven by an unconscious (most likely in most cases) confirmation bias – driven by political preferences.

        Of course, I’m not very smart and I don’t know very much. So keep that in mind.

      • Joshua wrote: “Reverse engineering from NYC’s low infection rate,,,”

        I’ve seen too many people saying the traditional formula for HIT needs to be revised have any confidence that I know where the HIT is. And every location that has an unusually high attack rate (60%? in Manaus, 40% in Tyrol, 80% in the Washington state choir and an Ohio prison) probably has something unusual about it that means its lessons may not apply to another location.

        I’ve search the US for signs of a second surge in ANY location. In the NYT bar graphs, only Louisiana has two surges and they were in different areas of the state. I’m startled that the top half of states all have between 2,000 and 3,500 cumulative confirmed cases per 100,000 (2-3.5%), despite arriving at these values by many different routes. How can this not represent slowing down by approaching a common HIT? Then I saw the second surges in France and Spain. How can a second surge in NYC or Sweden not be a real possibility? And the more closely I compare one location to another, the more differences and uncontrolled variation I become aware of.

        So I’m agonistic about a non-traditional, much-lower HIT. However, I AM SURE that any current plateau or slow down (well below traditional HIT) has a non-trivial possibility of being followed by a surge. There are too many examples of our being fooled by plateaus and slowdowns – especially during the Spanish flu, which had three major surges in many locations and certainly didn’t reach HIT after the second nor probably after the third. Confirmation bias lets optimists reach different tentative conclusions than pessimists (like me). It is my job as a scientist to strive to overcome my biases.

      • stevefitzpatrick

        Frank,
        Number of cases is not a very good measure of the pandemic. Yes, there are ‘second wave’ surges in the number of cases in some places, but there are nothing like the death rates seen in the early part of the pandemic. Either the number of cases was much higher in the beginning, very much younger people are being infected now, or there has been a dramatic reduction in the rate of fatality due to big improvements in treatment. Seems to me it could some of all three, but most likely it is a combination of vast under-reporting of cases early in the pandemic, and of far fewer very elderly people catching the virus recently.

        Some local regions in Spain, Italy, New York state, and elsewhere were obviously isolated from the early part of the pandemic, and these regions have contributed to the recent increase in cases….. but with far fewer deaths per case, probably because those at risk of death are now being very careful, and because more cases are now being detected. New York City, Stockholm, and many other places do very much appear to be well past the HIT.

    • Steve wrote: “I think the biggest error, and one that cost far too many life-years, was not recognizing early on that the real risk was borne by those over 65, and especially those over 65 with other serious health issues. Had efforts focused on protecting those people from exposure…. and not on the general lock down of people at virtually no risk… then the total damage, in lives and in economic costs, would have been far lower.”

      This is the BIG LIE, or to be more accurate – since Steve is unlikely to be deliberately misleading us – the BIG MISCONCEPTION. There is no way to effectively protect the vulnerable in a pandemic. In the most dangerous areas of our country, more than 50 new cases of COVID are confirmed per day per 100,000. If those 50 people were infectious for only 4 days and only 4 other infections were undetected for every one confirmed by PCR, that would mean 1% of the people on average are infectious in dangerous locations. In a nursing home with 100 residents, there will be about 100 staff. In dangerous areas, this means in an average of one staff member in a nursing home with 100 residents is infected on any day and most likely asymptomatic. Without the capability of testing every staff member almost daily, we can’t effectively protect nursing home residents! This is why professional athletes whose careers might be ended by a serious, but non-fatal infection, have insisted on daily testing. This is why, despite three months to prepare, 45% of the deaths during the recent surge in Florida occurred in nursing homes. Vulnerable people who live at home are also vulnerable to the 1% of the people who surround them that are infectious – and those people may be doing little or nothing to prevent transmission! You can “focus on protecting the vulnerable” and reduce the death toll, but you can’t really protect them.

      The best way to protect the vulnerable is to reduce the fraction of infectious people from 1% in the most dangerous areas of the US to the 0.1% typical in safer areas. Or the 0.01% in Europe this summer. Or the 0.001% in South Korea. Or Taiwan, where there has never been a lockdown. All Taiwan needed to do to protect the vulnerable was impose a mandatory 14-day quarantine on everyone who had significant contact with someone with a confirmed case of COVID. Here in the US, where we might not be able to impose a mandatory quarantine on someone who isn’t proven to be sick, we’d need to offer perhaps $1,000 day with a $10,000 bonus for completion (call that an “economic stimulus” if you like) with free room and delivered meals for those willing to quarantine away from home (especially a crowded home). This would have been practical in locations that were lucky enough to avoid most of the initial surge, but those locations never invested in contact tracing and testing with a fast enough turnaround time to make it practical. So they got hit by the summer surge. Today North Dakota, of all places, leads the nation with an absurd 347 new cases per day per 100,000 people. (If you believe China’s numbers, cumulative cases in Wuhan (80% of total China cases) amount to about 500 per 100,000. OK, maybe the lied by a factor of ten.)

      • Frank, EXACTLY! Thank you. As one of the vulnerable, I’ve been trying to get people to understand how “protect the vulnerable” is mostly a fantasy, and that the percentage of people infected needs to be brought way down to do it (along with lots of testing).

        Also, it isn’t just the elderly. Obesity is very common in the US, and is an independent, significant risk factor for severe infections. Diabetes is common now among younger people. So is asthma.

        And, those people are not able to isolate well, because they are living with, and caring for and being cared for, in families with members who need to go out for economic reasons.

        And, the most vulnerable are also the ones who most need medical services, which is a well known significant source of infection.

      • Frank

        The death rate in the general community in Sweden was very small, as it was here in the UK

        Some 75% of deaths occurred in care homes and in home care situations-that is to say to the vulnerable and often elderly, as this new paper about Sweden shows

        https://ltccovid.org/2020/07/23/new-country-repor

        Many of the infections were brought in by staff who commonly work in more than one care home. Testing of them was very slow so they had the opportunity of returning several times to several homes before being removed from the equation.

        The situation was very similar in Italy and also in the UK. I suspect also in France where you will remember many elderly died in care homes during an August heat wave some years ago.

        Strip out the very vulnerable and the very elderly with existing health problems and the number of deaths in the UK for example was in the very low thousands according to the ONS.

        So basically in Sweden, and I suspect in a number of other major countries, their govts were so busy getting into a panic that they forgot to deal with the most obvious sector vulnerable to covid which were those in care homes. Perhaps the elderly are invisible?

        Tonyb

      • Mesocyclone: As someone with one very vulnerable family member and others (including me) with a range of vulnerability, I don’t believe I have any special insight into how to balance the risks to the vulnerable against the non-vulnerable majority. Quickly reaching herd immunity via an explosive pandemic may be the least costly option for society as a whole. Fortunately, I’m not responsible for making that decision. Those leaders who were responsible were unlikely to ever let a pandemic run wild, letting people die at home or waiting for a hospital bed and professional attention. The only reason Sweden was able to let the pandemic “run wild” was that their doubling time was about twice as long in March as in most countries

        My goal is simply to explain to the poorly informed why “focusing more attention on the vulnerable” while letting infection rates among the non-vulnerable rise above 50 cases/100,000/day doesn’t “protect” the vulnerable – it endangers the vulnerable. And it is unlikely to move society as a whole quickly towards herd immunity, because that soon overwhelms hospitals with patients. At least one Texas hospitals sent vulnerable patients home to die this summer to make space for patients with a better chance of surviving. As best I can tell, if you are forced to intervene in this “war”, winning as soon as possible, not stalemate (flatten the peak), is the superior strategy.

      • Franktoo – I think we are very much in agreement. From a selfish standpoint, if the epidemic had been allowed to run its course without mitigation, I’d have probably survived and now be free.

        But… two things… first, as you point out, there would have been people dying for lack of hospital rooms. I do believe that would have overall been worse for society – the death rate would be 4X-5X the death rate with adequate hospital care, as has already been demonstrated.

        The other is that, no matter what the government did, the epidemic wouldn’t run at that level. People would do what many of us did: engage in mitigations – risk avoidance – even if government was saying to go out and party. In fact, my biggest error in planning for this was failing to account for the fact that I wouldn’t be the only one hunkering down. I think the result would be the epidemic rising likely to levels where hospitals were overrun, followed by people panicking and hiding out, then when levels dropped, some of those people would stop being careful and it would happen again.

        Here in Arizona, I observed (anecdotally), that as soon as the government lifted the very weak stay-at-home order, a lot of people decided to act as if there was no epidemic at all. A few weeks after that, our case rate started rising, eventually (as exponential things do), rising very rapidly, to over 10X our spring peak, and with 5000 people per day testing positive – almost .1% of the population per day. But then it stopped rising. I believe that was a combination of mandates – the governor allowing mask mandates by lower levels for the first time, and strong restrictions on high danger businesses – bars, gyms, etc.

        It dropped way down – our Rt went to the lowest in the nation – about .75. Now it is going up again – probably (based on the county breakdown) as a result of colleges going back to in-person attendance.

        BTW, 91-divoc.com is a great site for visualizing this data – including population normalized graphs, and the ability to compare states with others on the same graph.

      • Mesocyclone: You may appreciate these graphs from mid-May, when I was arguing that we needed to further suppress transmission (make every contact between people increasing safer) before we could fully re-open our economy (and increase the number of contacts between people. 20/20 hindsight has clarified many issues, but the need to make contacts between people increasing safe was correct. Quarantining those who have been in contact with people with confirmed cases is a great way to make everyone’s contacts safer.

        https://judithcurry.com/2020/07/27/why-herd-immunity-to-covid-19-is-reached-much-earlier-than-thought-update/#comment-923639

      • Tonyb wrote: “So basically in Sweden, and I suspect in a number of other major countries, their govts were so busy getting into a panic that they forgot to deal with the most obvious sector vulnerable to covid which were those in care homes. Perhaps the elderly are invisible?”

        Tony, I think one problem is that nursing homes initially didn’t realize that asymptomatic staff members would be the major route by which the virus would invade their facilities and that the initial spread within the residents could involve an asymptomatic resident. Nevertheless, the number I cited for Florida – 45% of deaths were among nursing home residents – was from a statement issued by the state in the middle of summer when they blamed unacceptable delays in receiving PCR assays results.

        My somewhat educated OPINION is that the COVID survivors who were discharged to nursing homes were probably not responsible for the early problems in nursing homes in NYC. US hospitals don’t discharge weakened elderly patients possibly incapable of taking care of themselves at home until they identify a nursing home capable of rehabilitating them. When COVID hit NYC hard, no nursing home was eager to take “lepers” recovering from COVID for fear of lawsuits if something went wrong. With hospitals nearly full, Cuomo needed to act fast and ordered the nursing home to take recovered COVID patients believed to be non-infectious. Later we realized that that PCR can sometimes detect viral RNA fragments for a long periods of time after a recovered patient is no longer infectious. So some recovered COVID patients sent to nursing homes may have later been found to be positive by PCR. That is likely meaningless. The CDC lets health care workers recovering from COVID return to the job ONE day after all symptoms including fever (without medication) have disappeared regardless of PCR status. So I expect and hope that none of the hospitalized and recovered COVID patients sent to nursing homes were infectious, despite rumors that some were PCR positive. Nursing home operators, fearing lawsuits, want to blame the governor rather than their staff. However, if I am wrong, there will someday be a trial and sequence data will be able to clearly show that Patient X from Hospital.Y infected Nursing home residents A, B, C, D and secondarily E, F, G … When that happens, I will change my opinion. Otherwise I will continue to hope that this is merely a remote possibility being exploited for political purposes that is difficult to explain to the public. I don’t object to the Republicans bashing Cuomo, but I do object to their misusing my profession, science, to do so.

      • stevefitzpatrick

        Frank,
        The dramatic drop in deaths per confirmed case suggests that protecting the most vulnerable is very important. The rate of death per case is 90% explained across a range of countries, regions, and cultures only by the age of the patients… the simplest explanation for the dramatically lower recent death rate is that the most vulnerable (which are mostly elderly and very elderly) are now being exposed much less than early in the pandemic.

      • Steve replied: “the simplest explanation for the dramatically lower recent death rate is that the most vulnerable (which are mostly elderly and very elderly) are now being exposed much less than early in the pandemic.”

        In the first surge in the US, detected cases and deaths peaked at 96.5 and 8.2 per million per day; while the summer surge peaked at 203 and 3.5. This suggests that the pandemic is predominantly raging among younger, less vulnerable people and that the vulnerable have learned to reduce their exposure to others. However, medical treatment has certainly improved and a larger fraction of those hospitalized are presumably surviving. And with increased access to testing, we are likely detecting more milder cases that pose no threat of death. In Florida, 45% of deaths (which occurred mostly this summer) were nursing home residents. So the change in this death rate is due to many factors. Arguably, little of this change appears due to our public health system doing a better job of protecting the vulnerable.

        If you want to drive yourself crazy, try making sense of the same data for Spain and France (currently experiencing still-growing second surges larger than their first ones) and Sweden (with a mini-surge in cases but not deaths in June). The French death rate per detected case was the biggest during the first surge (3X ours!) and the smallest during the second. The closer I look at some of this data, the less confidence I have interpreting the cause of changes.

        Many people think that infections of younger people are good in the sense that they bring us closer to herd immunity. Some may say that we want to get those cases over as soon as possible and merely need “protect the vulnerable” while this happens naturally. If one assumes this pandemic will be ended by herd immunity instead of vaccination, those people may be correct. (It is very clear from some Asian countries and European countries that this pandemic can be controlled until vaccine is available, so I question the sanity of those advocating giving up all hope of control.) But the threat to the vulnerable is the infected people who surround them. If herd immunity requires that 50% of the people having been infected, that 50% of the population IS the threat to the vulnerable – you aren’t protecting the vulnerable by failing to control the pandemic. To some extent, the vulnerable living in the community have increasing been able to protect themselves. But the threat to the vulnerable can be more than 10X higher in some US urban areas, 100X compared to Germany, and 1000X compare to some Asia countries. That is “protecting the vulnerable”. So far, we haven’t been able to protect nursing homes, but an adequate supply of new rapid antigen tests may improve that problem.

      • How do you protect older people who live in multi-generational households (there are 64 million) or skipped-generational households or who are primary caregivers for their grandchildren, or older people who need to work and take public transportation to get to their jobs and go to doctors?

        This “protect the vulnerable” hand-wavimg from people who don’t want their hard-earned money to be “stolen” from then through taxes too pay for social welfare programs is a bit much.

        How are the vulnerable going to be protected?

      • I should correct that – 64 million Americans live in multi-generational households, (not that there are 64 multi-generational households, or older people who live in multi-generational households).

    • Steve: Trump catching COVID, despite all of the protection surrounding him, is further evidence (if you need any) that we can’t effectively protect the vulnerable in the midst of a raging pandemic. His risk of becoming infected would have been 10- to 100-fold lower in countries which have done a better job suppressing new cases. Trump does need to see an unusually large number of people to do his job.

      • Robert Starkey

        Frank too
        If a country did a better job of suppressing the virus (pushing the curve to the right) wouldn’t it mean that you just take longer to reach HIT. Shutdowns seem to delay not stop the spread in reality.

      • “wouldn’t it mean that you just take longer to reach HIT. Shutdowns seem to delay not stop the spread in reality.”

        Only if you assume there will never be a working vaccine – which is a quick, safe way to reach HIT. And if you assume that effective, life-saving treatments will never be developed.

        Higher viral prevalence means higher danger to those who are vulnerable, since only statistical, not perfect, protection in is practical.

      • Meso

        You seem to confuse multiple issues.

        Social distancing pushes the curve to the right. That delays people getting infected. That increases deaths and economic damage.

        Therapeutics reduce deaths but to wait for them to be developed is dangerous as you don’t know if they will save more lives than the time cost, and they don’t reduce economic hardship.

        Vaccines speed in reaching HIT and help individuals from infection. Assume a vaccine is taken by 1/3 of the population and it is 50% effective (both optimistic). That is not HIT.

      • > Social distancing pushes the curve to the right. That delays people getting infected. That increases deaths and economic damage.

        Norway, Finland, and Denmark will likely never reach the per capita deaths from Covid even if a vaccine is never developed and distributed. That would apply to excess deaths as well. And apparently they suffered no greater economic damage. As we can see from looking at a whole set of countries, less per capital death from Covid is associated with less economic damage.

        https://ourworldindata.org/grapher/excess-mortality-p-scores?tab=chart&stackMode=absolute&time=earliest..latest&country=NOR~SWE~FIN~DNK&region=World

        –snip–

        But among countries with available GDP data, we do not see any evidence of a trade-off between protecting people’s health and protecting the economy. Rather the relationship we see between the health and economic impacts of the pandemic goes in the opposite direction. As well as saving lives, countries controlling the outbreak effectively may have adopted the best economic strategy too.
        -snip-

        https://ourworldindata.org/covid-health-economy

        Also this:

        -snip-

        States that were quicker to end shelter-in-place rules and to reopen in the spring have paid an economic price. Our Back-to-Normal indices for Arizona, Florida, South Carolina and Texas indicate that their economies have effectively gone nowhere since mid-May.
        -snip-

        https://www.moodysanalytics.com/webinars-on-demand/2020/how-far-from-normal

      • Rob – nobody who pays attention is ignorant of the argument for achieving herd immunity by not taking precautions. So assuming I am ignorant, even *after* I explain why I believe your strategy is wrong…

        Sigh. Why do I bother?

      • Robert Starkey

        Joshua
        You wrote-
        “Norway, Finland, and Denmark will likely never reach the per capita deaths from Covid even if a vaccine is never developed and distributed.”

        What you wrote makes no sense. I’d have to guess at your meaning.

        Regarding the “excess deaths metric”, I am skeptical of the data overall, but it has nothing to do with the points I wrote.

        You wrote
        “But among countries with available GDP data, we do not see any evidence of a trade-off between protecting people’s health and protecting the economy.”

        Generally the Our World data is suspect. It is obvious that shorter disruption is better than longer economically. What will the data look like after another year of shutdowns if that is allowed to occur.

        Joshua, you do frequently post links to weak or outright bogus data and seem to hope not to get called on the data. Is that generally your goal?

      • Rob –

        You’ve posted no data. You’ve posted no real analysis of the data I’ve posted. Merely said it was “suspect” with zero evidence as to why.

        When I posted the Moody’s Report, you complained you couldn’t see the details of the analysis and the metrics. A simple Google f ound them. When I posted them, you said nothing.

        > What you wrote makes no sense. I’d have to guess at your meaning.

        At current rates of spread, the total per capita deaths and infections in Norway, Finland, and Denmark will NEVER reach the per capita death and infection total that Sweden has reached.

        Here’s an example:

        Per capita deaths in Sweden = 583 per million
        Per capita deaths in Finland = = 62 per million

        Average deaths per day in Sweden has been very low but over the last few months basically the same as Finland.

        If a vaccine is developed and distributed it is likely that the per capita death rate in Finland will never reach that of Sweden. Even if the rate in Finland were to spike to something like 5 per day, lower than its been for the entire pandemic except about 10 days in April, and it were to stay at around 1 in Sweden Finland’s per capita death rate would take years or decades to reach that in Sweden.

        And Sweden has likely not suffered significantly less economic damage from the pandemic than Finland as yet.

        I hope that was easier to understand.

      • Robert Starkey

        Joshua wrote- “At current rates of spread, the total per capita deaths and infections in Norway, Finland, and Denmark will NEVER reach the per capita death and infection total that Sweden has reached. ”

        It would not seem to be a valid comparison unless you account for the different data collection processes in the different countries and the different conditions (density etc.) in the countries.

      • Robert Sharkey asked: “If a country did a better job of suppressing the virus (pushing the curve to the right) wouldn’t it mean that you just take longer to reach HIT.”

        NO. The situation is not that simple. The first question should be: How serious is the threat from COVID or any other potentially pandemic pathogen? Consider SARS, MERS and Ebola. I’m certain you wouldn’t support a public health strategy which allowed these viruses to become pandemics that rage until herd immunity is reached. You’d demand seriously efforts to suppress these viruses until a vaccine is available and not wait for herd immunity. On the other hand, we haven’t taken extraordinary measures to suppress seasonal influenza. One the other hand, the annual average death toll from seasonal influenza in the US has been about the same as the monthly death toll from COVID, despite all of our efforts to suppress the latter, but not the former. This makes unrestrained COVID perhaps two orders of magnitude more deadly than seasonal influenza. The US has suffered 630 cumulative deaths per million people so far – roughly 0.1% of the population per year. The death rate from all causes is about 0.8%/year. Tell us how many extra deaths a year you are willing to tolerate without taking action.

        The second questions should be: How easily CAN its pandemic be controlled? Given the success of Taiwan, South Korea, China and a few other Asian societies, COVID obviously can suppressed 100- to 1000-fold better than the US has (though China’s measures were initially severe). Germany’s death toll is about 20% of that of the US and they (and Italy) have succeeded in keeping new cases suppressed since May. Italy, France, Spain and UK had initial death rates much higher per confirmed case, but their death rates (except in Spain) haven’t surged much during the second surges they are experienced. Then then is the complicated case of Sweden – which isn’t doing worse than the worst countries nor as well as logical comparison countries – without closing businesses and schools. Given the disdain for experts and the disorganization and lack of discipline in the Trump Administration, it should not be surprising that the US attempts to control the pandemic have been among the least effective in the world.

        When Robert Sharkey comments: “Shutdowns seem to delay not stop the spread in reality”, he is ignoring the evidence. In March, the number of cases in the US was doubling every 2.5 days – a 5,000-fold increase – and that exponential growth and stopped the first week of April, about 1 week (roughly the period between infection and detection) after lockdowns began. New case peaked on April 10 and began falling slightly. There is no doubt in my mind about cause and effect here. However, it is also clear that people begin to change their behavior when pandemics get worse. Some people were told to work from home before governments required change, the NCAA cancelled March Madness on March 10 and professional sports and other forms of indoor entertainment involving indoor crowds soon followed. Changed behavior and changing behavior have made it easier to control later surges. The surges in summer were much more gradual and easier to control for that reason: Texas merely closed its bars. Then there is the possibility that Nic discusses in this post, that many locations are approaching herd immunity much sooner than expected. With the new report that 60% of the people in Manaus, Brazil have been infected (according to antibodies), I’m not sure how many people still believe the US is near herd immunity, but I’m trying to keep an open mind to good reasoning.

      • Franktoo

        Sweden, like the UK failed to protect its care homes. To make matters worse hospitals were told to clear their beds ready for the covid rush and pushed out those elderly with covid who then infected their care home. Many staff are agency workers, here and in Sweden, and they also provided care at home with inevitable results.

        The majority of deaths were amongst the very elderly who were already Ill , either in care home, in care at home or who went to hospital for unrelated matters and caught covid there.

        If much better attention had been paid to this vulnerable sector the whole covid panic would have been seen in better perspective as the number of previously healthy adults who have died are in the low thousands here for those over 65 and in the hundreds for those under 65 .

        It is primarily an old persons disease, but the rest of society is being dismantled because of the shameful failure to look after them. So the Swedish experience would have been much nearer to that of its Scandinavian counterparts if they had been as vigilant with their older population as Norway etc were.

        In the UK our experience would have been akin to Germany if we had acted more promptly.

        I do not know the situation with regards to the US regarding the number of deaths in care homes and care at home or in hospital of people who originally went in for other reasons

        Tonyb

  8. The data shows that herd imm is being reached at 66% in Manaus, Amazonas. As the town is very isolated but was hard hit from chinese importers in May, it is a quite a good mini-state for a test.
    The towns to the N have adopted a protocol with ivermectin being handed out via local clinics with very good results, so it is posible that the population of manaus is also self-medicating (as we are) with this, zinc & Vit D.

  9. It’s unwise to make estimates of herd immunity under summer infectivity conditions. This disease is much more infectious in enclosed spaces and much more deadly to anyone with Vitamin D deficiency. The timing of the first wave was bad for Vit D but the warmer weather led to a big reduction in infection rate a few months later. Now the northern hemisphere is past the equinox and heading for flu season there is the potential for things to get much worse, especially with social distancing fatigue setting in. Take those Vit D tablets!

    • I second this opinion. Note I am not making a prediction, only an observation that this is an important source of uncertainty. Also, HIT is not a constant it is dependent on social interactions, amongst other things, many of those things change based on the season.

  10. As someone who lives in NY State, and who likes to travel into NYC on occasion, I certainly hope that something like increased “herd immunity” helps to explain the relatively low rate of transmission there, as well as the relatively low rate of positivity there in the testing. If increased “herd immunity” is a significantly explanatory factor, then it would suggest a greater degree of sustainability to those lowered rates than if other factors are more explanatory. That said…

    The rate of spread in Sweden has been on the increase over the last three weeks. The rate of increase is about the same as in Finland. In Norway, the rate of spread has been flat over that period. In Denmark there has been a considerably greater rise in infections (increased by about 5x as opposed to slightly under doubling in Sweden, and reached a per capita rate more than double that of Sweden). Since those countries are probably the best comparisons, it would seem to me that attributing any particular trend in any particular country to “herd immunity” would require some serious cherry-picking and confirmation bias at this point. I certainly hope that I’m wrong and that the trends that apparently undermine the argument that Sweden has a low rate of spread specifically because of “herd immunity” (given that two of the other Nordic countries have a roughy equivalent or lower rate of increase in spread, and a lower rate of spread in absolute numbers per capita), but it seems to me it’s waaaaay tooo early to reach a conclusion with any confidence.

    But even if it were true that “herd immunity” has created an advantage relative to the rate of spread in Sweden – given that we have clearly seen an improved fatality rate in many, many places, and that the improvement is at least to some degree a function of better therapeutics and a better understanding of the disease among medical professionals developed over time, it wouldn’t change the simple logic that Sweden, at least at this point, has traded off far more early deaths, and far more early illness, without any clear benefit (as of yet). No benefit as of yet in terms of rate of spread, and no benefit as yet in terms of (less) economic pain. As near as I can tell, the non-economic impact of Sweden choosing to not mandate social distancing measures as compared to the other Nordic countries doesn’t seem to be significantly different either – especially since it seems that in Sweden, people have adjusted their daily activities to a similar level as happened in those other Nordic countries, even if those changes weren’t government mandated.

    From what I’ve seen from people who study the medical science, T-cell immunity would not explain lower rates of transmission, although it is possible that it would help explain lower fatality rates. But is the effect of T-cells on fatality rates significantly a function of government policy? The existence of shelter in place orders or the lack thereof would obviously not directly affect the level of pre-existing T-cell immunity in the population. I suppose that in a complicated calculus, smart people could make the argument that SIPs retard the extent or at least rate of T-cell immunity’s impact of reducing transmission – but it seems to me that again, there’s a ton of uncertainty there that should temper the confidence with which people draw conclusions in that regard.

    On the other hand, it could well be that SIPs, which could in effect reduce the intensity of exposure among people (leading to them spending less time in close proximity), and the encouragement or mandating of mask-wearing could well help explain the lowering of the fatality rate (due to lower “viral load/titre/burden”). And there again, if that is true then the lack of SIPs and lack of mask-wearing in Sweden may in the end lead to rates of death and serious illness per capita that will never be reached in the other Nordic countries – even if eventually they reach the same level of per capita infection as Sweden reaches (because, as some people seem so certain, the level of “herd immunity” is the ultimate determinative factor for how far the virus spreads).

    And of course, if vaccines are developed and distributed on a reasonably short time frame, then Sweden’s choice to go for faster/deeper spread rather than slower/broader spread will have been a trade-off of greater serious illness and death for virtually no return benefit (assuming that Sweden starts to differentiate itself economically, from the impact of Covid in a way that it hasn’t done so far when compared to the other Nordic countries).

    • It is very difficult to draw conclusions from the impact of government actions such as SIP. People voluntarily restrict themselves, or not, based on their perception of risk. This tends to somewhat match the SIP and other orders (such as mask wear), because the individuals and the government are reacting to the same data.

      For that reason, it is very hard to tell which of Sweden’s policies had what effect. Here in Arizona, there did seem to be a good correlation between a couple of government actions and the resultant sharp reversal of our summer surge. Masks were mandated at a local level, covering most of our population, at around the same time that high risk venues such as bars were closed by decree. But, by then, the drastic rise in both cases and deaths was obvious to anyone who had any exposure to the media.

      • Also, this:

        -snip-

        Moody’s Investment Service, a bond rating company, and CNN Business have teamed up to track the economic recovery of each state.

        They say right now, Maine’s economy is operating at 93 percent of where it was in early March, making it number one in the so-called “Back-to-Normal Index.”

        They point to the state’s low infection rate, as well as the fact that Maine didn’t rush to re-open, as factors.

        -snip-

        https://wgme.com/news/local/study-maine-recovering-from-pandemic-better-than-any-other-state

      • Arizona implemented a shutdown which was effective at flattening/turning down, in the short term; the virus curve. It had vastly negative economic and societal impacts. Was it really a positive action or did it go on too long?

      • How do you distinguish between the effect of the shelter in place orders and the effect of the spread of the virus? The snswer is that you can’t.

        Many places shut down before the SIPs were put into effect.

        Also,

      • Notice there are no details as to Maine’s metrics.

      • Also, this:

        https://ourworldindata.org/covid-health-economy

        Maine shut down hard. Moody’s says it is number one in their “Back-to-Normal Index.”

        -snip-

        States that were quicker to end shelter-in-place rules and to reopen in the spring have paid an economic price. Our Back-to-Normal indices for Arizona, Florida, South Carolina and Texas indicate that their economies have effectively gone nowhere since mid-May.
        -snip-

        https://www.moodysanalytics.com/webinars-on-demand/2020/how-far-from-normal

      • -snip-

        How we created the index
        Our Back-to-Normal Index combines 37 indicators, including traditional government statistics and metrics from a host of private firms to capture economic trends nationally and across states in real time. The government statistics cover retail sales, industrial production, durable goods orders and housing starts, to name a few. Private contributors to the index include Zillow for home listings, OpenTable for restaurant bookings, Homebase for its measures of hours worked at small businesses, the Mortgage Bankers Association for data on applications for mortgage loans, the Association of American Railroads for rail traffic, and Google, whose cellphone-based mobility data is a window into how actively people are shopping, going to work and venturing out to play. (Read the full methodology here.)

        -snip-

        https://www.moodysanalytics.com/-/media/whitepaper/2020/back-to-normal-Index-methodology

      • Arizona’s spring shutdown corresponded to a relatively modest drop in cases. It also was a relatively moderate shutdown – “stay at home” was not enforced at all, for example.

        But, we had a real explosion in June and July, and that explosion correlated nicely with the end of the shutdown.

        It was my anecdotal observation at the time that many people took the end of the stay-at-home to mean it was time to go back to life as normal. I saw a large increase in the number of people going indoors to lots of businesses, and usually they did not wear masks [note: it was obvious to me in March, from reading pre-prints, that masks were important]. At the time, I feared we would see a surge, and we certainly did – much, much higher than our original spring peak.

        Eventually, it became clear that something needed to be done, and our relatively libertarian governor, for the first time, allowed localities to impose mandates. He also imposed closures on high risk businesses, and encourage responsible behavior.

        Our huge peak turned around shortly afterwards – we went from the highest per-capita rate in the world, with a high effective Rt (or put another way, a short doubling time), to an Rt that was the lowest in the country, and our case rate (and corresponding hospitalization and death rates) dropped back to spring levels.

        Now school is in session, college kids are being irresponsible, and our rate is starting to climb. We’ll see.

        Two sites are good for looking at this: 91-Divoc has great graphics, with lots of customizations, and has per million numbers and the ability to overlay data from more than one place on the same graph.

        Johns Hopkins has a page that shows cases or deaths, with government actions marked.

        91-Divoc: http://91-divoc.com/pages/covid-visualization/

        Hopkins: https://coronavirus.jhu.edu/data/state-timeline/new-confirmed-cases/arizona/33

    • Do you go into NYC to check on your tenement in Queens regularly, joshie? How are your renters? That demographic has been hit very hard by the capo di tuti and underboss De Blasio Wuhan virus debacle. The Democrat State Legislature, some of the very few in the press with a little integrity and folks who have lost loved ones have been trying to get to the bottom of the Cuomo-De Blasio virus outrageous fatality toll, but the regime has stonewalled. Now the DOJ is on the case. Grand jury time:

      https://www.wsj.com/articles/cuomo-gets-a-nursing-home-inspection-11598655585

      “New York Gov. Andrew Cuomo has resisted inquiries by the press and his own Democratic Legislature into how his policy of returning Covid-19 patients to nursing homes contributed to an untold number of elderly deaths. But New Yorkers may finally get an honest accounting thanks to the Trump Justice Department”

      • I offered my tenants a reduced rent if they lost jobs or took a hit on their income. I have good tenants who have been renting from me for a long time. I keep the rents low and take good care of the apartments. Only two took me up on it. The rest said thanks but it wasn’t necessary. My approach is to keep the tenants happy and then they take care of the place and there’s little turnover. Works out well for everyone involved and it’s less stress for me.

      • That’s the way to do it, joshie.

    • -snip-

      Sweden says Stockholm measures possible as COVID cases rise

      STOCKHOLM (Reuters) – Sweden, which so far has decided against lockdowns as a means to contain COVID-19, is seeing early signs that the number of coronavirus cases are rising again and could impose new measures in the capital, its chief health officials said on Tuesday.

      […]

      Tegnell said that new measures for the capital could not be ruled out. “We have a discussion with Stockholm about whether we need to introduce measures to reduce the spread of infection. Exactly what that will be, we will come back to in the next few days,” he said.

      Earlier on Tuesday Stockholm’s top health official warned that the region saw an increase in cases.

      “The downwards trend is broken,” Stockholm Director of Health and Medical Services Bjorn Eriksson told a news conference. “We can only hope that this is a blip, that the spread start decreasing again. That depends on how well we follow the guidelines,” he said.

      -snip-

      https://news.yahoo.com/sweden-says-stockholm-measures-possible-131658321.html

      • It’s only Stockholm and Dalarna regions that show a noticeable recent increase in cases. Dalarna has had a low number of cumulative cases relative to its population and the absolute increase in cases has been small there.

        In Stockholm cases fell to around 500 a week by mid July. After decling to close to 200 a week by early September, over the last week or so they have returned to about the 500 level.

        It is possible that part of the increase is related to a recent substantial rise in other respiratory diseases, which may have resulted in a higher proportion of COVID-19 infections being detected than previously. There has been zero change in the number of COVID-19 patients in intensive care in the Stockholm region over the last 7 days. I think it is too early to tell whether this is a blip or not.

      • > It’s only Stockholm and Dalarna regions that show a noticeable recent increase in cases.

        So the increase is primarily in the area with the highest percentage of infected people.

        And there’s no way that other regions of Sweden have reached even 10%.

        And people who study this issue (including authors of the Nature study) say that T-cell immunity doesn’t likely prevent infection but may lower the severity of illness once infected.

        You really are treating the uncertainties in a very selective fashion.

        You really ought to stop doing that. You should consider that like everyone, you are influenced by your political orientation. You can help to control for that by making a concerted efforts to treat the uncertainties equally.

      • > There has been zero change in the number of COVID-19 patients in intensive care in the Stockholm region over the last 7 days.

        Why would you be looking for that?

        First it’s too early for a rise in infections to result in higher ICU admissions, and cersinku for deaths.

        Second, with the improved understanding and treatment of the virus we would expect that associated rise to be quite gradual – particularly since the overall numbers are still relatively low. What’s most important to your advocacy is that the numbers have risen – which is problematic to the high level of certainty you have displayed, that Stockholm, let alone Sweden on the whole, has reached a “herd immunity” threshold.

        Third, they seem to have taken a lot of steps to help protect those most vulnerable. So we would expect a relatively low rise in absolute number of infections would not be strongly associated with a rise in ICU admissions or deaths even after we properly allow for the obvious lag. The more relevant question is whether it is practical to think that other countries would be able to put into place the same measures as Sweden put in place to protect the most vulnerable. Given that a much higher % of elderly people in the US live in multi-generational households, a much higher % have poorer baseline health and co-morbidities, many communities have a much higher population density, a much higher % lack access to healthcare, a much lower % have the option to work from home, etc., it could well be that the answer to that question is “No.”

        Fourth, ICU admissions and deaths are important measures for tracking the disease (in particular because they track independently of the rate and efficacy of the testing), but they are not the only important metric. The total number of illnesses is also important because illnesses that don’t result in ICU admissions or deaths can have serious health impacts and also have economic impacts as with increased infections you have lost work productivity and the like.

        Fifth… I gotta go but there more.

      • > It’s only Stockholm and Dalarna regions that show a noticeable recent increase in cases.
        > So the increase is primarily in the area with the highest percentage of infected people.

        I don’t know where Joshua got this from. Dalarna appears to have had a below average total percentage of people who have been infected. Stockholm is the most densely populated region, so one would expect that a higher proportion of people would neen to have been infected there to reach herd immunity

      • In Sweden the 7-day average of deaths has remained at or below 3 since the beginning of August. Cases? So what?

      • Joshua the source of extremely long-winded comments with little meaningful content.

      • So we go from herd immunity has been reached in Stockholm (months ago) to cases are increasing now in Stockholm but so what it couldn’t mean that the cases are increasing because herd immunity has been reached,

        to herd immunity has been reached in Stockholm even though Stockholm has the highest infection rate in Sweden,

        to cases are rising in Stockholm but so what.,

        to herd immunity has been reached in Stockholm even those cases have been rising because…. “T-cell immunity” (even though people who study T cell immunity say that T-cells likely don’t lower the infection rate)

        to “your comments are too long.”

        I think we’ve covered the whole gamut – but I don’t doubt you’ll come up with more.

      • BTW -.

        This is why I love you Boyz. You call yourselves “skeptics” and yet remain completely unskeptical about the potential influence of your own biases, and fail to address critiques of your arguments and instead respond with inanities or irreleavancies.

        Anything in fact, to avoid due skeptical diligence.

        Months ago, Nic pronounced with great certainty that he had shown that Stockholm had reached “herd immunity.”. Months ago.

        Let’s look past his attempt to extrapolate his policy advocacy from Sweden’s putative “herd immunity” to other countries without controlling for confounding variables.

        The current rise in cases in Stockholm is problematic to Nic’s confident assertion of “herd immunity” in Stockholm. And so is the lower relative rates of spread in other Nordic countries and non-Nordic countries that currently have lower rates of spread than Sweden and have had so for months)..

        And so are the high % of infection in many other communities. And so is his attribution of causality to “T-cell immunity” when it isn’t clear that T-cells increase immunity to infection.

        Maybe the recent rise in cases in Stockholm is just a blip. I hope so. Reaching “herd immunity” at low levels of population infections would be a great thing that would likely save millions of lives.

        But saying “maybe it’s a blip” isn’t a coherent counter to someone questioning the level of certainty previously exoressed. “Maybe it’s a blip” would be the argument of someone who isn’t confident about any assertion of causality.

        So there is a disconnect here. A true skeptic would see that.

        That’s why I put “skeptic” in quotes.

      • And BTW redux –

        I would be remiss for not noting the delicious irony of “skeptics” blindly trusting in the certainty of having reached her immunity, based on theoretical/computer modeling of extremely complex real world dynamics.

        And from that blind trust in cimiter modeling, these “skeptics” want to dismiss uncertainties to advocate for political policies, and in the process politicize science.

        Not sure I could find a better example of the power of motivated reasoning.

  11. Nic and others, you may be interested in the CEBM Oxford University analysis as well. From their site:

    Click to access PCR-test-Infectivity-Sep-2020.pdf

    One of the things they point out is that the RT- PCR that is the most common test cannot tell you whether or not the subject is infectious. The RNA strands on which the genes they detect can survive in the body for a long time, weeks even months. It’s very unlikely that they are picking up active viral infections. The only way to tell is to actually cultivate the virus, which is not the basis for detection.

    As well as this, it’s possible and even likely that the reason for the recent increase in detected cases is because of increase in testing, catching many more people that would not have ordinarily have sought one. So the second wave may at least be partially spurious. Hospital admissions for CV19 are still very low.

    Their verdict as of the 16th of Sept is that there is no epidemic level transmission in the community and URTI and LTRI levels are also much lower than normal probably as a result of social distancing:

    https://www.cebm.net/covid-19/what-does-rcgp-surveillance-tell-us-about-covid-19-in-the-community/

    I was aware that the immune system was able to adapt to similar pathogens – so it is able to swing into action if the molecules of the pathogen are similar enough to something it has already seen. I thought that was through the IgM axis though. A very interesting article. Thanks.

    • The RTPCR issues have been discussed for some time.

      But… at least here in Arizona, we had strong correlation between positive tests, hospitalizations, and deaths – with the expected lags between each category. In other words, the tests did a good job of profiling the epidemic. We had a huge rise in cases, that ended shortly after mask mandates were put in, followed by a huge fall. The correlations all tracked that curve nicely.

      So, while some of the tests were detecting people who were not infectious, and many people who were infected were not even getting tested, the overall result was pretty accurate.

      • YEs that what’s we found here -intially. That is indicated in the CEBM paper. What isn’t understood (well they have taken what I think is a pretty reasonable stab at it) is why they no longer are. Here, the rise in detection is no longer correlating with increase in hospital admissions or deaths. THat’s very clear in the stats.

      • Doesn’t it depend critically on a selection of test subjects?

      • agnostic2015… there could be a number of explanations. One, of course, could be inappropriate sampling in the testing. That’s one reason they use the (coarse) metric of test positivity as an indication of the effectiveness of testing.

        But another is likely a change in demographics. People more likely to end up in the hospital are likely to be avoiding infection better than people who feel that it won’t hurt them badly – if the latter are usually right.

      • “Doesn’t it depend critically on a selection of test subjects?”

        At the beginning of the pandemic, they were testing 2000 people per day, and now they are testing 200,000. That means are catching many more people who might otherwise not have been tested, people with mild or even asymptomatic people, and people who have symptoms but not CV19. The implication is that the virus is more widespread, but the population is more resistant. So the answer is to your question would have to be “yes”, but in the context of forming a proportionate response to increased detection, the question of whether those detected cases are actually infectious has to be asked. It seems it’s picking up people who have been in contact with the virus but are no longer infectious.

        THE CEBM also took a look at Spain, who are ahead of the UK in the pandemic. Their stats are show really clearly – they are not seeing the CDR or hospitalisations correlate to detection in their “second wave”. Not even close:

    • Thanks. I’ll take a look.

  12. Following the math of this paper https://www.medrxiv.org/content/10.1101/2020.07.23.20160762v1.full.pdf which is similar to Nic’s….I feel there is a logic issue.
    To whit, let’s do a hypothetical situation….say all subjects are blindfolded and an infected subject only infects another subject when he bumps into an uninfected subject. Say there are a 100 uninfected people in a darkened airport terminal. The infected blindfolded person walks through and bumps into 3 people infecting them. We do this repeatedly to get consistency and he bumps into an average of three people per trip. So R0 is 3.
    Classical herd immunity would technically be reached at 1-1/R0, which is 2/3. This means 2/3 of the people in the terminal already have been infected and presumably recovered. So when the infected person walks through, bumps into 3 people, but 2 of the 3 are immune, so he only infects one person. Effective RO has been reduced to 1, below which the infections will steadily diminish.
    Now add to the formula is a coefficient of variation resulting in the formula becoming 1-1/R0^(1/1+CV^2) where CV is a coefficient of variation. Our intension is to show the effect of the blindfolded person bumping into groups of people and wandering through open spaces as a result of some people being in groups not in his path. The math is correct, but the assumption that the variation in CV can be from 0 to 5 does not necessarily follow. In fact what follows is that the average number of people he bumps into after many attempts will still be 3. And herd immunity will still be 2/3. And in the somewhat more realistic world CV likely varies from 0 to 1, not 0 to 5…..

  13. Doug,
    I don’t think your example makes sense. The point is that some peple go out a lot more than others and/or are more likley to become infected when they do bump into someone. Such people will get infected early on. As they cease to be susceptible, the average susceptibility of the remaining pool of uninfected people falls, so the spread slows faster that if all people were equally susceptible.

    The formula you quote applies where the variation is in susceptibility that is uncorrelated with infectivity, that is in particular biological susceptibility arising from immune system annd health differences. But variation in social connectivity (contact rates) causes strongly correlated variability in both susceptibility and infectivity. A person who goes to a lot of crowded social events is both more likely to be become infected and to infect others. For that type of variability, the reduction in HIT is twice as great: HIT = 1-1/R0^(1/(1+2*CV^2)). Where both uncorrelated (CV.a) and infectivity-correlated (CV.b) variability in susceptibility exist, the formula becomes
    HIT = 1-1/R0^(1/(1 + CV.a^2 + 2*CV.b^2))
    The Gomes et al. paper (https://www.medrxiv.org/content/10.1101/2020.04.27.20081893v1) showed evidence that CV varied between 1.8 and 3.3 for some other infectious diseases. A more recent paper estimated, for US data, that the (1 + CV.a^2 + 2*CV.b^2) term lay between 4 and 5 for SARS-CoV-2. For an R0 of 3 that implies an HIT of between 20% and 24% ; or between 24% and 29% if R0 = 4.

  14. Would that this was original:-

    There has been an increase in Covid-19 cases because there has been an increase in testing!

    If more people took IQ tests there would be an increase in idiots too…

  15. Nic,
    I agree with the concept that the blindfolded people that go through the darkened building a lot will be infected early on. This would contribute to a reduction in what everyone thinks the R0 is as time passes. But that this would drop herd immunity from 2/3 to as low as 7% seems unlikely when, in the blindfolded man analogy compared to the real world, we have quite a bit of uncertainty knowing how many people are in the darkened building and how many times the blindfolded man actually walks through….with the result that the initial estimate for RO likely includes a CV component.
    And thanks for your good thought-expanding work on this topic.

  16. Neodymigo,
    R0 will indeed be increased on account of the CV component, but will drop sharply over time. It is arguable that R0 may have been substantially higher than the 2.4 estimate in Prof. Ferguson’s Imperial College ‘lockdown’ Report 13. The doubling time over a short period (up to about a week) after an community-transmission of the epidemic got established (say, 100 cases) suggests Ro may have been as high as 4. However, such a high R0 would only apply in a densely populated major city, which is where the epidemic typically starts.

    If R0 were as high as 4, With a (1 + CV.a^2 + 2*CV.b^2) term of between 4 and 5, that would imply a drop in the HIT from 75% to circa 25% for a densely populated major city, or a region dominated by one. For a country as a whole, the HIT would be lower, because in other regions the R0 value would be lower, potentially much lower. In some regions, a HIT of 7% or so might well be possible.

    • Nic – a minor comment. The literature I’ve read treats R0 as not varying (with caveats). They use Rt to represent the time and circumstance dependent reproduction number ( as opposed to R0 being the basic reproduction number). I’ve also seen Reff. I’ve never seen R0 treated as varying.

      • mesocyclone,
        Sorry, sloppy language on my part. R0 does indeed in theory not change over time (for a given region), although in reality it will do so if societal behaviour changes.
        What I meant when I said R0 would ‘drop sharply over time’ was that Rt would drop much more sharply than in proportion to the number of remaining susceptible individuals – which is what Rt does in the absence of heterogeneity in susceptibility.

      • Nic – that’s why I called it as minor comment. Your meaning was still clear, so not that big a deal.

  17. Pingback: Herd immunity to COVID-19 and pre-existing immune responses |

  18. jeffnsails850 | September 22, 2020 “The death rate in NYC right now can’t be explained by claiming people are more cautious there now than they were in April. A recent Wall Street Journal article had a chart saying the immunity for Covid 19 lasted about 6 months- like many common colds, which is why you can catch the cold again. T cells must have a big impact, but can’t be all important or we would see more immunity in older people.
    niclewis | September 22, 2020 at 3:30 pm | I don’t think that follows, since old people generally have relatively weak T-cell activity.”‘
    jeffnsails850 | September 22, 2020 at 3:54 pm |
    how did prior immunity help older people with H1N1?

    The article said
    “In late 2009, months after the World Health Organization declared the H1N1 “swine flu” virus to be a global pandemic, Alessandro Sette was working to explain why the so called “novel” virus did not seem to be causing more severe infections than seasonal flu. The answer was pre-existing immunological responses in the adult population: B cells and, in particular, T cells, which “are known to blunt disease severity.” Other studies came to the same conclusion: people with pre-existing reactive T cells had less severe H1N1 disease. In addition, a study carried out during the 2009 outbreak by the US Centers for Disease Control and Prevention reported that 33% of people over 60 years old had cross reactive antibodies to the 2009 H1N1 virus, leading the CDC to conclude that “some degree of pre-existing immunity” to the new H1N1 strains existed, especially among adults over age 60. The data forced a change in views at WHO and CDC, from an assumption before 2009 that most people “will have no immunity to the pandemic virus” to one that acknowledged that “the vulnerability of a population to a pandemic virus is related in part to the level of pre-existing immunity to the virus.”

  19. thecliffclavenoffinance

    You speculated in your May 10 article and you are speculating again. This is data mining and jumping to conclusions with incompkete, unverified, data in the middle of an ongoing pandemic. Jumping to conclusions gets attention but getting attention doesn’t mean the speculation is correct. No nation is at or even close to herd immunity.

    • You are jumping all over conclusions, cliffy. Why don’t you act like a man and write up your rationale and supporting evidence for your hyperbolic criticisms of Nic’s quest posts on a blog.

      You could submit your life-saving public health insights to the Guardian, WaPo , NYSlimes etc., put an end to Nic’s influence over public health policy and very likely be awarded a Pulitzer Prize, by the hysterical left loons who are in charge of honoring fake news.

  20. The best way to address this is a little extra history and a little comment on the logic.
    Swine Flu H1n1, which was the related Influenza A variant hat caused the Spanish Flu in 1919 for the next 3 years continued on until displaced in frequency by the Influenza A Asian Flu in 1955.
    There are multiple Influenza A and B variants of varying severity in existence.
    The people who survived developed B cell antibodies which protected them and helped reduce severity from related H1N1variants.
    The ability to produce antibodies from B cells generally persists for life even though they may become undetectable in the blood stream.
    “33% of people over 60 years old had cross reactive antibodies to the 2009 H1N1 virus, leading the CDC to conclude that “some degree of pre-existing immunity” to the new H1N1 strains existed, especially among adults over age 60.”

    Consequently older people, born and infected before 1955 have a level of protection to H1N1 when it reappeared, ramping up their B cell antibodies and associated T cell assistance [not weak at all in older people in this example].

    The article makes quite clear that the B cell antibodies are what works but repeats Nic’s idea of plausibility on the actions of Tcells.
    ” in particular, T cells, which “are known to blunt disease severity.” Other studies came to the same conclusion: people with pre-existing reactive T cells had less severe H1N1 disease.”

    I find it perplexing that we overlook the baby, Antibodies by B cells for the bathwater, T Cell activity.
    Especially when advocating it’s effectiveness then denying it
    “nic lewis I don’t think that follows, since old people generally have relatively weak T-cell activity”

    B cells form antibodies which inactivate viruses outside cells leading to their destruction. T cells are activated to help at the same time. It would be correct to say that B cells work without T cells but work better with them.
    The T cell destroys infected cells [at a price] enabling the B cell antibodies to do their jib.

    Imagine the new DNA spike producing T cell activating vaccine.
    Yes they are really working [28 labs] on this white elephant.
    Step 1. A miracle happens, the DNA is air blasted through the walls of unspecified cells in the arms ending up in cells that then start making Spike protein in the membranes of cells that magically activate a T cell response that will then destroy any cells in the body that later show the same spoke protein when they do catch Covid.
    Lost?
    I hope so. But that is the literature.

    Consequences
    Step 2 You actually catch the virus.
    It goes to and infects the target cells and makes virus and spikes.
    The T cells destroy the host cells releasing swarms of virus.
    These in turn infect billions more cells
    No Bcell antibodies yet but they will get switched on.
    Billions of cells lyse through increased T Cell activity.
    Pile of goo on the floor desperately tries to make B Cell antibodies.
    Successful T Cell plan, pity the patient dies.
    – BTW this was supposed to follow on a previous comment which appears to be lost. Can you restore and connect the two?
    Thanks

    • “The T cells destroy the host cells releasing swarms of virus.
      These in turn infect billions more cells”

      Not so. T-cells release perforin and cytotoxins. Perforin first makes a pore, in the membrane of the infected cell. Cytotoxins go inside the cell through this pore, destroying it and any viruses inside.

      • niclewis | September 24, 2020 at 10:28 am
        “Not so. T-cells release perforin and cytotoxins. Perforin first makes a pore, in the membrane of the infected cell. Cytotoxins go inside the cell through this pore, destroying it and any viruses inside.”
        Thank you for your response and information.
        -.
        Cytotoxins are by name cell destroyers, not virus destroyers. If they destroyed viruses these substances would be called virolytics or virotoxins.
        It is wrong to say that the cytoktoxins destroy any viruses inside a cell.

        The destruction of a cell by lysis, a process that kills the cell by bursting its membrane, is one of the three ways that viruses are released by cells. “Exocytosis is the process where vesicles containing the virus are secreted/excreted out of the infected cell. “Budding” through the cell envelope, in effect using the cell’s membrane for the virus itself is most effective for viruses that need an envelope in the first place. These include enveloped viruses such as HSV, SARS, or smallpox. Prior to budding, the virus may put its own receptor onto the surface of the cell in preparation for the virus to bud through, forming an envelope with the viral receptors already on it. This process will slowly use up the cell membrane and eventually lead to the demise of the cell. This is also how antiviral responses are able to detect virus infected cells.”

        Perforin can help cause a cell to die by lysis. [Add granulysin]
        It can cause a slower death of the cell apoptosis which turns off the viral reproduction as well. This does not kill any virus already made.

        From the British Society for Immunology.
        ” Immune responses to viruses”
        Cytotoxic factors are stored inside compartments called granules, in both cytotoxic T cells and NK cells, until contact with an infected cell triggers their release. One of these mediators is perforin, a protein that can make pores in cell membranes; these pores allow entry of other factors into a target cell to facilitate destruction of the cell. Enzymes called granzymes are also stored in, and released from, the granules. Granzymes enter target cells through the holes made by perforin.
        Once inside the target cell, they initiate a process known as programmed cell death or apoptosis, causing the target cell to die. Another released cytotoxic factor is granulysin, which directly attacks the outer membrane of the target cell, destroying it by lysis. Cytotoxic cells also newly synthesise and release other proteins, called cytokines, after making contact with infected cells. Cytokines include interferon-g and tumour necrosis factor-a, and transfer a signal from the T cell to the infected, or other neighbouring cells, to enhance the killing mechanisms.”

        If you could identify and name any common direct viral killing protein I will thank you.

        Until then antibodies rule.

        “Viruses can also be removed from the body by antibodies before they get the chance to infect a cell. Antibodies are proteins that specifically recognise invading pathogens and bind (stick) to them. This binding serves many purposes in the eradication of the virus:
        Firstly, the antibodies neutralise the virus, meaning that it is no longer capable of infecting the host cell.
        Secondly, many antibodies can work together, causing virus particles to stick together in a process called agglutination. Agglutinated viruses make an easier target for immune cells than single viral particles.
        A third mechanism used by antibodies to eradicate viruses, is the activation of phagocytes. A virus-bound antibody binds to receptors, called Fc receptors, on the surface of phagocytic cells and triggers a mechanism known as phagocytosis, by which the cell engulfs and destroys the virus.
        Finally, antibodies can also activate the complement system, which opsonises and promotes phagocytosis of viruses.”

  21. I must apologise having taken some comments in a news service so literally ” First needle-free coronavirus vaccine trial set to start in Australia”
    A better but older guide 28 April 2020 “The race for coronavirus vaccines: a graphical guide” suggests the DNA is helped into cells by a process called “‘electroporation”.
    DNA insertion is going to be an incredible and dangerous tool in years to come for other conditions including helping people who are missing genes.

  22. Here is one of the authors discussing reactivity

    There are THREE questions

    1. is there pre existing reactivity? Yes
    2. What is it from : the common cold
    3 DOES IT MATTER?
    A) Yes and it makes the disease worse
    B) NO it has no effect
    C) Yes and it makes the disease less severe

    All three hypotheses A, B and C remain viable and there is NO evidence
    to prefer one over the others.

    As the author points out the only way to look at that is a longitudinal study
    takes about 6 months

    Step 1. identify a group of people who have the Reactivity
    Step 2 identify a group that does not.
    Step 3. Watch them for 6 months.

    Prior to that what you have is guessing. no politician will guess

    • > and there is NO evidence to prefer one over the others.

      He does speculate as to a likelihood. There’s prolly an evidence-based reason for his stated speculation.

  23. @Nic Lewis
    You might consider looking at what Pavel Volchkov wrote at the end of June: http://johnhelmer.net/no-second-wave-pandemic-in-russia-pavel-volchkov-russian-leader-in-genomic-engineering-he-rejected-harvard-for-moscow-explains-why/
    Specifically, Volchkov cited multiple European studies employing ELISPOT testing to check T-cell and B-cell reactions to COVID-19.
    The conclusion from those studies was that exposure to COVID-19 was much higher than what antibody tests indicated – 200% to 300% higher.
    Or in other words: 20% antibody presence means 40% to 60% actual COVID-19 exposure with corresponding progress towards herd immunity.
    The dichotomy in ratio between infections to deaths in the early US states: New York, New Jersey, Massachusetts and Connecticut – which averaged 12-15 infections per death is contrasted by the so-called Republican hot spot states where the ratio is 55 to 148 infections per death.
    It would not be surprising that the reality is some combination of T-cell activation via exposure to sister coronaviruses plus no-antibody exposure to COVID-19 (i.e. no symptoms), and that actual policies such as lockdowns have minimal impact.

    • > The dichotomy in ratio between infections to deaths in the early US states: New York, New Jersey, Massachusetts and Connecticut – which averaged 12-15 infections per death is contrasted by the so-called Republican hot spot states where the ratio is 55 to 148 infections per death.

      Are you attributing that dichotomy to a different in prevalence of T-cells in the populations in those locations, respectively? If so, how would that work?

  24. I just saw Anthony Fauci state that if you believe that herd immunity can be achieved at a 20% infection rate, i.e. in New York City, you’re alone. Anthony Fauci, meet Nic Lewis.

    • A lot of (wealthier) people have relocated out of NYC.

      In those communities where a large % haven’t relocated. It’s quite likely that a higher % than 20% have been infected.

      And behaviors have changed dramatically.

      It is essentially meaningless, at least at this point in time, to say that NYC has reached “herd immunity” because 20% of the population has been infected.

    • Joe - the non epidemiologist

      NY is having new case counts running at less than 10% of the case counts from march & april. So maybe the 20% (or 30% range ) is a reasonable estimate of herd immunity

    • DeWitt: And Fauci had the audacity to deny the possibility of herd immunity from a 20% infection rate to Rand Paul, an opthomologist capable of understanding the issue. But Rand Paul failed to cite the names of any epidemiologists who have published about lower herd immunity. The Republican gadflies are happy to bash Fauci without caring about whether their information came from InfoWars or a reliable source. And it is possible the new data from Manaus has been circulating before publication and few if any still believe in herd immunity at 20%. The question is what kind of answer Fauci should have provided if the CDC hasn’t decided as a community what the public should be told about evolving new ideas.

    • Actually you should read Nic’s article more carefully, and also the BMJ article (British Journal of Medicine) where they point out what Nic was talking about “inhomogeneties” in the population. According to that article HIT can indeed be between 10-20%, and assumptions that populations are perfectly homogenous (thus a higher HIT) is “naive”. So Fauci narrowly is wrong at least on this point.

  25. -snip-

    All but 2% of Swedish residents who responded to a government poll in April said they’d changed their behavior to protect themselves from COVID-19. In May, 87% of respondents reported that they were keeping a greater distance from others in shops, restaurants, and on public transport.

    Sweden did impose some restrictions, though: It closed high schools and universities for three months, urged people to work from home, required social distancing in bars and restaurants, and told the sick and elderly to stay home. Gatherings of more than 50 people were banned in March.

    “There is often quite a misconception about what has been done and what is being done in Sweden,” Althaus said. “Whereas other European countries had maybe more strict measures and lockdowns, but came out of that in April or May, Sweden had softer measures, but kept them in place for a very long time.”

    […]

    If we were to encounter the same illness with the same knowledge that we have today, I think our response would land somewhere in between what Sweden did and what the rest of the world has done,” he told Swedish Radio in June.

    -snip-

    https://www.businessinsider.com/sweden-decline-coronavirus-deaths-cases-2020-9?amp

    • Thanks for that excellent reference. One of the main problems in the arguments about the effect of mandatory policies is that it ignores voluntary actions. And, of course, too many people are unaware that Sweden did take significant measures, and also don’t know that Sweden’s cases are rising agin.

      • Joe - the non epidemiologist

        most every country and region that had early high case counts and early high death rates are having spikes in cases, yet the death counts and icu counts have spiked

    • You post a comment made in June

      Based on the current situation, which country seems seems to have had the best approach?

      • https://ourworldindata.org/covid-health-economy

        Looks like there are many countries that have had far, far better results than Sweden, and certainly the US.

      • But actually, I should take that back – as it’s too early to tell.

        Attempts to do so without any reasonable control for confounding variables (read the article to see a short discussion of some of them) is more an exercise in confirmation bias than a careful analysis or quality science.

        That said, it’s clear that with any increase in likelihood of an effective vaccine being developed and distributed, the shortcomings of Sweden’s choices will become all that much more substantive.

      • Robert Starkey

        It is especially to early to tell anything based on an analysis of data through the 2nd quarter.

        Potential therapeutics and vaccines are what might change and lower the ultimate result for total deaths.

    • .joshua

      Hysteria and panic and the spending of vast sums of money without proper scrutiny and debate, an over reliance on one group of experts and absurd models and the intention to radically change our lives. But thats enough of climate change.

      The death rate in the general community in Sweden was very small, as it was here in the UK.

      Some 75% of deaths occurred in care homes and in home care situations-that is to say to the vulnerable and often elderly.

      https://ltccovid.org/2020/07/23/new-country-repor

      The situation was very similar in Italy. I suspect also in France, where you will remember many elderly died in care homes during an August heat wave some years ago.

      Strip out the very vulnerable and the over 85’s with several existing health problems, and the number of deaths in the UK was in the very low thousands according to the Office of National Statistics., Focus on those people below 60 and the number of healthy who died was in the low hundreds. A number that astonished a senior Govt figure when told it on Live Radio.

      So basically in Sweden, and I suspect in a number of other major countries including the UK, govts were so busy running round in circles back in February that they forgot to deal with the most obvious sector that was the most vulnerable to covid, which were those domiciled in care homes and those needing care in their own homes. Perhaps the elderly are invisible?

      The result is that thousands of people died and the scene was set for the public to be driven to near hysteria through imagining the modern day equivalent of the Bubonic plague was rampaging through their community, which it never was.

      tonyb

    • One of the reasons that Sweden’s death rate was so high was because many elderly COVID-19 patients were given only palliative care to preserve hospital beds for people with a longer life expectancy. That sounds like New York too.

      https://www.bioedge.org/bioethics/questions-raised-about-swedens-covid-19-policy-on-nursing-homes/13479

      • I think it’s possible that the stay-at-home orders, social distancing, contract tracing, etc., may not have been necessary.

        What if wearing a mask, early on, was all we had to do?

      • Judith

        Any chance of finding my post?

        I tried to post a link to a science paper on the elderly in Sweden twice, but it hasn’t appeared.

        Basically no less than 75% of those who died in Sweden were those in care homes or receiving care at home. That is to say the vulnerable and the elderly. Strip those out of swedens overall figures and their overall death rate and herd immunity starts to look much better

        Smilarly in England the number of healthy under 60’s who have died numbers in the low hundreds and the previously healthy in other age groups who have died numbers in the low thousands.

        In other words the vast majority of people who have died in England were those over 85 with several pre existing illnesses. The same is true in Italy and also in France I believe

        People have been terrified into believing the virus is rampaging through their community but if you are not in a care home that isn’t true.

        Tonyb

      • > One of the reasons that Sweden’s death rate was so high was because many elderly COVID-19 patients were given only palliative care

        Yah. I’ve been talking about that here for months. It’s interesting to see American (DEATH PANEL!!!) conservatives who freak out about “rationing” when lefties talk about nationalized health insurance embrace soshlist Sweden – a country where the populace has a high level of trust in government, and in public health officials, and a tradition of a collectivist sharing of responsibility for societal outcomes – in a bear hug despite the fact that they’d never accept hardly any aspects of Sweden’s healthcare ;policies.

        Of course, there are many other problems with the embrace as well, given the high % of Swedes who live in single-person households, the relatively low % who live in multi-generational households, the relatively low % of seniors who are primary caregivers for their grandchildren; the relatively low population density for much of the country, the better baseline health and lower level of co-morbidities, the lower % of poor and minorities where Covid outcomes are significantly worse, the better access to healthcare, the higher ease for most people to work from home, the greater ease with which people can take leave from work, the more time off that people get, etc., etc., etc.

        It seems that American conservatives don’t want to consider how any or all of those factors (plus many more) could represent confounding variables if you try to extrapolate outcomes in Sweden to infer something about what kinds of policies would be best in the US.

        I’ve also tried many times to get Nic to address those issues. Strangely enough, he has failed to do so also. Seems to me that someone who is serious about this issue should energetically examine the potential of confounding variables as they advocate for other countries to follow Sweden’s approach.

        I guess the reason he hasn’t addressed my comments about this is because my comments are too long?

      • Here are a few of the places where mask-wearing was widespread early on:

        Japan
        Indonesia
        South Korea
        Taiwan
        Thailand
        China
        Hong Kong
        Philippines
        Vietnam
        Nigeria
        Congo
        Bangladesh
        India

        All have very low death/capita rates compared
        to most places where mask-wearing was an afterthought, and implemented after the virus had already become widespread.

        Why the interest in Sweden? Places with a good record should be the focus, instead of a pissing contest between one bad place and another.

      • Bob – yes and no. Of course, at the time of the orders, nobody knew enough about the numerical impact of mitigations like mask wear to make decisions. 20-20 hindsight is just that – looking back with more information than they had at the time.

        Still, many of us started mask wear back when the government was (as Fauci said) purposely lying about whether they helped. They did that conserve masks for medical workers, but I still think it was a mistake. After that, it’s not clear to me why their messaging on masks was wrong. I think it was some confusion over ways it spread – no doubt engendered at least in part by early lies from China (after earlier truths leaked out).

        But, masks are such an easy mitigation that they should have urged them. At least, it’s easy except where people get weird political ideas about masks. I’d much rather wear a mask than be locked down, for example. A lot of people don’t realize that those are the actual choices – they are in denial about the seriousness of the situation.

        I have been aware of the SARS situation and the use of masks tsince the SAR outbreak in 2003 or so, so I started wearing a mask if indoors with strangers early in March.

        To quench the epidemic, you need to reduce the reproduction number Rt to below 1 – meaning that each infected person, *on average* infects less than one person. Each mitigation serves to reduce Rt, as does acquired immunity from vaccination or infection.

        But no, just mask wear would not and will not do the job, most likely. But, it will sure help. Add in sensible social distancing, especially indoors, and also sanitation – cleaning surface and hands – and that should do the trick. But, you also need contact tracing and consequent quarantine, if you really want to stop it. Taiwan is an example. China is another.

        Masks reduce both the spread of virus containing droplets from the wearer, and the inhalation of them by the wearer. They are less effective against aerosols. Plus, since most people aren’t going to wear tight fitting masks (think: rubber gasket against your face), so that reduces the effectiveness some.

        It isn’t clear if mask wear in east Asian countries was significant, but my bet is that it was. Those countries experienced SARS – which is caused by a very close relative to COVID19 (SARS-CoV vs SARS-CoV-2), and thus had already adopted mask wear. Plus it is a custom in some to wear masks during any epidemic, including seasonal influenza.

      • Bob

        12 of those places are tropical/sub tropical , two had very severe lockdowns, few have an obese population and many have a young age profile. So it’s a very mixed bunch with a variety of known factors that ensure a low death rate.

        Spain, Italy, France, Israel, Peru amongst many others had a very strict mask order and yet the pandemic has resurged

        Tonyb

      • The interest in Sweden is because of the future. Are the mask/lockdown states going to have more cases than Sweden in the future? They took a different path. The game isn’t over yet and I think there’s more uncertainty and overhead costs in the mask/lockdown states. A question is, is our future forever changed? Sweden will tell us shortly. You need mavericks.

      • meso –

        I assume you know, but there is no specific universal dividing line between droplets and aerosols.

        W/r/t aerosols, masks can increase humidity and dampen air flow, therefore altering transmission dynamics.

        And there’s a chance that while not fully blocking aerosols, masks might partially block them. In this situation some blocking is better than none.

      • > Are the mask/lockdown states going to have more cases than Sweden in the future?

        Keep in mind that at current rates, that could take years or a decade or more.

        Snd if a vaccine is developed and distributed it could likely NEVER happen.

      • Mesocyclone,

        “Bob – yes and no. Of course, at the time of the orders, nobody knew enough about the numerical impact of mitigations like mask wear to make decisions. 20-20 hindsight is just that – looking back with more information than they had at the time.”

        In March, when cases and deaths were spiking in Western Europe, mask-wearing was already the norm in the locations I mentioned. The strong correlation between mask-wearing and the containment of COVID should have given researchers pause. They should have said,

        “Do what appears to be helpful, and wear a mask, at least until we have determined for sure that the correlation is just coincidence.”

        Instead their guidance was condescending and dismissive.

      • Ragnar: “The interest in Sweden is because of the future. Are the mask/lockdown states going to have more cases than Sweden in the future? They took a different path.”

        It needs to be repeated: we don’t know how different Sweden’s path was. They had substantial mitigations, as the article posted by Joshua above shows. And, they had a high degree of voluntary mitigation measures – which is tied to the Swedish tendency to go along with advice, without mandates.

        We don’t know if their surge and high death rate was due to government policy or not. There are too many unknowns, and variances from minimal mitigation, to consider Sweden as a model for the impact of minimal mitigation.

        We do know that Sweden, so far, has done very poorly, compared to its Scandinavian neighbors. We don’t know why.

      • Tony –

        > People have been terrified into believing the virus is rampaging through their community but if you are not in a care home that isn’t true.

        Some 35% of the covid fatalities in minority communities in the US have been younger than 65.

      • Joshua

        Link please to the study showing that percentage you cite, which should give numbers, places and circumstances. Our ethic communities also have high rates but that is often because of their work, often on the front line in the NHS and are included in the overall figures I quoted from the office of National statistics.

        Tonyb

      • tonyb,

        Yes. You have it right. The rates are not bad at all as long as we don’t count most of the people who are dying. The rates are actually great. Full speed ahead.

      • Tony –

        I note that you want proof – which indicates that perhaps the disparate impact on minorities isn’t something that you were considering when you were citing numbers to downplay the significance of the pandemic

        I don’t have a direct link nor the time to search. I was quoting this dude:

        https://en.wikipedia.org/wiki/Peter_Hotez

        I shouldn’t have just quoted him, and he’s an MSNBC dude so what he says should be taken with a grain of salt….but I’m inclined to think that he knows what he’s talking about and wouldn’t just lie about something like that.

        Plus, just a quick Google search serves to underscore why I’m not inclined to say “It’s just a bunch of old and sick people so why should we care?”

        -snip-

        These disparities can be observed at all ages, but are especially marked in somewhat younger age groups. These disparities can be seen more clearly by comparing the ratio of death rates among Black and Hispanic/Latino people to the rate for white people in each age category. Among those aged 45-54, for example, Black and Hispanic/Latino death rates are at least six times higher than for whites:

        -snip-

        https://www.brookings.edu/blog/up-front/2020/06/16/race-gaps-in-covid-19-deaths-are-even-bigger-than-they-appear/

        I mean one problem with such rhetoric is that there is a much higher number of people who get seriously ill but don’t die – with not a trivial % of them likely to have long-term health consequences.

        And another problem is that there significant sacrifices made by the heroes who are enabling others to stay safe.

        And another problem is that there is a significant economic impact from this serous pandemic.

        But the big problem I was pointing to is reality that giving aggregate stats obfuscates (whether intentional or not) the disparate impact on those very communities who already endure disparate hardship.

      • And Tony –

        > but that is often because of their work, often on the front line in the NHS and are included in the overall figures I quoted from the office of National statistics.

        I fail to understand the significance you’re attaching to that. It doesn’t change the simple fact that if you downplay the significance of the overall death and illness and economic impact, you’re still obfuscating (whether intentional or not) the disparate level of impact on minority communities.

        Ine interesting thing that I note is that the set of people who stress that abortion is disproportionately prevalent in some minority communities largely overlaps with the set of people who don’t stress the disproportionate impact of covid in minority communities.

      • James

        As you well know I am pointing out that the vast majority of people dying fall into a very specific category! which are the seriously all and the very elderly, which are overwhelmingly the same group. My further point is that to prevent deaths we need to protect this group. In the early months this was not being done which resulted in many more deaths than there should have been.

        I quoted a paper above that confirmed the nature of the problem in care homes and in home care.

        I don’t think any of this is contentious. More people died than needed to because govts didn’t look at the obvious groups to protect first. Testing and PPE, isolation and quarantine was slow to get off the ground

        Tonyb

      • Joshua

        So you made an assertion without having any stats to back it up?

        The stats, for the UK at least, that I have published! come from the official office of national statistics. They show who died by age and ethnic group. There was a parliamentary inquiry because it was said that the ethic community was disproportionately impacted.

        Overwhelmingly it is the elderly and already sick who died primarily because of the care home and home care scandal as shown in the Swedish study. That includes the ethnic community and the indigenous population. The former are well represented in the NHS and a disproportionate number of younger than average people died as they were on the front line.

        I think you are beng argumentative for the sake of it. You will have to argue with someone else as its time for my bed. Good night

        Tonyb

      • Tony –

        > So you made an assertion without having any stats to back it up?

        My bad. I should have said that 30% of the dead from Covid are under 65 for non-whites. The 35% number is for Hispanic Americans.

        The interesting question is why do you doubt that statistic? Maybe you should consider how you think about this issue if the disparity comes as such a shock to you?

        And how is them being more likely to be essential workers of any relevance?

      • tonyb,

        The problem is that protecting the “vulnerable” groups is easier said than done when they live in nursing homes and multigenerational households. A significant number of the “vulnerable” must work and care for themselves, which requires that they have contact with others. In addition, a good number of the “non-vulnerable” can have difficulties with COVID which can result in death or long-term health problems.

        The pandemic problems are whole societal problems not solvable simply by isolating the so-called “vulnerable”.

      • I love me the irony of “civil libertarians” (at least the brand that we have in these threads) who live them some Swedish public policy.

        -snip-

        “Swedes have followed the rules more dutifully than in other countries — perhaps because they trust the public health officials,” Richard Smith, a former editor of the British Medical Journal, wrote for the publication this week.

        -snip-

      • > Team blue has the person who recommended ignoring the red line in Syria, presided over Benghazi, sent a planeload of unmarked bills to the Iranian Republican Guard, and missed the Russian interference in elections.

        (1) He’s not on “team blue,” (2) even if he were it would have no relevance to the critique he gave..

        Whars interesting is that you uniformly feel the need to deflect legitimate criticisms if Trump with irrelevancies.

        Why is tha…

        … oh right.

        Cult member.

      • Joshua wrote: “meso – I assume you know, but there is no specific universal dividing line between droplets and aerosols.”

        Of course – like many things in life and science, one ends up having to be arbitrary in dividing categories.

        “W/r/t aerosols, masks can increase humidity and dampen air flow, therefore altering transmission dynamics.”

        That’s an interesting idea. I’m not sure of the magnitude of that effect.

        “And there’s a chance that while not fully blocking aerosols, masks might partially block them. In this situation some blocking is better than none.

        I have been arguing that from the start. I started wearing a mask in early March, based on some data out of Wuhan.

        I suspect you confuse me with one of the other commenters in this thread.

      • It is not just Sweden that is not wearing masks. None of the Scandinavian countries are wearing masks.

  26. I am totally confused. If I were to follow science, what would I do now?

      • It is known that the masks we are all wearing are not effective at blocking aerosols. It is also known that aerosols play a role in the transmission of pathogens. The effectiveness of masks at preventing disease transmission is uncertain as the NAS acknowledged months ago.

        If you want to wear a mask wear one, but don’t mislead people into believing they are more effective than they are. The NAS specifically stated that one risk of mask wearing is that people may engage in risky behavior because they think they are safe.

      • Masks help. Period. Don’t be mislead by the logic that if they aren’t perfect, then they are useless. And, contrary to what dougbadgero says, yes, they do block aerosols. They just don’t do it as well as they block droplets (yes, the dividing line is arbitary).

        But… a lot of transmission is droplets, and stopping that is a good thing. And reducing the transmission of aerosols is a good thing too.

        Wear a mask. It is a very minor inconvenience compared to getting the disease, or killing someone else by spreading it.

      • And then there’s this… based on the pretty well established principle with many diseases that getting a lower dose of the agent either prevents an infection, or makes it less severe.

        It’s a surprisingly accurate article, given that it is in the Telegraph.

        “Face masks could be giving people Covid-19 immunity, researchers suggest ”

        https://www.telegraph.co.uk/global-health/science-and-disease/face-masks-could-giving-people-covid-19-immunity-researchers/

      • Nothing you have said in these three post changes what masks are and are not physically capable of doing:

        https://www.nap.edu/read/25776/chapter/1

      • And on what basis do you claim there is a lot of transmission in droplets?That one of the sources of uncertainty…the relative importance of each pathway of transmission. Droplets by definition follow a ballistic path and fall out of the air due to gravity. Aerosols remain in the air for relatively long periods…much longer than droplets.

      • Joe - the non epidemiologist

        The study cited by mesocyclone makes the following statement – “A recent study published in Health Affairs, for example, compared the COVID-19 growth rate before and after mask mandates in 15 states and the District of Columbia. It found that mask mandates led to a slowdown in daily COVID-19 growth rate, which became more apparent over time. The first five days after a mandate, the daily growth rate slowed by 0.9 percentage-points compared to the five days prior to the mandate; at three weeks, the daily growth rate had slowed by 2 percentage-points.”

        The delta between wearing a mask and not wearing a mask was only a 2% reduction in the growth rate – that for all practical purposes is trivial.

      • The nation in Europe with the highest adoption of face mask wearing- for many months now – is Spain. The nation in Europe that currently has the fastest spread and growth in case counts is… Spain.
        If we cared about science we’d be trying to answer “why?” Possible answers are
        -that masks give a false sense of security – people will go to crowded places or other risky activities thinking they are safe because they’re wearing a mask.
        -People report that they wear masks, but the young ones really don’t.
        -people aren’t wearing masks properly
        -masks don’t really work

        Because we care more about politics than science we couldn’t care less about why- we just shout “Trump!” and swear masks work perfectly.

      • Joe – the study is only one of many, and suffers, as they say, from the inability to actually measure mask use. We know that many people adopt protective measures before mandates, and after mandates, many people just violate them.

        Also – a problem with the study: nowhere does it define what “percentage of growth rate” means. That is not the way epidemiologists would say it – they’d talk about the change in Rt or perhaps the doubling time.

        But… from the article that you cherry picked: “These estimates are not small; they represent nearly 16 percent to 19 percent of the effects of other social distancing measures (school closures; bans on large gatherings; shelter-in-place orders; and closures of restaurants, bars, and entertainment venues) after similar periods from their enactment.21 The estimates suggest that the effectiveness of and benefits from these mandates increase over time. By May 22, 2020, the estimates suggest that 230,000–450,000”

      • Joe - the non epidemiologist

        Mesocyclone ‘s comment –
        “Masks help. Period. Don’t be mislead by the logic that if they aren’t perfect, then they are useless. ”

        Its not that masks dont help to reduce the spread.

        Its that masks are mandated in environments where the additional protection/ reduction in the risk of transmission is trivial. marginal Cost / Marginal Benefit , law of probabilities, etc.

        For example, If the risk of transmission in a particular environment is .05%,, then the mask only reduces the risk of transmission to .025%.

        the interaction at the typical grocery store is too short to have a high risk of transmission. Yet it is treated as all public environments are equally high risk,

      • I would argue that the risk of transmission in a closed public space is more dependent on the HVAC turnover rate than the prevalence of mask wearing.

      • Joe the non writes: “Its that masks are mandated in environments where the additional protection/ reduction in the risk of transmission is trivial”

        I think there are a several reasons that this actually makes sense. The most important is that you need to keep the rules simple. Complex ones both confuse and anger people.

        Another is that you cannot tell the risk level – environments that appear similar in risk may have a wide variance, depending on things like air flow and air filtering, or percentage of population that are likely infectious.

        Finally, if you create lots of exceptions, people who want to flout the rules will take advantage of those to claim that masks are useless.

        A 50% reduction (which you cite as trivial because it is reducing an already low risk) is a huge reduction, still. Yes, in any one encounter, the risk is quite low. But those add up – both population-wise, and on an individual basis.

        Finally, all the complaints about masks strike me as bizarre. I can understand people being really upset about businesses closing, or stay-at-home orders. But mask wear? I think the resistance there is purely symbolic, ideological, or just orneriness or ignorance. It’s a simple precaution and is low impact to the vast majority of the population, so why is everyone still in a lather about it?

        Just wear a mask and stop fussing. It sounds to me like whining.

      • > just shout “Trump!”

        -snip-

        I served under six presidents — four Republicans, two Democrats — only one has failed to serve U.S. national security interests.

        […]

        I spent over 300 mornings in the Oval Office briefing the president and his senior staff. I had the privilege to manage, edit and deliver the president’s Daily Brief a summary of the most timely and critical intelligence threats to the U.S. from 2010 to 2014.

        As a Deputy on the National Security Council, I spent over 1,000 hours in the White House Situation Room providing the intelligence assessments which informed critical U.S. national security policy decisions — including the raid that rendered justice for the victims of 9/11.

        Since I have been eligible to vote, I have never registered with a political party. I remain an independent with a history of voting for candidates I believe in — I focused on their policy and not their party. Before this election, I have never spoken out for or against a candidate for any office.

        But I can be silent no longer.

        -snip-

        https://www.denverpost.com/2020/09/25/donald-trump-fails-us-national-security-interests/

      • Meso, your question deserves an answer:

        1. Masks are being sold to the public as much more effective than they are. This is because politicians and the media know that if the uncertainties are acknowledged people will not wear them. There are now in my estimation 10s of millions of people in the USA that think masks will keep them safe. This is almost certainly killing people.

        2. The material that good masks are made of is only 50% or so effective at filtering out aerosols. But much of our breath doesn’t go through that material, it bypasses it. For example, the stories we hear about glasses fogging are an indication of breath bypassing the mask. Worse, the way we are actually wearing masks and the masks we are wearing means they are even less effective, e.g. neck gaiters, handkerchiefs, below our nose, at the tip of our nose, etc means essentially all aerosols escape.

        3. COVID19 presents a risk similar to diseases we have always faced and have never worn masks for in the past. Why should I not believe that I will be expected to wear a mask all the time now? There is no logical reason to believe otherwise. Consider…how long before the argument is made that COVID19 is less dangerous than the flu for children…I mean “think of the children.”

        4. I am a civil libertarian. That means, amongst other things, that my bar is set very high to accept government interference in my life. Especially, when governors claim the right to unilaterally implement arbitrary rules with open ended timelines and no stated goals or acceptance criteria that will result in the lifting of the offending rules.

      • Joe - the non epidemiologist

        Mesocyclone – “Finally, all the complaints about masks strike me as bizarre.”

        I gotta wonder if you flunked high school math, understand the law
        of probabilities, or understand the concept of marginal cost v marginal benefit.

        People that arent wearing masks are not wearing masks because the incremental reduction in the risk of transmission doesnt justify wearing a mask. With emphasis on “incremental reduction in risk” (aside from the futility of the elimination strategy of combating covid ).

        I presume you wear a seat belt in a car, I presume you wear a helmet when riding a bike or riding a motor cycle. But do you were a helmet when walking the dog or do you wear a seat belt when sitting on the couch. there certainly a possibility you could fall and have a traumatic brain injury, but that possibility is remote. Wearing a mask in most environments is equivalent. Sure the there is the risk of transmission, but the risk remains remote.

      • Dougbadgeroo – the risk of masks being oversold is far less than the risk of not using them. Yes, some fools will think they are safe in a mask. Nothing is perfect.

        Your argument about how effective masks are is simply incorrect. It depends on the mask. Furthermore, even when the droplets get around the mask, their trajectory is changed and reduces their range. Yes, aerosols are a tougher problem. BUT… a reduction of 50% over aerosol spread overall is enough to almost, by itself, quench the epidemic. I would much rather wear a mask a lot, and have other relatively light interventions, then to have out economy stay crippled while thousands of our citizens are dying and those of us at risk are forced into hiding!

        South Korea got it right. Too bad we have too many “civil libertarians” to succeed here.

        That we have not worn masks in the past is hardly an argument. As for “expected to wear a mask all the time” – that’s a silly hypothetical.

        I am also a civil libertarian. Government interference is dangerous. So is this disease, which contrary to what so many people want to believe, is far more serious than any past pandemic back to the 1918 outbreak. Yes, the IFR is low – at least, when people get low viral loads and vulnerable people have already been killed off, and when lots of hospital resources are available to treat the seriously ill. But those are all conditions that are only met with mitigations, serious ones.

        The cure to government interference issues is to elect politicians who are parsimonious in its use, not to just reject everything any government tries to do to prosecute its citizens.

        I’ve said this before and it bears repeating: a mask mandate is utterly trivial compared to other mandates long accepted. The best example is the military draft. Many of us faced the draft, joined the military (voluntarily for the most part), went to war. People whining about mask mandates seem like little children to most of us.

      • Joe – the non epidemiologist – I can generally tell when people are out of arguments when they start with an insult (“flunked…”) and then rehash old points.

        People who refuse to not wear masks are:

        1) Refusing to follow the recommendations of most of the experts ni the world, and rarely do those refusicks have as much information

        2)Ignorant of the overall epidemic dynamics

        3) Cherry pick evidence to create false statistical inferences

        4) Have an emotional negative reaction to mandates which leads them to do the cherry picking and ignoring of experts

        I’d say that you fit all of those, plus resort to insults. Bye.

      • Meso, I am not sure you read my comment thoroughly.

        That masks block droplets is not in dispute, they do, the issue is aerosols getting through them and around them in a manner that renders these unsealed masks essentially useless at blocking aerosols.

        Silly hypothetical my arse. There is no factual basis to argue that we won’t be wearing masks always now. The only hope is that people’s opinions continue to be divorced from reality. When the government gives the all clear people just stop wearing masks without consideration for other risks of similar magnitude.

        This pandemic is no where near as severe as the 1918 pandemic. The 1918 pandemic killed 4500 people per million in the USA, and the average age was about 28. This pandemic is at about 630 per million and the median age is over 75. The 1957 pandemic was 680 per million. The 1968 pandemic was about 500 per million. In QALYs lost, a metric emphasized by epidemiologists in other pandemics, this pandemic isn’t close to 1968 or 1957, and not even in the same conversation as 1918. Many of the people who died in this pandemic would have already been dead in 57 or 68 simply because of the increase in life expectancy in the last 60 years.

      • Meso, I am not sure you read my comment thoroughly.

        That masks block droplets is not in dispute, they do, the issue is aerosols getting through them and around them in a manner that renders these unsealed masks essentially useless at blocking aerosols.

        Silly hypothetical my arse. There is no factual basis to argue that we won’t be wearing masks always now. The only hope is that people’s opinions continue to be divorced from reality. When the government gives the all clear people just stop wearing masks without consideration for other risks of similar magnitude.

        This pandemic is no where near as severe as the 1918 pandemic. The 1918 pandemic killed 4500 people per million in the USA, and the average age was about 28. This pandemic is at about 630 per million and the median age is over 75. The 1957 pandemic was 680 per million. The 1968 pandemic was about 500 per million. In QALYs lost, a metric emphasized by epidemiologists in other pandemics, this pandemic isn’t close to 1968 or 1957, and not even in the same conversation as 1918. Many of the people who died in this pandemic would have already been dead in 57 or 68 simply because of the increase in life expectancy in the last 60 years.

      • > It is known that the masks we are all wearing are not effective at blocking aerosols.

        […]

        >> the issue is aerosols getting through them and around them in a manner that renders these unsealed masks essentially useless at blocking aerosols.

        You think you know things that you don’t know. Masks may alter airflow that carries aerosols. Masks may change humidity levels behind the masks, which might alter the flow of aerosols. Masks might outright block some % of aerosols. The distinction between droplets and aerosols and droplets is an arbitrary distinction..

      • ” I had the privilege to manage, edit and deliver the president’s Daily Brief a summary of the most timely and critical intelligence threats to the U.S. from 2010 to 2014.”

        So… This the person who recommended declaring and then ignoring the redline in Syria, sending a planeload of cash to Iran sparking an increase in regional terrorism, ignoring the request for additional security at Benghazi (and telling the media that the resulting murder of an ambassador was a mostly peaceful protest of a video), presided over the rapid growth of Isis in the middle east, and got Hillary to declare the TransPacific Partnership trade deal to be the “gold standard” before she read it and then ran a presidential campaign promising to repeal it.

        That’s the person who thinks they did great on the subject of national security?

        That’s the person you think did great on the subject on national security?

        No wonder you think Trump handled Covid poorly.
        Or were you trying to convince people to vote for Trump with that post because literally anyone has my vote if they are opposed by Obama’s 2010-2014 national security briefer.

      • “I had the privilege to manage, edit and deliver the president’s Daily Brief a summary of the most timely and critical intelligence threats to the U.S. from 2010 to 2014.”

        Team blue has the person who recommended ignoring the red line in Syria, presided over Benghazi, sent a planeload of unmarked bills to the Iranian Republican Guard, and missed the Russian interference in elections.

        I’m sure you’re proud.You can keep that one.

      • A review paper I just found (fortunately, not pay-walled) strongly suggests that droplets, not aerosols, are the dominant mode of transmission of this virus (and as an aside, surfaces are not at all significant). They inferred this from contact tracing studies that show that proximity was very significant in transmission: “That proximity so clearly increases risk for infection suggests that classic droplet transmission is more important than aerosol transmission (51).”

        Of course, proximity would also affect the level of dilution of aerosols, and the size of the dose of virus matters too.

        I haven’t dug into this, but if it is correct, that’s a strong argument for both mask wear and “social distancing.”

        Caveat: yes, the dividing line between droplets and aerosols is arbitrary. But… the general idea that droplets fall relatively qujickly, while aerosols do not, is the key concept.

        https://www.acpjournals.org/doi/10.7326/M20-5008

    • Joe - the non epidemiologist

      mesocyle – The article you said I cherrypicked was the article you linked.

    • Joe - the non epidemiologist

      Mesocyclone –

      My apologies if my comment came across as insulting

      That being said, please provide an explanation as to why masks mandates are justified in environments when other behavioral changes and protocols have reduced the risk of transmission.

      Please explain why marginal benefit v marginal cost (sometimes referred to as the law of diminishing returns) should be disregarded.

      I await your justification.

  27. ” I opined, based on my modelling, that the HIT probably lay somewhere between 7% and 24%, and that evidence from Stockholm County suggested it was around 17% there, and had been reached.”

    “The numbers are startlingly high across India: Nearly 30% of capital city New Delhi’s 16 million people have had the coronavirus; in the western city of Pune, more than 50% have had it in some of the most densely packed neighborhoods. In financial center Mumbai’s slums, nearly 60% show evidence of infection and recovery.”

    Why do some communities ( well just the ones Nic loaves to look at )
    stop at 7-24% and why do others rage on above 50%?

    we DONT KNOW
    we will NEVER KNOW
    and we will never know because it is impossible to do controlled studies

    And knowing this every honest analyst must confront all the data,
    all the data always. That means when you cite the LOW herd immunity
    estimates you MUST at a minimum acknowledge the evidence for the high ones.

    in other words, do not cherry pick.

    So, why if herd immunity is high (60-70%) do we observe localities with
    slowing spread after low penetrations (~10-20%) are reached? And WHY
    if herd immunity is reached at low levels, as Nic argues, do we observe localities that exhibit penetration rates above 50% ( up to 80% +)

    Possible CONFOUNDING FACTORS, some unobservable

    1. Different age structures
    2. Different Mixing patterns
    3. NPI Masks, social distancing, hygiene, quarantine
    4. Pre-existing immunity differences
    5. Poor test coverage ( no testing no cases)

    I could go on. but here is the bottom line. we dont have un confounded test conditions that will allow us to predict for a GIVEN POPULATION
    when herd immunity is reached.

    lets grant that some populations might achieve it at 20%.
    SOME
    because we also observe that other populations suffer attack rates above
    50%.

    Which population is your city in? your country? One that is the lucky 20%?
    or the unlucky 50 or 60 or 70%?

    YOU DONT KNOW. And neither does any modeler. And neither does any scientist. And neither does any politician. and neither do I. And no amount
    of modeling or data will resolve it because it is all hopelessly confounded

    So, you have one question

    And to make matters worse you are not just deciding for yourself you
    are deciding for others

    • We have always been deciding for others on these questions where infectious disease is concerned. Never before have we expected others to help us manage our risk.

      • dougbadgero wrote: (September 24, 2020 at 7:47 pm). It is known that the masks we are all wearing are not effective at blocking aerosols. It is also known that aerosols play a role in the transmission of pathogens. The effectiveness of masks at preventing disease transmission is uncertain as the NAS acknowledged months ago. If you want to wear a mask wear one, but don’t mislead people into believing they are more effective than they are. The NAS specifically stated that one risk of mask wearing is that people may engage in risky behavior because they think they are safe.”

        Thanks for the link to emergency guidance the NAS provided in early April. I’m sure you must be aware that guidance is obsolete today. However, much of what you write is correct – as far as it goes.

        You are correct when you say that a mask may endanger the wearer – if the wearer believes a surgical, homemade, or common commercial (non-N95) mask provides complete protection against COVID AND therefore decides to engage in risky activities! However, this is a good reason why citizens need more education about masks – not a good reason for a knowledgeable or cautious person not to wear a mask. Public health officials approach this question from a slightly different perspective: First do no harm. If some people might engage in risker behavior, will the policy I recommend still save more lives than it costs? How can an official be sure what will happen without data? Should money and attention be invested in other interventions instead? However, from the citizen’s perspective, there is a simple answer: A mask will provide SOME protection if you don’t engage in risker behavior.

        You are completely correct to say that mask wearers are not completely protected because air leaks around the edges of ordinary masks. If half of the air you breath passes around the edges of your mask rather than through it, your protection against aerosols is 50% lower than it could be. Again, this is an area where occupational safety professional would like better data before making unambiguous recommendations and where public education could help tremendously. Masks with two elastic head straps can fit more tightly than those held in place by sensitive ear loops, but most masks sold today have the latter because the US public hasn’t been educated. An uncomfortable mask you won’t wear is inferior to one you will wear.

        You are completely correct that some materials (including the bandanas I first bought) provide almost no protection against aerosols. However, multiple layers of fabric are roughly additive in protection and each layer of a tightly woven fabric provides some protection. And viruses are big enough that a fabric with a permanent electrostatic surface (which is critical for attracting the finest particles that are too small to be mechanically filtered) aren’t critical for protection against virus.

        Occupational safety professionals focus on protecting workers in risky situations. If air leaks around the edge of a mask, it doesn’t provide full protection. Since faces differ widely, businesses and regulators insist on having a professional guarantee the fit of a mask for each worker. When that is done, clinical studies have shown that N-95 masks (with two elastic straps that go around the head, not ears, for snugness) are extremely effective in protecting doctors and nurses from air-borne viruses like COVID. Since these masks were in short supply early in the pandemic, the were reserved for essential health care workers. However, KF94 and KN95 masks (the Korean and Chinese equivalents to N95s) are becoming available on Amazon and I bought some. Most of us most of the time are forced to settle for lesser levels of protection.

        You are also completely correct that COVID likely can be transmitted by both a spray of droplets (which can be blocked by a mask) and aerosols (which can partly penetrate non-N-95 masks ). We know from influenza that both routes are likely important, but we don’t know the percentage transmitted by each route. However, we know from influenza that a single virus doesn’t cause an infection; it takes on the average about 1000 viruses to catch the flu. Those 1000 viruses might be delivered in one moment by one or a few droplets sprayed from 3 to 6 feet or from being in the same room for 1 hour, but not 30 minutes, with someone who is breathing out infectious aerosols. Wearing an ordinary surgical mask might block 90% of the sprayed droplets and 50% of the aerosols, keeping you reasonably safe for two hours instead of one.

        You are correct that improved indoor ventilation (turnover rate of air) and filtration rate and filter MERV might reduce transmission via aerosols as much as a mask. (Hong Kong has passed new regulations in this area and some US schools are upgrading.) However, the benefits of mask and ventilation multiply. If better air turnover dilutes aerosols by 50% and better HVAC filters like those used in hospitals capture 50% more aerosols, and your mask blocks 50% of aerosols, you could breathe aerosols for 8 hours with the same level of aerosol risk you formerly ran in 1 hour. From the ordinary citizen’s perspective, you can gain the benefits of a mask and you need Big Brother to regulate the other factors.

        Some fear that mask wearers might infect themselves while touching the outer surface of the mask while taking it off or storing it. This certainly happens in hospitals where the outside of N-95 masks can collect a large amount of infectious material. Some doctors have gotten infected this way. However, for both the doctor and the ordinary citizen, handling a mask with some infectious material on the outside is certainly LESS dangerous than breathing the same infectious material. And soap or hand sanitizer can eliminate most of the risk. Absolute protection is extremely difficult to achieve, but this objection is letting perfection be the enemy of good. And again, a little education helps.

        If masks don’t provide the wearer with 100% protection, are we being forced or encouraged to wear them to protect others? It’s both! If protecting others at the same time you are protecting yourself provides you with more motivation, great. If not, wear the mask for yourself.

        There have been several studies where college student volunteers or others were asked to wear surgical masks during peak flu season. The group wearing masks as a whole didn’t show a statistically significant reduction in flu compared with controls, but compliance was low. Those who reported wearing masks for a significant period of time did show significant protection. Ordinary surgical masks certainly work. From the public health perspective, recommending that colleges combat seasonal influenza by mandating wearing of masks is an intervention that is likely to fail. From the individual’s perspective, wearing a surgical mask can reduce infection rates by more than 50% if you are MOTIVATED enough to wear them in risky environments. From a societal perspective, if everyone wore masks in risky environments, the rate of transmission would drop by 50% and the pandemic would end. Avoiding COVID certainly provides more motivation than avoiding seasonal influenza, especially for the vulnerable and those close to them, which is why public health officials now recommend masks (but didn’t before this pandemic). Unfortunately, politics, lousy information and poor reasoning are preventing this country from realizing the full benefits of masks.

      • Frank –

        > You are completely correct to say that mask wearers are not completely protected because air leaks around the edges of ordinary masks.

        This comment refers to protecting the mask-wearer who presumably would be inhaling aerosolized virus around the edges of the mask where air follows a path of least resistance.

        But with an infected mask wearer…

        even if exhaled air containing aerosolized particles follows that same path of least resistance around the edges of the mask, might not the dynamics of the airflow might still be altered such that those particles won’t travel as far as they would were no mask present to alter the air flow?

        Further, might not wearing a mask increase the humidity level of the exhaled air, such as to reduce the distances that aerosolized particles and larger droplets travel?

        And am I correct to presume that since some airflow will still go through the mask rather than around the edges, some aerosolized particles would get trapped in the mask even as many (or even mos) will pass through – offering a partial benefit?

      • The authors of the NAS report stated that the science has not significantly changed only a few weeks ago. It was written after the CDC changed its stance to recommend mask wearing. Obviously that change was based on political considerations rather than scientific considerations.

        It is not as if the issue hadn’t been considered before 2020.

      • Joshua asked: “even if exhaled air containing aerosolized particles follows that same path of least resistance around the edges of the mask, might not the dynamics of the airflow might still be altered such that those particles won’t travel as far as they would were no mask present to alter the air flow?

        There was a paper on using light scattering to detect how OTHER PEOPLE are protect from the droplets sprayed out by a mask wearer. Many of the masks they tested reduced the count of droplets by 80%, but some designs were far worse. One stretchy thin neck gaiter didn’t significantly reduce the number of exhaled droplets and caused much controversy because there was a non-significant increase in droplets and meaningless speculation that larger droplets had been broken up into smaller ones by the neck gaiter. Loosely woven materials – not surprisingly – provide less of a barrier.

        https://advances.sciencemag.org/content/6/36/eabd3083

        I tried out my KN95 mask. It provides significant resistance to air flow (back pressure while exhaling and negative pressure while inhaling), but the strong head straps keep a tight seal against my face and prevent leakage. If you don’t feel any back pressure with an ordinary mask, you probably should find something a little snugger if you want protection against aerosols.

      • dougbadgero | September 28, 2020 at 8:49 pm | wrote: “The authors of the NAS report stated that the science has not significantly changed only a few weeks ago. It was written after the CDC changed its stance to recommend mask wearing. Obviously that change was based on political considerations rather than scientific considerations.”

        The scientific data doesn’t change, but the appropriate recommendations drawn from that data do change from situation to situation. When the recommendations change, politics isn’t the only possible reason for the change (unless the change is initiated at the White House). Given that we are talking about recommendations from scientists – who are expected to effectively deal with confirmation bias – politics should be the last explanation for change.

        Do masks work? Yes, the data says, beyond any doubt, they protect health care professionals working in hospitals.

        Do masks work? No, they fail to protect college students from seasonal influenza.

        The answer depends on many factors: compliance (motivation), mask material, mask snugness, your definition of “work” (20% reduction in transmission?, 50% reduction?, 75% reduction?, 90% reduction”). From the perspective of slowing a pandemic, a 20% reduction in transmission over 10 transmissions (about 2 months) would reduce the number of new cases in a stable pandemic by 89%. The difference between the EU countries that dramatically reduced their case loads in spring and the US (very modest drop in spring) in theory was about 20% less transmission. For individuals who perceive little risk, 20% reduction affords no motivation and masks that “work” fail due to compliance.
        Few fear seasonal influence, so surgical masks don’t “work” against seasonal influenza on college campuses. Many fear COVID more than influenza, and masks certainly work for them!

        I felt that the emergency NAS report did a lousy job of explaining these different perspectives to policymakers and the public. It was mostly relevant to influenza and is obsolete today for COVID. We have learned a lot since March. So why don’t you find some newer information suitable for readers of a scientific blog.

        At a Congressional hearing, the head of the CDC was challenged over reports that masks “don’t work”. His answer was that masks probably protect about as well as the COVID vaccines being tested right now!

        For a variety of reasons, influenza vaccines aren’t very effective and reduce death among the elderly only by 50%. Other vaccines protect 99+% of people, though that can require multiple injections. Guessing, the coming vaccines could protect 80% of people for a year or more, which might be enough to end the pandemic within a few months if a decent fraction of the population gets vaccinated. Nevertheless, until the pandemic dies out, vaccinated people would still have a 20% chance (compared to unvaccinated controls living in the same location) of getting COVID until the pandemic ends. Then both have the same probability (near 0%). Is 80% protection a vaccine that “works”? Again, it depends on your definition of “working”.

      • Frank –

        > There was a paper on using light scattering to detect how OTHER PEOPLE are protect from the droplets sprayed out by a mask wearer. Many of the masks they tested reduced the count of droplets by 80%, but some designs were far worse.

        This doesn’t quite connect with what I was suggesting. I’m suggesting that when larger droplets or smaller aerosolized particles exit around the edges of a mask they may well travel less far than if they go through a mask or if someone isn’t wearing a mask – because of changes in the dynamics of the air flow created by the mask (as well as because of increased humidity behind the mask).

    • Here are two studies presented as papers to the virtual corona virus conference held yesterday. You need to scroll to the bottom.

      https://www.dailymail.co.uk/news/article-8768723/Half-Britons-tell-tale-Covid-19-symptoms-NOT-disease-study-suggests.html

      Presumably the information presented will be discussed by delegates and further comments will be forthcoming

      Tonyb

    • As with a global climate models there is understanding. When it’s all done some year, there will be types of spreading. Types A – J I think. His model will match some situations and others will match other situations. And there will be greater understanding for the future.

      We are lucky. We live in the greatest nation that has been. And like Sweden we still enjoy a lot of freedoms. And that is the key to our successes.

      When it’s all said and done, our death toll will be 350,000. Which is a tenth of a percentage. And we will have retained some of the keys to our success, which is the important thing. To spread our awesomeness far and wide with real money to the poor.

      We are the luckiest people that have ever lived. Let’s get to work and solve some real problems.

      • You ignore the disparate impact in different communities.

        You ignore the far more serous illnesses in asdsirom to deaths.

        You ignore the uncertainties in how far this will go.

        You ignore the severe economic damage associated with the virus.

        You ignore the massive level of sacrifice that had been made to help you stay safe.

        You continue to ignore these things. It’s weird.

      • J:
        You are my favorite commenter. I think the lockdowns cause more economic damage than significantly less broad lockdowns taking into account all costs. Such as costs to be realized far in the future by not educating children. We don’t know. We can make a big list of all the cost of the lockdowns that apply to our states. People are paying less into social security because they are unemployed. Deal with that. State’s unemployment funds are being depleted. They will be restored someday raising the cost of labor here. We are burning through things. I am doing calcs on MN deaths and being a troll about it elsewhere. Our 7 day moving average of deaths works out to an annual death toll of 2185 in a population of 5 million. It’s over. But don’t tell our leaders that. We are true blue and I feel fine. We managed more than 60% of the deaths in old folks homes if I recall. As far as Black communities go, on average we would guess it’s harder to be Black and unemployed than White and unemployed. I happen to believe no one has sacrificed on my behalf. I do not expect them to. I could use some help pulling weeds from wildflowers I planted at a park though.

      • You ignore that you can’t disaggregate the economic cost of “lockdowns” from the economic costs of the pandemic itself. I point this out over and over. It’s weird that you never deal with that issue but keep arguing as if you van make that differentiation.

        For all you know, absent SIPs and NPIs, the reviving damage works have been worse. At least with the SIPs unemployed people can collect enemoloyment and get stimulus rather than get fired for not going in to work because they don’t want to get infected.

        It’s noteworthy that “skeptics” uniformly fail to deal with the obvious uncertainties even in the slightest.

        https://ourworldindata.org/covid-health-economy

      • You can’t disaggregate pandemic plus lockdowns from lockdowns alone. You can compare this pandemic to past pandemics though. This pandemic fits neatly between the 1957 and 1968 pandemics in severity. Economic impact from the lockdowns are completely unprecedented, the pandemic is not.

      • > This pandemic fits neatly between the 1957 and 1968 pandemics in severity. Economic impact from the lockdowns are completely unprecedented, the p

        First, this pandemic isn’t over. 2nd, you don’t know to what degree the outcomes (economic and health) have been mitigated/affected, at least to this point, by SIPs and NPIs.

        https://ourworldindata.org/covid-health-economy

        Again, you have no idea, whatsoever, what the differential impact of the SIPs and NPIs has been. It’s weird how people just ignore the uncertainties.

      • “…from the economic costs of the pandemic itself.”

        The economic costs of the pandemic itself are minimal. The economic costs of lockdowns is at least three times the minimal amount above. Yes, I can do that. If you feel you cannot do that, I can’t help you. It could be as high as 90% of the total costs. We put up with a lot of things the have similar death rates and also costs but we don’t significantly throttle our economy. We wouldn’t even think of it.

        We have plenty of analogies. Where we do little. It has worked. We accept risk. The experiment was to not accept risk and it failed.

      • There is no compelling evidence that lockdowns matter one iota. People point to countries that locked down early and are now “able to open”, usually Asian countries. Nearly every country on earth still has inoculating case activity for COVID19. Whatever has protected these countries from severe disease it isn’t lockdowns. If it was those lockdowns would still need to be in place.

      • Not sure what the issue is with the data on your link but it states that USGDP dropped 9.5% in the 2nd quarter. According to the FED it dropped nearly 32%.

        In any case, I don’t find their methods particularly compelling because it ignores the structural nature of each countries economy. For example, Sweden is much more an export dependent economy to areas locked down for COVID. Conversely, Taiwan is a country primarily dependent on exports of tech gear that have surged as the need for work from home tech has surged. It is ignorance or sophistry.

      • “Whatever has protected these countries from severe disease it isn’t lockdowns. If it was those lockdowns would still need to be in place.”

        Interventions sure worked in China, with lockdowns by far the most likely cause.

        But… lockdowns seem like what you need to do not as long term control, but to rapidly lower the viral prevalence down to where, with adequate testing, you can contain it using contact tracing.
        In other words, if the prevalence is low, and you do a lot of testing, you can keep it at bay. That isn’t to say that some NPI’s are still necessary – you don’t want to go totally back to life as normal.

        Look to Taiwan – kept the prevalence low, had tests ready in early January and deployed them well, along with traveler quarantine.

        But without the ability for massive testing with reasonably rapid results, it’s pretty hard to contain it. We are now in a huge experiment of partial interventions, including mask wear. We shall see.

        This virus spreads through the air, something that’s been obvious from early (pre-censorship) Chinese pre-prints. That makes it hard to contain except by keeping people apart, providing good ventilation, and wearing masks to reduce the probability of spread.

      • > In any case, I don’t find their methods particularly compelling because it ignores the structural nature of each countries economy. For example, Sweden is much more an export dependent economy to areas locked down for COVID. Conversely, Taiwan is a country primarily dependent on exports of tech gear that have surged as the need for work from home tech has surged. It is ignorance or sophistry.

        Yes. Control for variables across countries is difficult and we don’t have sufficient to evidence to understand the relationship between correlation and causation.

        Glad to see that you get that BECAUSE THAT’S EXACTLY MY POINT!

        You have no way to discern whether the correlations between SIPs/NPIs and economic harm is causal, or the direction of causality, or what key mediators or moderators might be. You don’t know yet you’re sure. It’s a matter of faith for you, obviously.

      • ‘Sorry: Contact tracing isn’t the answer to ending lockdowns”
        ‘Lancet Global Health scientists conclude that contact tracing will work when “less than 1 percent of transmission occurred before the onset of symptoms.” That’s the opposite of the coronavirus: Victims are most contagious before or just as their symptoms begin, research indicates.”
        It’s a fig leaf. I heard Florida opened it all up. A Republican didn’t cower. Happy Day. It’s Okay to happy in the middle of a pandemic.

      • Ragnaar wrote: “When it’s all said and done, our death toll will be 350,000. Which is a tenth of a percentage. And we will have retained some of the keys to our success, which is the important thing. To spread our awesomeness far and wide with real money to the poor.”

        Only 300,000 US soldiers died in WWII. Let’s fight a few more wars to spread democracy and our awesomeness?

        If we brought this pandemic under control without shutting down our economy or with a limited shutdown – like some countries have – we would have done better economically than letting the pandemic burn itself out. Shutdowns and lingering pandemic provide the worst of all worlds, high costs and high death persisting indefinitely. No one knew which future lay in front of us when shelter in place orders were issued in late March. We do know shelter in place orders had a huge impact: US cases stopped growing exponentially (doubling every 2.5 days) at the end of March and new cases peaked on April 10 and began to fall (slowly). Our policymakers took and an ENORMOUS ECONOMIC GAMBLE that SIP combined with other measures would control this pandemic. The US has lost that gamble (due to incompetence, IMO). Other countries have probably won. A full economic analysis depends on how much value you place on lives and other intangibles, However, it is absolutely clear that the economic optima lie at either extreme, doing nothing or doing everything possible and getting it over quickly. (It’s like fighting a war to gain economic resources or some other objective: Go all out to win as quickly as possible or don’t fight at all. A stalemate or fighting “not to lose” guarantees you will lose in the long run.)

        However, policymakers weren’t looking at the economic gamble when they decided to issue SIP orders. They were looking at projections that people would be dying in hospital hallways and waiting areas or sent home to live or die. This happened in Wuhan and Northern Italy. It barely began in NYC around April 1 (a little more than week after SIP). It happened in at least one Texas hospital this summer. People dying without appropriate medical care suddenly turns your country into a third world nation. No leader of a developed or developing country can survive that. Even Xi Jinping feared that the people would believe that “mandate of heaven” had been withdrawn from the authoritarian Communist party. (:)). In the real world, our leaders weren’t deciding which direction would be best for our country economically in the long run. They committed the US to that huge economic gamble without understanding or caring about what needed to be done to win that gamble.

      • Ragnaar: As for Sweden, with a pandemic that was doubling every 5 days in March, instead of every 2.5 days, they weren’t facing the immediate threat of having their hospitals overrun. They had other options – including waiting to see how much fear would motivate people to take less risk. They paid a large price in early deaths among the elderly, but fear turns out to be a great motivator. The second surge in the southern US was mostly brought under control by a combination of fear and less intrusive measures. Texas closed their bars. If we are approaching herd immunity, that may be helping some.

    • What should be done with Nic if he has got herd immunity wrong, Steven?
      What particular offense, criminal or civil, has Nic committed? What damage has been done by Nic expressing his opinion on COVID 19 herd immunity?

      The K-pop girls must still be under quarantine. Steven has nothing better to do than hyperventilate over Nic’s almost universally unseen ruminations on a little blog. Get a grip, Steve.

      • What should be done with Nic if he has got herd immunity wrong, Steven?
        What particular offense has Nic committed? What damage has been done by Nic expressing his opinion on COVID 19 herd immunity?

        The K-pop girls must still be under quarantine. Steven has nothing better to do than hyperventilate over Nic’s almost universally unseen ruminations on a little blog. Get a grip, Steve.

    • Mosh: One politician who will remain nameless may not have a future if he doesn’t get lucky. He could hold a rally of millions without masks in an attempt to prove COVID has been has been conquered on his watch. He’s already claimed to be the equal of Dirty Harry – able to shoot someone in cold blood on Fifth Ave and get away with it. And he has a reputation for being a narcissist, so others may not matter. Most importantly, Clint Eastwood was merely the mayor of of tiny Carmel. Your comment is provocative on many levels.

  28. -snip-

    “Although we don’t know yet, it is well within the realm of possibility that this coronavirus, when our population-level immunity gets high enough, this coronavirus will find a way to get around our immunity,” Morens said. “If that happened, we’d be in the same situation as with flu. We’ll have to chase the virus and, as it mutates, we’ll have to tinker with our vaccine.”

    -snip-

    https://www.washingtonpost.com/health/2020/09/23/houston-coronavirus-mutations/

    • It’s not our virus. It’s the world’s virus. A lot of poor countries aren’t going to do what we can do. Same as the flu. As Trump said. Sweden. We can accept it like we accept the flu. Or chase rainbows.

  29. A snippet from a BBC report on Britain’s ‘new’ Covid-19 tracking app is as follows:

    “People who test negative for Covid-19 are unable to share the result with the new NHS app for England and Wales if they did not book the test through the app in the first place.
    The app asks for a code to register a test result but a code is only received if the test is positive.
    Those who enter that they have symptoms without entering a result find a self-isolation countdown begins.
    The Department for Health and Social Care said the app would be updated.
    People who have been using the app since its launch on Thursday, and who had already booked tests before downloading it, have found that they are unable to stop the self-isolation countdown after reporting symptoms if they then get a negative result, because it does not come with a code they can share.
    “That’s so confusing as the app doesn’t tell you that can’t enter negative test booked outside it,” said Prof Deborah Ryan, who originally contacted the BBC.”

    Is it any wonder England is in a state of perpetual confusion when it comes t this virus?

  30. -snip-

    “It is slowly but surely going in the wrong direction in Sweden, even if the situation is not as serious as in other parts of Europe,” Tegnell said at a news briefing Thursday, according to the newspaper Svenska Dagbladet.

    -snip-

    https://www.washingtonpost.com/world/2020/09/25/sweden-coronavirus-debate-lockdown-new-cases/

    • More disinformation from the Washington Post. Worldometer shows that Sweden has a total of 15 people in critical or serious condition. That number has been falling strongly for months. Their average daily deaths was 1 yesterday using the 7 day moving average. Cases are growing very slowly but that’s been going on for at least a month and there is no measurable increase in any other more important parameter.

      The situation is similar in most US states. The peaks are past and deaths and hospitalizations are declining. The effects of strong lockdowns is just not clear from this data. California with the strictest lockdown of any state is only doing a little bit better than Texas and if current trends continue will end up with about the same per capita fatilities.

      The problem here really is political. Most of the “disagreement” is really not a disagreement about the science. It’s really about preserving the status quo or wanted to tear it down. What has changed in the last 20 years is the willingness to use sustained political violence to effect change. The flip side of this is Governors who are willing to suspend their State Constitutions for indefinite periods to meet what are in some cases impossible criteria.

      A worse problem is the media which have been shamelessly fear mongering since mid March. Before that they were amplifying politicians assurances that there was no need to worry. They are to blame for a lot of our problems right now. People simply can’t get accurate information from them anymore as. Bari Weiss’ letter points out. BTW, I’ve seen no refutation of that letter’s claims.

      • “The situation is similar in most US states. The peaks are past and deaths and hospitalizations are declining”

        The US has averaged about 800 deaths *per day* since the start of June.

        The only country in the western world to exceed that consistently per capita for even part of that time is… …Sweden.

        And as you say, cases are rising again in Sweden. Who could possibly predict what follows rising case numbers?

        US rate is currently approximately flat now and even Mike Pence says we should expect it to rise.

        And your conclusion from this? Well, that numbers are falling and also that people can’t get accurate information any more. I guess the latter could certainly be true – you’re sure struggling on that front.

      • > More disinformation from the Washington Post…

        Lol. Dude, that was a quote of Tegnell.

        You’re priceless.

  31. Well – looks like the governor of Florida has decided to conduct a real world experiment.

    I how he’s right and opening bars and restaurants prove economically beneficial with no significant negative health outcomes.

    Or if he’s wrongz I hope that people on Florida, especially those most vulnerable, do as much as they can to hedge for the potemtisl increase in the spread of the virus. If course, I recognize that many have no real practical options to do that.

    Florida’s winter weather obviously isn’t exactly typical for the US, and so I hope that if things go well there people exercise the appropriate cautions rather than just blindly extrapolate. My magic 8 ball says “outlook not so good” on that one (based on what we’ve seen with Sweden).

    At any rate, it will be a data point for those who ae interested in careful analysis. Let’s just hope it won’t be a sad data point.

  32. Here’s a good description of why all this love of Sweden among American conservatives will NEVER rise above politically expedient handwaving

    -snip-

    Take two people: one living in Malmö, the other in Manchester. When a Swede loses his or her job they are entitled to up to 80% of their previous salary for the first 200 days of inactivity – up to 910 krona (£78) a day for the first 100 days – dropping to 70% (to a maximum of 760 krona a day) for the next 100 days. Danes who are members of unemployment insurance funds can claim up to 90%. As importantly, Sweden is “the best place in the world to lose your job” because employers pay a levy to job security councils whose coaches seek you out and match your skills and ambitions with the market.

    -snip-

    https://www.theguardian.com/commentisfree/2020/sep/26/welcome-to-libertarian-covid-fantasy-land-thats-sweden-to-you-and-me

    • They went their own way. In this specific case are fortunate they did. There’s more than capitalism verus socialism and unemployment benefits are just a small part of that. A number of Scandinavian countries are telling Sanders he’s wrong.

    • We are fortunate they’re doing this. People can still stay in their homes the same as before. Wear their masks. Why is anyone who doesn’t want to be, exposed to more risk? Maybe it’s time for individuals to work this out amongst themselves.

      Some will die. That’s life. Biden’s handlers are still waving around Federal lockdowns. I am with Florida.

      • “Why is anyone who doesn’t want to be, exposed to more risk? Maybe it’s time for individuals to work this out amongst themselves.” – Classic libertarian blindness.

        If it were that simple to avoid risk, do you think we’d be so concerned? As has been explained before, it is pretty much impossible to avoid risk. One can reduce risk, as many of us have, but that only works so well. You cannot avoid all human interaction, under all circumstances. I know – I am at high risk and have been trying, making pretty big sacrifices as a result. But interactions still happen – getting needed medical care for example, getting a necessary appliance repaired, even getting food – curbside pickup is low risk, but not super low.

        Lower disease prevalence is the way to reduce risk. And the way you get there is by getting not-so-responsible people to avoid risk, whether they want to or not. Lower disease prevalence also allows contact tracing to work, it allows more of the economy to work.

        Higher prevalence leads to more people avoiding risk, with the attendant human toll, and for those who don’t seem to care about that, the attendant economic consequences.

        Why does anyone object to wearing masks when indoors or in crowds? It’s madness! I see people stretching, reaching to prove, to prove that masks don’t do any good.

        We know how to defeat this disease without a huge human toll: look to South Korea, Taiwan, or (I hate to bring up that despicable regime) mainland China. It can be done, until a vaccine (or good treatment options such as likely monoclonal antibodies) are available. Given that we have gone through 7 months or more of this, waiting a few more to preserve that sacrifice, and the sad death toll, seems pretty reasonable.

      • > Why does anyone object to wearing masks when indoors or in crowds?

        Because it had become a marker of tribal identity.

      • mesocyclone:

        Classic libertarian blindness.

        I you make the case for at risk people. We can look at this as rights. They have a right not to catch this because someone else doesn’t care. So we take the rights of the people who don’t care and pretend to give them to the at risk people. This rights transfer initiated and followed through on by government is what I am against in general. And this rule applies to many situations. For instance the right to not be poor and old. Fine. Here’s someone else’s money and let’s skip arguing about that. The right to healthcare. Someone else will pay for that if you don’t have the money.

        In your specific case, you can catch this. But if we all pull together, and borrow $5 trillion dollars, we lower your chance to catch this. And we unemploy 30 million people short term and 5 million people long term. And if we hit education. We have been transferring rights for at least 5 months to you. We as always have not created any rights. We just took them from somebody else.

        I don’t know if you call this classic. But this has been an inter generational transfer of rights like the national debt. What do we get in return?

        The Republicans will not say this. The governments steal our stuff all the time. For the old people. Do you realize how we treat old people? We send them to nursing homes. We didn’t used to do that. The nursing homes are happy to be a part of this. It’s a huge amount of money. And once the old person runs out of theirs, the bills still get paid.

        My Mom is stuck in Alaska and has been for this thing. Do I tell people what to do so that she can get home? No. We are adults. And the governments almost always acts in low resolution ways. Crudely, broadly and inefficiently.

        It’s easy. Look for governments assuming more power. Worse yet, look for governments where it’s easy for them to assume power because their people have all ready given up.

      • Joe - the non epidemiologist

        Mesocyclone’s comment – “curbside pickup is low risk, but not super low.”

        The reality – The risk of transmission via Curbside pick up is extremely low, nearly non- existent.

      • Curbside… the main risk is in contamination of the groceries. They are hard to decontaminate – lots of surfaces, many go into the refrigerator where the virus will live for long periods.

      • Joe - the non epidemiologist

        Mesocyclone’s comment’s

        – “curbside pickup is low risk, but not super low.”

        “Curbside… the main risk is in contamination of the groceries. They are hard to decontaminate – lots of surfaces, many go into the refrigerator where the virus will live for long periods.”

        So – how much does wearing a mask reduce the risk of transmission ?
        Probably something close to zero – so why the insistence on wearing a mask – unless its based on an irrational fear

      • “So – how much does wearing a mask reduce the risk of transmission ?
        Probably something close to zero – so why the insistence on wearing a mask – unless its based on an irrational fear”

        So there you go again with the insult – this time “irrational.”

        Here’s what you don’t get: if the risk of dying from something is 60% (which it is for people at high risk), then a relatively low risk per exposure translates to a much higher risk – one nobody would accept when getting on an airplane.

        One visit to curbside – pretty low. 100 visits – not nearly as low. Add in all the other encounters. I just returned from a curbside. The delivery person approached me closer than 6′ with his mask worn wrong – it happens. But the risk from that would have been worse if he had been wearing no mask at all, and I had been wearing no mask. Situations are not black and white – they exist in continua.

        But the more important point: mask wear reduces spread significantly. I explained this before: you cannot have a policy that seeks to define every different situation as to whether masks must be worn or not, because it doesn’t work. You have to have broad policies, even if some instances covered are not very important. Furthermore, because mask wear is such a small burden compared to alternatives, such as shut down economies, it is unreasonable to object to widespread mask wear given that it is proven to work in many situations.

        I don’t wear a mask on my daily walk. I am not required to, because our mask mandate is sensible. And, the risk is low – walkers stay away from each other, and it is out of doors – good ventilation. I wear a mask where there is a possibility of droplet or aerosol spray, because masks work in both situations (better against droplets). The mandate is consistent with that.

        Indoors, unless ventilation is known to be appropriate, spread is a real danger. All but one of the superspreader cases I looked at (around 1000) were indoors. Social distancing works less well indoors, because of aerosols, which ignore social distancing distances. Catholic churches in my diocese keep people separate, mandate masks, and have no singing (except by a few separated people), which reduces the risk, but does not eliminate it. The main function is to reduce the overall spread rate for the entire population, by taking these precautions – mask wear, distancing, etc, throughout society where appropriate. Masks are not to guarantee protection in any encounter or for any individual.

      • Joe - the non epidemiologist

        Mesocyclone comment – ” But the more important point: mask wear reduces spread significantly.”

        Your response indicates that you are not familiar with the basic concept of “marginal cost v Marginal benefit”. If you consider your inability to grasp the concept an insult, so be it. but I have already apologized for such an inference. Marginal cost v marginal benefit is very worthwhile concept to understand.

        Space and time are vastly more important factors in the reducing the risk of transmission. Wearing a mask is a distant 3 factor. Space being social distancing – time being the reduction of time interacting.

        If you have already reduced the risk to transmission to near zero via other protocols, the incremental reduction in the risk of transmission by wearing a mask becomes near meaningless. Reducing the risk of transmission from near zero to be closer to zero is not significant in any meaningful sense.

        You also seem to be making assumptions that the risk of transmission is much higher than it is in reality. Your example of curbside pickup is a great example of over estimating the risk of transmission. Did you catch the virus when curbside waiter was wearing his mask incorrectly, of course not. theoretically possible, but it remains highly unlikely. Your other example of not interacting with others on you walk is another example of an irrational fear of the risk of transmission. The risk of outdoor transmission in the setting you described is likewise near non-existent. BLM protests are a different matter.

        Quite frankly, the risk of transmission in the typical grocery store, typical retail store is near zero, even without the mask. The reason the risk is near zero is due to social distancing and due to the very limited time interacting with other individuals. Obviously, there is a higher risk of transmission in the settings such as mass transit, many office settings, meat packing plants, church. Mandating the wearing of masks in all public environments without taking into accounts the relative risks of transmission and without taking into account the incremental reduction of the risk of transmission with the each incremental step is overkill.

      • “marginal cost v Marginal benefit”

        For the curbside pick up. That had a cost in dollars. At a greater cost, someone could have been hired to bring what was delivered with the exact method one desired for that. But, you didn’t do that. If I assume that was not done for reasons of cost, now what is the answer?

        You know what it is you want. Now one can make a voluntary exchange to have that happen. I can say, that’s a tiny benefit. One can say, but I want it and I will pay for it.

        One can pay the marginal cost to obtain the marginal benefit they desire. Unless the government interferes. Unless government distributes the benefits.

        Joe Biden wishes to distribute anti-virus benefits as he thinks not enough of those have been distributed. We got the benefits figured out. Now let’s figure out the costs. And we could argue, they just needed to distribute the benefits in a smarter way. We can’t go back and do that.

        We have governments controlling marginal costs and benefits. It didn’t work. It’s not going to work. A better model is how we handle the flu.

      • “Your response indicates that you are not familiar with the basic concept of “marginal cost v Marginal benefit”. If you consider your inability to grasp the concept an insult, so be it. but I have already apologized for such an inference. ”

        Joe, you appear to think you can read minds, and seem to assume without evidence that people are dumber than you are. It’s pretty sad. And would be insulting too, if I thought you meant it as opposed to are just obtuse.

        I am familiar with the costs. I also know how repeated interactions increase the risk – something you keep eliding.

        I have calculated risks – probabilities of this sort are not black magic, nor is the math for compounding them, for applying Bayesian priors, for combining multiple effects, etc.. What is very hard to do, though, is find reliable data on the actual risk of a particular interaction. A friend and I both have dug around for that data for some time, because it assists in the calculations of actual risk – as opposed to magically assumed risk, which appears to be your approach.

        You will remain convinced forever that a mask which reduces risk 50% should not be worn except in situations that, in your wisdom, are of high enough risk to “justify” it given the extremely low marginal cost of mask wear vs. no mask wear.

        I will not try to change your mind. The only reason this sort of debate has any utility is if it results in some people being more careful, as a result of reading better information. As for marginal utility, the marginal cost of death is quite high, especially for the person who dies, hence the marginal utility of minimizing risk is a lot higher than if one is fiddling with pure economic considerations.

      • “…the marginal cost of death is quite high…”
        We have an Okay record of coming to terms that and were doing that for a long time. This time it is different. And I would say, no it’s not.
        The cost of the GMST rising 10 C is astronomical. Skewing the decisions towards very high costs. The 10 C scenario is over weighted. Likewise the death scenario is overweighted here. I am reminded of no regrets polices. And the way they have been shortchanged in the climate debate.

    • > Why is anyone who doesn’t want to be, exposed to more risk?

      Amazing.

      • Let everybody stay home indefinitely. That would nicely sort us into people immune to starvation, and the rest.

  33. >>>I opined, based on my modelling, that the HIT probably lay somewhere between 7% and 24%, and that evidence from Stockholm County suggested it was around 17% there, and had been reached.”

    Anders Tegnell two days ago:

    “On Tuesday, Tegnell opened to introduce stricter local restrictions, including in Stockholm, to prevent the infection from continuing to increase. Two weeks ago, 1.3 percent of those tested were infected, while last week, 2.2 percent of the samples were positive.”

    https://www.abcnyheter.no/nyheter/verden/2020/09/24/195707671/tegnell-det-gar-sakte-men-sikkert-i-feil-retning

    • The number of cases reported in Stockholm region has returned to that in the first half of July. We don’t know for sure whether COVID-19 infections have increased by the same proportion.

      The opinion that I expressed in my May article was based on the behaviour of Stockholm inhabitants and the virus at that time.

      The HIT depends on people’s behaviour as well as that of the virus and the proportion of people who have already been infected or are otherwise effectively immune. Reports suggest that people in Stockholm, the young in particular have become increasingly relaxed in their behaviour, with decreasing social distancing over the summer, as cases declined. That change would have increased the HIT. In addition, cooler temperatures and less sunlight in September with the approach of autumn may have increased the virus’s ability to spread, which would also increase the HIT.

      • Oslo has a population of 693 ‘, Stockholm has 975’. The total number of confirmed infections since February is 4,342 and 24,067, respectively. New infections in the last 14 days are 604 and 844, respectively. In Oslo, the development is flat and in the last 14 days has added around 50 new cases of infection per. day. In weeks 35 to 38, Stockholm had 240 (the lowest since February) 254, 305 and 529 new cases. In both cities, many are tired of the measures and have begun to be sloppy, but I can not yet see any evidence that Stockholm, with far more infected, has any more favorable development than Oslo. One should also ask how sensible it is to treat “Stockholm” and “Oslo” as representative units, both cities are divided into a number of districts where it is reported separately, and the infection rates vary greatly between the different districts.

      • Nic,

        I wish that you had clarified your meaning of HIT. When arguing for herd immunity, unless otherwise specified, people think you are referring to herd immunity for the population with life as normal.

        Otherwise, it is fair to say that any sustained decline in any population meets herd immunity, even if .1% of the population has been infected in total. In other words, if strong mitigations – which are behavior changes – lower the Rt < 1, then by your latest usage herd immunity has been reached, and when mitigations are relaxed, it will again be lost (when the HIT rises due to the change in Rt).

        Thus, the two hump curve in the US would mean we reached herd immunity earlier, and then lost it, not due to loss of immunity, but due to behavior. That's not a useful way to look at it.

      • Nic Lewis

        “The HIT depends on people’s behaviour”

        If that’s your definition, then it’s utterly meaningless.

        There’s then no difference between “herd immunity” and “effective social distancing”.

        Your claim of Stockholm “reaching herd immunity” and someone else’s of Stockholm “having effective social distancing” are synonymous.

      • Matthew R Marler

        nic lewis: The HIT depends on people’s behaviour as well as that of the virus and the proportion of people who have already been infected or are otherwise effectively immune.

        That change would have increased the HIT. In addition, cooler temperatures and less sunlight in September with the approach of autumn may have increased the virus’s ability to spread, which would also increase the HIT.

        In that post, you seriously undercut the notion that herd immunity has any serious meaning — health consequences, estimability, empirical test, etc. You mnight as well drop the concept and see whether R0, the other parameters of the models, and their changes across time, can be estimated from some kind of obtainable data.

      • Matthew,

        Now you’re catching on. What Nic said in this post is obviously true. Behaviors are embedded in R.

      • mesocyclone

        “I wish that you had clarified your meaning of HIT. When arguing for herd immunity, unless otherwise specified, people think you are referring to herd immunity for the population with life as normal.”

        In my June 28 post, which was specifically about the progress of the epidemic in Sweden, both in Stockholm and elsewhere, I wrote in the final paragraph of my conclusions:

        “The herd immunity threshold is likely lower at present than it would be if people were behaving completely normally; it may also be seasonally lower.”

        So I did state that I was not referring to the HIT with life as fully normal.

        My original post on May 10 about the HIT was not primarlly about Sweden or Stockholm, but I did say in it that Sweden had implemented “relatively modest social distancing policies”. My HIT analysis for Stockholm was accordingly necessarily based on behaviour at that time in the light of those policies. How could it have been based on life completely as normal? Nevertheless, a reason for giving Stockholm as an example was that the moderate degree of social distancing in Sweden was considerably closer to life as normal, and much more sustainable, than behaviour as constrained by the policies that had been adopted in most other European countries.

      • Doubgbadgeroo..

        “Behaviors are embedded in R.”

        Rt is based on a combination of behavior, acquired immunity, and the more basic characteristics embeeded in R0. The latter is the Rt value for the pathogen in the specific population with life as normal, which has not previously been exposed to this specific pathogen.

        Theoretical herd immunity threshold HIT is 1 – 1/R0. Pre-existing immunity is thus already accounted for, as is pre-existing heterogeneity (with a big caveat).

        But, to say “herd immunity is achieved” without saying anything else is to imply that herd immunity is as roughly immutable as R0. That is, I think, what everyone read into Nic’s observation that Sweden appears to have achieved it.

        But now, that is apparently not what he means. If that’s true, then his statement has a very different meaning: that without changing behavior, the epidemic will die out (ignoring imported cases). It also means that behavior changes, in the direction of relaxation of mitigations, will let HIT go back up.

        That is a very, very different meaning, and situation.

        By that definition, the US hit herd immunity this spring. After all, Rt became less than 1, as is obvious from the epi-curve. That definition, in other words, is far less meaningful than “herd immunity has been achieved” or “HIT has been reached” (which are equivalent) in the more traditional sense.

      • nic – thanks for your clarification, and I did miss that paragraph in my first reading. I would suggest that, given the sensitivity of the HIT issue, that it might be a useful caveat up front, to avoid misinterpretation.

        I do not share your optimism completely, but I do believe that your hypothesis on heterogeneity (also shared by some others) makes a lot of sense.

        However, the true valu eof the life-as-normal HIT threshold remains a mystery to me. I see the declining case rates around the world, but disentangling individual behavior and government coerced or advised behavior from the impact of acquired immunity seems very difficult to do. How to apply Sweden isn’t clear, and if we are to do that, how about Manaus or other situations?

        Cross-immunity would already be included in R0, if the populations for which R0 is estimated include that immunity. In that sense, R0 was also measured with some degree of heterogeneity . But there are other sources too – the idea that social network choke points might “burn out” has been mentioned. And, of course, there are other differences between populations.

        Anyway, sorry I missed your refinement in the initial article.

      • mesocyclone
        ‘But, to say “herd immunity is achieved” without saying anything else is to imply that herd immunity is as roughly immutable as R0.’

        I think you are missing the point that the reason why the herd immunity threshold depends on people’s behaviour (and that of the virus, which may be seasonal) is precisely that R0 changes with those factors – R0 is not immutable.
        For any given fractional change in R0, the fractional change in the HIT I calculate is generally smaller – it is somewhat more stable than R0.

      • “I think you are missing the point that the reason why the herd immunity threshold depends on people’s behaviour (and that of the virus, which may be seasonal) is precisely that R0 changes with those factors – R0 is not immutable.”

        If you are using R0 to mean Rt – yes, I understand exactly that. The standard formula for HIT in that situation would be 1-1/Rt. In fact, that’s my point.

        My point is that, in the public debate and in general usage, herd immunity is meant to apply to a life-as-usual behavioral situation. That’s how it is used in debates of policy: seeking herd immunity via natural infection vs waiting for vaccination to achieve it.

        Hence, I think it important to state, for people who are dealing with policy and are not familiar with the variations we both understand due to behavior, that the herd immunity you say was reached in Stockholm is *not* the life-as-usual herd immunity, but rather is conditional on unusual behavior.

        “For any given fractional change in R0, the fractional change in the HIT I calculate is generally smaller – it is somewhat more stable than R0.”

        Hmm… the derivative gives a sensitivity of the square of 1/Rt, but I don’t know how you are calculating it or deriving it from simulation. d(HIT(Rt)) = 1/(Rt)^2

      • > Hence, I think it important to state, for people who are dealing with policy and are not familiar with the variations we both understand due to behavior, that the herd immunity you say was reached in Stockholm is *not* the life-as-usual herd immunity, but rather is conditional on unusual behavior.

        And further, because of behavioral and other dissimilarities when comparing Sweden to other countries such as the US or the UK, it is problematic for Nic to use Sweden as a reference point in his advocacy for particular public policies in those other countries.

        In the very least, as he seeks to influence the politics of public policy development in domains of science outside his domain of expertise, he should be up front about addressing the implications of those dissimilarities. Especially since he had been asked, repeatedly, to do so.

        I’m surprised Judith hasn’t called him out on his political advocacy in an area of science outside his domsin of expertise, as I know that’s something she feels very seriously about.

        Oh.

        Wait.

        Nevermind.

      • mesocyclone
        “If you are using R0 to mean Rt – yes, I understand exactly that.”

        I’m not doing that, but I do agree that the usual terminology isn’t ideal here.

        R0 is normally defined as the expected number of cases directly generated by one case in a population where all individuals are susceptible to infection (see, e.g., https://en.wikipedia.org/wiki/Basic_reproduction_number).

        R0 cannot be estimated directly from the growth rate of infections other than in the very early days of an epidemic, since not all individuals will then be susceptible. Nevertheless, it remains a useful theoretical parameter throughout an epidemic.

        There is nothing in its above definition that says R0 won’t vary with the behaviour of individuals and/or of the virus. Indeed, it is bound to so vary, and thus R0 as well as Rt will in reality be a function of time.

        The effective reproduction number Rt is the number of cases generated in the current state of a population, and will differ from R0 when any individuals have already been infected. So it is dependent both on R0 and on the proportion of the population that has been infected.

        The herd immunity threshold is reached when Rt = 1. It depends on R0, but not on Rt. If the individuals’ susceptibility is gamma-distributed with a coefficient of variation (standard deviation / mean) of CV, then in simple models that allow for varying susceptibility

        HIT = 1 – R0^(-1/[1+m*CV^2])

        where m = 2 if infectivity is perfectly correlated with susceptibility (due to social connectivity) and m = 1 if they are uncorrelated. Rt does not appear in this formula. It is variation in R0 that affects the HIT.

  34. The Swedish newspaper “Expressen today:”

    “The number of covid-19 infected in Stockholm has almost doubled in two weeks in a row.

    In the nursing homes, there has been no spread at all to 16 new cases in the last week.

    “We see a trend break,” says Maria Rotzén Östlund, acting infection control doctor at the Stockholm Region. ”

    https://www.expressen.se/nyheter/coronaviruset/larmet-fran-stockholm-nu-kommer-smittan-igen/

    Climate etc. used to be a climate skeptical blog, has it evolved into a Covid – 19 denier blog?

    • If by that they mean a doubling time of one week, seen twice in a row, that’s an Rt value of about 1.6, depending on which generation time you use. That is not good at all.

    • Unless it’s some weird blip, it’s a strange development considering they reached herd immunity a full two months ago.

    • And also keep in mind they have changed the reporting methodology to self-reporting. So likely the number of cases is even higher and may have begun to grow several weeks ago.

      As long as any kind of preventive measures are in place (either self-imposed or government mandated), there will likely be new cases and new waves as the measures loosen. There may not be as many deaths because we have more hospital capacity and better treatments. We can expect more pronouncements of herd immunity every time there is a temporary plateau but the whole thing won’t end a high percentage of people are immune either by catching the disease or immunization.

  35. Joshua | September 26, 2020 at 10:11 pm | Reply
    “Unless it’s some weird blip, it’s a strange development considering they reached herd immunity a full two months ago.
    “Herd immunity is supposedly reached when R naturally falls below 1.“
    Herd immunity does not mean no infections or no blips or no strange developments.
    It refers to the overall herd not, outbreaks which are a different matter

    • Angrch –

      > It refers to the overall herd

      Sure.

      And “overshoot” us an issue that’s relevant. Is that an issue that Nic has previously included in his analysis)?

      The herd we’re talking about here is the population of Stockholm. Nic confidently said they reached herd immunity 4 months ago based on the % of that population *who could no longer get infected.* Not included in his pronouncement were caveats about behaviors that would change, or conditions specific to Stockholm. He ignored specifics like % of people who lived in single-person households, or number of people who left the city for vacation, or % of people who live in multi-generational households, or the ease with which the residents of that city could work from home, to advocate that public health officials in other counties follow Sweden’s lead.

      In fact, he ignored it when commenter pointed out those variables as being relevant and problematic to his extrapolation.

      And many people, who for years have been very heavily focused on doubting the very idea of using theoretical modeling to predict outcomes from very complex real world dynamics, signed on to advocate like Nic did, that other counties very dissimilar to Sweden adopt a “herd immunity” approach to dealing with the pandemic, based on outcomes on Sweden, without integrating the iimplications of those many dissimilarities (and more) .

      Notice Nic’s self-sealing logic above:

      https://judithcurry.com/2020/09/22/herd-immunity-to-covid-19-and-pre-existing-immune-responses/#comment-927446

      The possibilities abound. That he was just wrong isn’t one of them, apparently.

      Before, Nic included a picture of young people in Stockholm partying in Sweden AS EVIDENCE that “herd immunity” had been reached, and now he says how young people partying in Sweden is evidence he that he right all along even though infections have been increasing in a way that is inconsistent with reaching “herd immunity” – BECAUSE YOUNG PEOPLE PARTY!

      C’mon, you gotta admit that’s some beautiful irony.

      From what we’ve seen so far, it doesn’t appear to be what I’d call an “outbreak, ” but a broader, if short-term, increase in infections – in that it doesn’t seem to be a cluster of people who interacted with each other

      But maybe I’m wrong about that and yeah – it could just be a blip. I hope it is. Too early to tell. And my point all along was that it’s too early to try to draw conclusions from the highly uncertain and very noisy data that we have, in the manner in which Nic has done.

  36. The FUN part is that according to some papers many animals already had immunity to “sars-cov-2” going back to October 2019! And if more older samples are still stored probably we’ll find out that after all “sars-cov-2” is not new!

  37. No doubt some yahoo will post that Sweden isn’t doing as well as we think. Here is a chart showing HOSPITALIZATIONS per day. The number of cases doesn’t matter since that depends on the frequency of tests. But hospitalizations tells the real story:

    https://www.covid19insweden.com/en/healthcare.html

    • > No doubt some yahoo will post that Sweden isn’t doing as well as we think

      Yeah. Some yahoo:

      snip-

      “It is slowly but surely going in the wrong direction in Sweden, even if the situation is not as serious as in other parts of Europe,” Tegnell said at a news briefing Thursday, according to the newspaper Svenska Dagbladet.

      -snip-

      Freakin’ yahoos.

    • jim2: https://www.covid19insweden.com/en/healthcare.html

      Thank you for the link. Pandemics, epidemics, endemics, etc are stochastic processes. There will be transient ups and downs when they are in steady-state or declining, as there were when they were increasing.

    • >>>The number of cases doesn’t matter since that depends on the frequency of tests. But hospitalizations tells the real story.

      Disagree, the number of infections and hospitalizations depends on, among other things, who gets infected. If there are a lot of young people, it is less likely to lead to hospital admissions, but then it is only a matter of time before more vulnerable people become infected and then hospital admissions also increase. In Bergen, we had a major outbreak in connection with the semester opening of the Norwegian School of Management (partying), the outbreak was isolated after a couple of weeks, then hospital admissions began and the infection also reached a couple of nursing homes and has so far led to three deaths.

      • Disagree. The number of hospitalizations has been low and pretty constant for many weeks. The infection of “vulnerable” people hasn’t materialized.

  38. Nic,
    Here is a very interesting pre-print:- https://www.medrxiv.org/content/10.1101/2020.04.05.20054627v3
    It investigates the contribution of genetic ancestry in Europe and Far East to immune response. The authors claim that it is a significant explanatory variable when examining the disparities in COVID-19 disease severity and progression between the Far East and European nations.
    The authors (also) investigate the effect of genetic ancestry within Europe, where the proportionate presence of certain genome types correlate with disease severity. It suggests inter alia that the large difference in COVID-19 response between Finland and Sweden may be due to genetic ancestry. The paper can be challenged for its use of the ratio of deaths to recoveries as a predicand, but it is nevertheless a very informative read.

    • Paul,
      Thanks. Very interesting. It seems very plausible that genetic differences between populations may account for a significant part of the variation in COVID-19 severity and the IFR. But there are various potentially confounding variables that make me cautious of their statistical analysis. For instance, Finland has a far lower population-weighted population density than does Sweden, and Sweden will have had a much greater seeding, as Stockholm is much more internationally connected than Helsinki.

      • > . For instance, Finland has a far lower population-weighted population density than does Sweden, and Sweden will have had a much greater seeding, as Stockholm is much more internationally connected than Helsinki.

        Nice to see you discuss confounding variables when making cross-country comparisons. I wish you’d do that more often.

        Have you previously discussed the impact of Sweden’s population-weighted population density and seeding as a result of international connectivity (in particular international connectivity to early hotspots) when advocating that Sweden’s policies should serve as a model for other countries’ policies for addressing Covid? If so, I seem to have missed it.

  39. New MAGA Covid test developed under the direction of MAGA POTUS Donald J. Trump. Easy peasy low cost $5 ea., no lab equipment required and MAGA results in 15 minutes. 150 million MAGA tests in the works already several million distributed where MAGA needed most. Best MAGA testing regimen available in the world. Watch MAGA Admiral in WH Rose Garcen with the MAGA demonstration:

    • I”m glad to see that they’re rolling out some of this testing.

      I’ll even applaud despite the lame attempt to label the tests as a political ploy.

      There have been advocates for this kind of testing for months. Better late than never.

      Of course, the numbers they’re rolling out are insufficient in comparison to what the advocates say is really necessary. I think it’s unlikely that the Trump administration will get it together to manufacture and distribute the tests in the numbers that are really required (Michale Mina suggests up to 100 million tests a day would be the kind of testing regime we should have).

      But it’s a start.

      • Testing will get less important when a vaccine becomes available.

      • George –

        > Testing will get less important when a vaccine becomes available

        Well, *if* one becomes available and widely distributed.

        But sure, that’s a valid point.

      • Trump apparently foresaw your *if*, and three(?) different vaccines are being mass-produced as we speak, in a hope that at least one might be safe and effective. That’s spending money to save lives.

        Wasn’t he horrible in the debate? Just like everybody else?

    • Yeah, 100 million tests a day is doable. You are a fool.

    • Entirely doable. Read the article.

      It would enable us to completely open up the economy..

      Anyone capable of simple math would see that it would more than pay for itself. It would cost considerably less than the Covid stimulus and relief already paid for by the Trump administration.

      • You are not very bright. It’s not a matter of simple math. The tests have to be manufactured:

        https://www.who.int/news-room/detail/28-09-2020-global-partnership-to-make-available-120-million-affordable-quality-covid-19-rapid-tests-for-low–and-middle-income-countries

        These are your international “progressive” do-gooders and their plan to supply the tests to the poorer nations. Bill Gates has got a gazillion dollars and other resources are available, but they are looking at 500 million tests in 12 months.

      • Posted early:

        Abbott has announced their capacity after very big investment in production facilities will be 50 million month. Nobody is going to produce 100s of millions of these test a day, you dummy.

        And as for the timing of test development:

        “The ACT-Accelerator Diagnostics Pillar is co-convened by FIND and the Global Fund, working closely with WHO and over 30 global health expert partners to accelerate innovation and overcome the technical, financial, and political obstacles to achieving equitable access to effective and timely testing. Such unprecedented global collaboration has enabled development and deployment of the first WHO EUL-approved Ag RDT within eight months of the first identification of the virus. In comparison, it took nearly five years to develop the first RDT for HIV. Several more antigen RDTs for COVID-19 are currently under WHO EUL review. Overall, the ACT-Accelerator Diagnostic Pillar aims to facilitate the supply of 500 million tests to LMICs within 12 months.”

        Your pathological lack of self-awareness is legendary, and amusing.

      • With the Defense Production Act, the Trump administration, if it were anywhere near competent, could make it happen to manufacture and distribute millions of tests a day, tens of millions of tests a day. With $2 trillion they could build the manufacturing and distribution infrastructure necessary, and even give people good jobs in the process instead of just handing out checks and passively watching the virus spread.

        But they lie about the need for testing, they lie about their capacity for testing, the make promises about the amount of testing they’re going to provide and fail to live up to those promises over and over.

        They lack the leadership and the balls to do something other than throw scraps to their adoring fans.

        And their sycophantic cult supporters continue to let them off the hook, over and over.

        Read the article. Educate yourself. Read the many articles on the topic. Throw off the shackles of the Trump cult. Use your imagination to visualize a world beyond sycophancy.

        This is a good thing that they’re doing. It would be great if they did it on a much more massive scale. As a country we have the resources and capability. All we need is competent leadership and an citizenry that is at least willing to expect basic competency rather than accepting scraps of crap getting thrown to them and saying “Please sir, may I have some more?”

      • You don’t know when to quit.

    • The stimulus they’re talking about now could buy 440 billion tests.

  40. As for those who use facile logic to claim that the low rates of spread in NYC proves that it has reached “herd immunity.”

    -snip-

    The daily positivity rate is above 3% in New York City for the first time in months, according to New York City Mayor Bill de Blasio.

    However, the city uses the seven day rolling average to determine if schools should close. That number stands at 1.38% citywide which is below the mark for school closures.

    The daily positivity rate is 3.25% which is under the threshold of five percent. Nine zip codes with a serious problem are impacting the overall daily number according to the mayor who notes these are nine out of 146 zip codes in the city, but it’s still a “cause for real concern,” he said Tuesday

    -snip-

    The notion of the rate of spread in NYC in some aggregate form as showing the achievement of “herd immunity” at a low % seems facile, and best seen as an example of confirmation bias.

    NYC, obviously being a very diverse place, requires a more sophisticated analysis. There are neighborhoods with vastly different population infection rates, and the association between those rates and positivity rates had many interacting variables and mediators and moderators.

    While the diversity is likely less pronounced in Sweden, the assertion that it has reached “herd immunity” should be held to a similar standard. Theoretical modeling is important and relevant – but facile application of theoretical modeled to the real world, without a sophisticated attempt to account for confounding variables is bad science. Extrapolating from Sweden to other, very dissimilar countries, is even worse science.

    Although it does serve political advocates well in their political policy advocacy.

    • Instead of using the term, Herd immunity, let’s use to the word, Showtime.

      Once Showtime is reached, kids can go back to school, we can go back to work, we can carry on as before if we so desire to.

      We don’t even have to discuss what herd immunity means. It doesn’t matter. Have we reached showtime? We can’t be sure. Each person can make that decision, unless the government makes it for them. Trump is blaming Cuomo, Cuomo blames Trump, I blame us. For letting governments decide for us.

      Yes we might run off of a cliff. But with government deciding, we’ve all ready given a pretty imitation of that. Just look at the economy and the riots.

      I can’t help being mad at South Korea. Maybe they are docile enough. Some of us are, but hey, then there are the deplorables and they have their President. I don’t think South Korea has reached Showtime. They’ve reached herd isolation.

      Herd isolation loses to Showtime. Most people don’t want to get to Showtime because of the increased risk. So the idea is to get people to accept risk, and win versus the herd isolationists.

      I’ve wondering about the people of South Korea:

      Don’t Forget the Dark Side of Living in South Korea

      https://time.com/5308394/south-korea-trump-human-rights/

      They live with a threat, from their own government too.

      • > Have we reached showtime?

        It depends on the metrics.

        And whether there’s a competent government.

        > I can’t help being mad at South Korea. Maybe they are docile enough

        Too bad they aren’t macho like you are. Meanwhile, they have far fewer deaths and illness per capita and less economic damage. Because they have a competent government.

        But I’m sure that like me they’re impressed with how macho you are.

      • J:
        The bias towards the metrics is the problem. It depends on you. You are the authority. The one’s we want to look to are playing the same game they always play. They got us here didn’t they?
        Sweden has a competent government. Doesn’t China have a competent government?

  41. It seems that Trumps drug might work after all, not in treating covid but helping to prevent it.

    This is a major study from Australia

    Scroll to the bottom of the link for the story

    https://www.dailymail.co.uk/news/article-8790261/Australian-scientists-insist-hydroxychloroquine-prevent-people-catching-COVID-19.html

    Tonyb

    • tony –

      That’s an impressive story. Some people in Australia think that HCQ might be help prevent infection. And some scientists are studying it. Wow!

      Interesting that they seem to dismiss all those who believe that it’s helpful for treating the virus once people are infected..

      And meanwhile:

      -snip-

      In a real‐world setting, HCQ/CQ treatment is associated with higher reporting rates of various CVAEs, particularly cardiomyopathy, QT prolongation, cardiac arrhythmias and heart failure. HCQ/CQ‐associated CVAEs result in high rates of severe outcomes and should be carefully considered as an off‐label indication, especially for patients with cardiac disorders.

      -snip-

      https://bpspubs.onlinelibrary.wiley.com/doi/10.1111/bcp.14546

      -snip-

      In a clinical trial testing whether a daily regimen of hydroxychloroquine could protect those most likely to be exposed to COVID-19, researchers from the Perelman School of Medicine at the University of Pennsylvania found there was no difference in infection rates among health care workers who took the drug versus those taking a placebo. While the researchers observed a lack of effect associated with hydroxychloroquine, infection levels were low among the participants, which the researchers believe points to the effectiveness of other prevention measures in the health system: social distancing, use of personal protective equipment, and proper hand hygiene. The study was published today in JAMA Internal Medicine.

      -snip-

      https://medicalxpress.com/news/2020-09-hydroxychloroquine-effective-placebo-covid-.html

      • Joshua

        Clearly IF it could prevent infection in the first place, and that is a very big IF, then that could be highly significant and could be another tool in the fairly sparse tool box of prevention rather than attempted cure.

        The other tools seem to be keeping fit, not getting obese, keeping your vitamin D levels up and there is obviously a very big space, as yet unfilled marked ‘vaccine’ . So it’s not a very impressive tool box at present

        Tonyb

      • “In a real‐world setting, HCQ/CQ treatment is associated with higher reporting rates of various CVAEs, particularly cardiomyopathy, QT prolongation, cardiac arrhythmias and heart failure. HCQ/CQ‐associated CVAEs result in high rates of severe outcomes ”

        This is in a specific real-world setting where high doses are used. Unfortunately, that is also the situation almost all the studies have been done.

        In lower doses, HCQ especially, has a very low side effect rate – so low that it used to be a standard malaria prophylactic. I was prescribed it, by an infectious disease doc, for a trip to the jungle, for example. Soldiers in Vietnam who went into the jungle took it through their entire tour.

        I don’t think the verdict is yet in on HCQ. Indications are not promising, but I don’t think its use can yet be excluded in non-severe cases, especially if low dose is used, where the risk is low enough that non-proven treatments may make sense. Unfortunately, because and only because Trump promoted it, there has been an emotional (and hence, I suspect, funding) backlash within the scientific establishment, and also a countering reaction among some Trump supporters who are overzealous in their enthusiasm for it.

      • Curious George

        “In a real‐world setting, HCQ/CQ treatment is associated with higher reporting rates of various CVAEs, particularly cardiomyopathy, QT prolongation, cardiac arrhythmias and heart failure.”

        I remember reading that report with a total consternation. They used near-fatal doses of HCQ. Surprise, poisoned recipients did not fare any better than a placebo control group. Why would DOCTORS deliberately kill patients to prove Trump wrong?

      • Research seems to show those with previous mental health problems had a much greater chance of dying if they caught covid

        https://www.dailymail.co.uk/health/article-8790111/Study-suggests-mental-health-affect-coronavirus-risks.html

        So age, obesity, mental health, lack of vitamin D, ethinicity, are amongst the factors likely to affect your reaction to covid

        Tonyb

      • Joshua: In a clinical trial testing whether a daily regimen of hydroxychloroquine could protect those most likely to be exposed to COVID-19, researchers from the Perelman School of Medicine at the University of Pennsylvania found there was no difference in infection rates among health care workers who took the drug versus those taking a placebo. While the researchers observed a lack of effect associated with hydroxychloroquine, infection levels were low among the participants, which the researchers believe points to the effectiveness of other prevention measures in the health system: social distancing, use of personal protective equipment, and proper hand hygiene. The study was published today in JAMA Internal Medicine.

        I see you beat me to it.

    • And this is infortunate:

      -snip-

      The people who took the drug, including the president himself, could be denied health insurance.

      Larry Levitt, the executive vice president for health policy at the Kaiser Family Foundation, noted that patients who had taken Hydroxychloroquine Sulfate used to receive automatic “medication denials” before Democrats passed the Affordable Care Act during the Obama administration.

      This means, if Trump’s Department of Justice is successful in overturning the Affordable Care Act, Republicans who listened to Trump may have a hard time buying insurance in the individual market.

      -snip-

      https://news.yahoo.com/trump-fans-took-hydroxychloroquine-could-103201799.html

      • Oh, please. Those denials were because they had Lupus or other auto-immune diseases. And there were probably not that many, because most people have group insurance with coverage of pre-existing conditions, and people who stayed in the individual market would already have insurance, and thus continuous coverage.

        PEE restrictions are to reduce free-riders – people who don’t buy insurance until they are sick, thus not contributing to the system. ObamaCare has produced a lot of free-riders. The penalty was never high enough to discourage that for people who needed insurance after getting sick. I know people who bought the insurance, had an oepration or whatever, and then canceled it.

        Also, if they are successful in court, that does not, as implied, mean that the PEE protections will disappear, but they are more likely to address the free-rider problem.

      • Meso,
        “PEE restrictions are to reduce free-riders – people who don’t buy insurance until they are sick, thus not contributing to the system.”

        Joshua’s party is entirely built around pandering to free riders. Creating more free-riders was the intent. These are people who think “corporations” pay for free riders with money they grow on trees somewhere.

        Biden’s argument is that you can be a free rider.

      • May 31, 2020:
        “Peru will continue to use the controversial drug hydroxychloroquine to treat patients, Health Minister Victor Zamora said, adding that it was recommended by a team of experts.”

        https://tinyurl.com/ycdqzteo

        ————

        September 9, 2020:
        “Peruvian Health Minister Pilar Mazzetti informed Congress’ Special COVID-19 Commission that hydroxychloroquine will be removed from the treatment guide for novel coronavirus patients, but ivermectin will remain on the list.”

        “The latest publications on hydroxychloroquine tell us that it does not seem to be useful. It will only be withdrawn from the guide for COVID-19 (treatment), it cannot be withdrawn from the request because hydroxychloroquine is a drug used in rheumatology,” she reported.”

        https://tinyurl.com/yd5ffd7

      • > Joshua’s party is entirely built around pandering to free riders.

        Jeff’s party freaked out when the aca mandated against free riders wouldn’t get insurance and then just show up on the ER expecting care.

        What’s funny ’bout that is that Pubz used to care about personal responsibility when Romneycare was a Pub idea and before an insurance mandate became TYRANNY!!

      • meso –

        Surely it would suck that if Trump gets his way, people with lupus xould be denied health insurance because of that preexisting condition as indicated by taking HCQ.

        But good catch.

        Still, given that it’s down on paper that taking HCQ could be disqualifying, and that insurance companies hunt out reasons to deny coverage, I wouldn’t put it past them to deny people who took HCQ for covid prophylactically, along with those people who might be suffering sequellae from a covid infection or who had a documented infection. .

      • ” if Trump gets his way, people with lupus xould be denied health insurance because of that preexisting condition as indicated by taking HCQ” – Only people who chose not to buy insurance until the condition developed. Those are an important part of your party’s constituency. I note that you ignored the free-riders statement above.

        So… to be clear… when people choose not to buy health insurance, and then get sick, and then claim a right to health insurance, they are free-loaders – people who are not personally responsible. We should not encourage that, because their health care costs are borne by everyone else, unfairly.

        BUT… you assume there would be no PEC protection, but without evidence.

        As for denying HCQ for taking it prophylactically – don’t be absurd. I say that both as someone who has had disqualifying PEC’s most of my life, who worked for a time in the medical insurance world, and who also helped my small company buy employee insurance. PEC’s are defined… taking a medication is *not* a PEC. It might be assumed as such by their computer system, but that can be appealed.

        And again, you are assuming that we will just go back to the system we had in the past, and yet Trump has said otherwise. I think you are maybe slipping into a talking-point role.

        I suggest we get back to the COVID19 science.

    • Tonyb
      Deaths are more closely correlated to age than any other factor. Comorbidities also closely related. Statistics too sparse for any other correlation.
      https://www.businessinsider.com/coronavirus-death-age-older-people-higher-risk-2020-2

      Hope you are doing well. I’m out and about now but wash hands and wear mask when close to others. Open the economy!!

      Scott

      • That was too old. Here is more recent data from Johns Hopkins U

        https://coronavirus.jhu.edu/covid-19-daily-video

        Scott

      • HI Scott

        Great to hear you are ok. The average age of death here is 85 with an average of 2.6 co morbitities. The number of over 65’s to have died who were previously healthy are inn the low thousands and those under 65 in the low hundreds. Its not the bubonic plague. The number of over 85’s has more than doubled here since 2000. its not a pandemic that could have happened even at the turn of the century as the number of aged and the obese was so much smaller

        Unfortunately we seem to have wandered into a lunatic asylum where the Chief warder and all his staff are the former inmates. The West seems to have gone mad and are suffering collective hysteria.

        Mind you those of us who have been dealing with climate change for so many years recognise the symptoms all too well!

        tonyb.

    • An interesting article. Also interesting that Gomes et al. have an update out.

      Unfortunately, like so many of the “herd immunity” advocates who refer to the papers on “T-cell immunity,” it mostly ignores that the researchers who wrote those papers caution that while T-cell reactivity might, that I’d mjfhrz reduce the severity of disease in those infected it doesn’t likely prevent infection (or people from getting infected and transmitting the virus to people who have no T-cell reactivity.).

      • I don’t think most of the studies say that T-cell reactivity is unlikely to reduce transmission of the virus, if it reduces disease severity. Indeed, contrary to your claim that all T-cell studies say that, as I recall they generally say little or nothing about transmission.

        Can you cite several specific examples to support your assertation?

        Even if researchers did write that T-cell reactivity is unlikely to reduce transmission of the virus, in the likely absence of providing any evidence for such statements they would be scientifically unsupported.

      • It has been widely said by people who don’t actually research the science (particularly right wing policy advocates) that “T-cell immunity” means immunity from infection. These right wing policy advocates say this with great certainty.

        Well, I certainly hope that it’s true – but it seems to me that their great ertainty is based more on motivated reasoning and confirmation biased than the science itself.

        And unfortunately, a lot of the policy advocates seek to leverage ambiguity in the definition of “T-cell immunity” to promote their preferred policy options.

        > Even if researchers did write that T-cell reactivity is unlikely to reduce transmission of the virus, in the likely absence of providing any evidence for such statements they would be scientifically unsupported.

        What a fascinating statement. So people who don’t actually study the science get to say that T-cell reactivity prevents against infection, even if they don’t have the science to back it up, but the scientists who study the science aren’t scientifically supported if they say that it may reduce severity but is not likely prevent against infection?

        For example, if you look at the actual quotes provided in that article from the scientists themselves, you see a higher degree of uncertainty, with respect to protection from infection, than that expressed in the rhetoric of the right wing policy advocates.

        Even in the quotes from the actual scientific articles provided in the article that Mark linked, we can see that while the right wing policy advocates are entirely certain that T-cell reactivity means “T-cell immunity” which means immunity against infection and not just protection against severity if infection, the articles they’re basing their opinions are are somewhat more nuanced.

        > –The presence of cross-reactive human coronavirus antibodies [22] (i.e., induced by coronaviruses responsible for 15-30% of seasonal common colds [23]), *which might lessen covid-19 disease severity.*

        > Our collective dataset shows that SARS-CoV-2 elicits broadly directed and functionally replete memory T-cell responses, suggesting that natural exposure or infection may prevent recurrent episodes of severe COVID-19” [28].

        That last quote is somewhere in between.

        Here is what I first saw that clued me in to the distinction between what the scientists who study this are saying about “T-cell immunity” in comparison to what the right wing policy advocates are saying:

      • I mean seriously, is it really that hard for right wing policy advocates to be more careful to convey accurately, the level of uncertainty that exists in the science they are using to leverage their advocacy preferred policy outcomes?

        Why can’t they be more thorough in their treatment of the science, like being sure to discuss the influence of confounding variables when making cross-country comparisons to compare the outcomes of policies in different countries? Why can’t they be more careful to mention caveats and control for confounding variables when they extrapolate from sampling that isn’t representative to the populations they are Extrapolating to?

        What happened to Mr. Uncertain T. Monster?

      • “is it really that hard for right wing policy advocates to be more careful to convey accurately”

        Because most advocates are not scientists and are unaware of the subtleties. This is true in general, not just right wing. I see left wing renewable energy advocates who almost always are unaware of critical issues that I know as an engineer and who has had my knowledge refined by this blog.

        I also see those who support the “left wing” policies (Joshua, you assigned wings) who also are unaware of subtleties and of the uncertainty issue. I have seen them over-react to any treatment Trump mentions (steroids being the most mistaken over-reaction, refusal to look at subtleties in the HCQ issue being another). I suspect Trump advocacy, especially distorted by media lies such as Trump advocating drinking or injecting bleach, unconsciously biases many in the scientific field since, on average, they are on the left.

        In general, in our society, people expect “science” to produce perfect answers instantly. It doesn’t work that way.

        But also, scientists want extremely good studies with serious peer review, but in this situation, we should accept lower quality evidence if, on a probabilistic basis, acting on it will do more good than good. I see clinicians, especially those in the research field, wanting gold plated results before acting, because that is what they do in non-crisis situations.

        Risch, an advocate of HCQ, wrote about the divide between gold plated science and field expedients necessary in epidemics. I suspect he is wrong about HCQ, but right about this bias towards too-perfect results. He argued that lower dose HCQ is a very low risk approach to try, even if it turns out to not be effective. To me, that was a reasonable argument. The fact that most Americans have been told, by scientists, that HCQ is a high risk treatment is testimony to the way experts can mislead themselves when politics is involved.

        So, it isn’t just “right wing policy types” who are not acting rationally in this debate.

        As a right wing person myself, I find myself dismayed by mask “deniers” (hate the term) and people on my side who are cherry picking evidence. But I am likewise dismayed by inappropriate behavior on the other side.

      • Joshua appears to have failed, upon challenge to do so, to produce even one example of a paper that states that T-cell reactivity is unlikely to reduce transmission of the virus, if it reduces disease severity.

        “scientists who study the science aren’t scientifically supported if they say that it may reduce severity but is not likely prevent against infection?”

        No, Joshua, they aren’t scientifically supported if they do not produce or cite evidence backing up such a statement.

        Joshua focuses on problems with claims by people you term “right wing policy advocates”, but fails to see that his own claims are problematic.

      • > Joshua appears to have failed, upon challenge to do so, to produce even one example of a paper that states that T-cell reactivity is unlikely to reduce transmission of the virus, if it reduces disease severity.

        Ah yes, I failed to prove a negative. Great logic there, Nic.

        What I said was that the scientists who are doing the research are careful to caveat what is mean by “T-cell immunity.” Which is in contrast to right wing policy advocates who fail to respect the uncertainty, and instead make claims FOR WHICH THEY DON’T HAVE SCIENTIFIC EVIDENCE.

        You fail to notice Nic, that you don’t have evidence of papers that support your certainty that T-cell reactivity provides immunity from infection. Yet you act as if you do. And when I point out that the science is more uncertain than what you claim in your advocacy, you duck that your claims are overly certain and set up a self-sealing criticism of me for pointing out the uncertainty, by arguing that I should be able to prove a negative.

        Once again, here’s what you said:

        > > Even if researchers did write that T-cell reactivity is unlikely to reduce transmission of the virus, in the likely absence of providing any evidence for such statements they would be scientifically unsupported.

        I don’t know their reason for stating such, but the idea that T-cell reactivity provides immunity against infection, which you state confidently is that case, is not scientifically supported.

        > Joshua focuses on problems with claims by people you term “right wing policy advocates”, but fails to see that his own claims are problematic.

        Why is my “claim” problematic? My “claim” is that scientists who do the research are careful to provide caveats and state the uncertainties. And I provided examples of where they had done so, including from the quotes excerpted in the article that Mark linked.

        It’s interesting that you think that providing examples of scientists stating uncertainties and caveats is “problematic”

        Indeed, I can see where you would find it problematic, as it undercuts your statements which lack appropriate scientific respect for uncertainties.

      • Apparently you think that I’ve claimed that T-cell reactivity doesn’t provide immunity from infection.

        You should read again, as I have said that.

        Apparently you are arguing against a straw man. What I have said is that the scientist who are doing the research have said that T-cell reactivity might provide protection against severe infection, but isn’t likely to provide protection against infection.

        And I gave you examples.

        Why is it “problematic” that you foist onto me your straw man argument?

        Instead of wasting your time with that – why don’t you address the uncertainty that the scientists doing the research are talking about?

      • Nic –

        I look forward to you explaining why these scientists who actually study the issue, among with Crotty, are wrong.

        -snip-

        15

        SCI-TECH SCIENCE
        SCIENCE
        Pre-existing memory T cells may only reduce COVID-19 severity, do not prevent infection
        Innate resistance: Among people not infected with novel coronavirus, 20-50% harbour memory T cells derived from previous exposures to common cold coronaviruses.
        Innate resistance: Among people not infected with novel coronavirus, 20-50% harbour memory T cells derived from previous exposures to common cold coronaviruses.
        R. Prasad
        29 AUGUST 2020 20:01 IST
        UPDATED: 30 AUGUST 2020 10:43 IST

        The immune cells may mount a faster and stronger response upon exposure to the SARS-CoV-2 virus
        At least five papers published in reputable journals — Cell, Nature, Science, and Science Immunology — have found that 20-50% people who have not been infected with novel coronavirus (SARS-CoV-2) still harbour memory T cells derived from previous exposures to common cold coronaviruses. The memory T cells were found to cross-react with SARS-CoV-2. A team of researchers from La Jolla Institute for Immunology, La Jolla, California has published three papers that established the presence of memory T cells from common cold coronaviruses in people who have not been exposed to SARS-CoV-2 virus and found the memory T cells cross-reacting with novel coronavirus.

        With Mumbai, Delhi, and New York witnessing a peak weeks after the coronavirus blazed through the cities, people have wrongly assumed that pre-existing memory T cells have been providing the much-needed protection from SARS-CoV-2 virus infection leading to mistaken assumption that herd immunity when be achieved when just 20-30% of the population is infected.

        “Pre-existing T cell immunity to SARS-CoV-2 could be relevant because it could influence COVID-19 disease severity. It is plausible that people with a high level of pre-existing memory CD4+ T cells that recognise novel coronavirus could mount a faster and stronger immune response upon exposure to the virus and thereby limit disease severity,” Alessandro Sette and Shane Crotty from La Jolla Institute for Immunology, La Jolla, California say in a Comment published in Nature Reviews Immunology.

        Advertising

        Advertising
        “The memory T cells are extremely unlikely to prevent SARS-CoV-2 infections. That is just not what T cells generally do. We (Prof. Sette and I) speculate that they may reduce COVID-19 disease severity and prevent deaths,” Prof. Crotty says in an email to The Hindu.

        But in a paper published in Cell, a team led by Dr Marcus Buggert from Karolinska Institutet, Stockholm, Sweden found robust memory T cells responses even in healthy people. Based on this they noted that memory T cells indicates a “previously unanticipated degree of population-level immunity against COVID-19”, which contradicts the observation by others.

        In an email to The Hindu, Dr Buggert clarifies: “I completely agree with Prof. Crotty and Prof. Sette that T cells are not going to protect against reinfection by SARS-CoV-2, but may prevent from recurrent severe COVID-19. That’s what T cell immunity is all about.”

        In a communication to The Hindu, Prof. Gagandeep Kang, Division of Gastrointestinal Sciences at CMC Vellore, echoed the views of Prof. Crotty. “Memory T cells generated by seasonal coronavirus alone are very unlikely to prevent [SARS-CoV-2] infection. It is plausible that they play a role in reducing [disease] severity,” Prof. Kang says.

        In a series of tweets, Prof. Crotty further clarified the misconstrued role of memory T cells in achieving herd immunity. “Even if our most optimistic speculations about cross-reactive T cell memory were found to be correct, it would mean that just as many people would get infected with SARS-CoV-2, but fewer would become severely ill and die from COVID-19,” Prof. Crotty says.

        Explaining how the memory T cells may help reduce the severity of the disease, virologist Dr. Shahid Jameel, CEO of DBT-Wellcome Trust India Alliance, says: “The cross-reactive memory T cells on activation would help in the development of plasma cells and thus antibody production, and in the development of killer T cells that would kill virus infected cells. The latter reduces the reservoirs of infection. This would most likely reduce disease severity. Though a low probability event (if at all), we don’t yet know if such cross-reactive activation would have effects on the cytokine storm that causes most of the pathology and mortality in severe COVID-19 cases.”

        Dr Jameel says that the adaptive immune system works at two fronts — humoral (produce antibodies) and cellular (T cells) immunity. “Antibodies protect against extracellular pathogens. But since antibodies cannot enter cells, these are unable to destroy cellular reservoirs of infection. For this, we need T cells that can seek and destroy infected cells and thus eliminate infection,” he explains.

        -snip-

        https://www.thehindu.com/sci-tech/science/pre-existing-memory-t-cells-may-only-reduce-covid-19-severity-do-not-prevent-infection/article32475102.ece

        I hope they are wrong, because T-cell reactivity preventing new infections would be a great thing – so I’d love to see your counter-argument. In lieu of providing one, perhaps rather than building straw men, and asking me to prove negatives, you could actually deal with the uncertainties?

        I’m sure talking to the uncertainty monster would make Judith proud of you.

      • Just a comment and a question on the T-cell issue. Whatever effect cross-reactive T-cells have, they have had throughout the epidemic and are thus reflected in the original R0 estimates, and in the observed disease severity and epi-curves. If they are to have any new impact, then they have to have come from new infections by COVID19, and the total percentage of those infections in most populations is most likely quite low, unless we make some pretty improbable leaps about asymptomatic *and* undetected case ratios.

        My question: has the issue of T-cells reducing transmission been directly addressed. I am not an expert, and it looks like the pros are saying that they don’t prevent infection, but may lessen it. If so, are those lessened infections less likely to transmit the disease? My hunch would be: yes (but, already captured in R0)

      • meso –

        > My hunch would be: yes

        That would be my assumption – based on the idea that people with less severe infection are less infectious. Although I have seen some surprising science that indicates conflicting evidence on the association between severity of infection and level of infectiousness. And if course, I would think that people who are more sick would be more likely to isolate.

        But obviously that’s all a hunch and not a scientific opinion.

        BTW, I wrote a repsonse to you on the healthcare thing but it got ate. If I have time I’ll try to reconstruct it.

      • Joshua, you wrote:

        “while T-cell reactivity might … reduce the severity of disease in those infected it doesn’t likely prevent infection (or people from getting infected and transmitting the virus to people who have no T-cell reactivity.).

        Your above statement covered the likely effect of T-cell reactivity on both (a) preventing infection and (b) preventing transmission of the virus.

        I did not dispute point (a), preventing infection.

        Rather, I disputed point (b) and challenged you to provide several examples of studies stating that T-cell reactivity was “unlikely to reduce transmission of the virus”. You have failed to produce a single such example.

        It is you, not me, who is tackling a straw man argument.

        You write:
        “You fail to notice Nic, that you don’t have evidence of papers that support your certainty that T-cell reactivity provides immunity from infection.”

        KIndly quote my exact words when making any claim about what I am or am not certain about or have asserted. I don’t believe that I have ever expressed “certainty” that T-cell reactivity provides “immunity from infection”.

        In this post I specifically mentioned uncertainties, writing:

        “Although noting that these epidemiologists added the qualification that this hypothesis is currently unproven, the article quotes Daniela Weiskopf (the senior author of the Science paper mentioned earlier) as commenting:

        Right now, I think everything is a possibility; we just don’t know. The reason we’re optimistic is we have seen with other viruses where [the T cell response] actually helps you.”

        In an earlier article I wrote about cross-reactive T-cells providing “resistance”, not “immunity” against the virus:

        “a substantial proportion (35% to 80%) of unexposed individuals have T-cells, circulating antibodies or other components that are cross-reactive to SARS-CoV-2 and can be expected to provide substantial resistance to it.”

        As your comments in this thread are now focusing on political issues and making untrue claims about what I’ve said, I shall cease wasting my time responding to them.

      • Nic –

        I’ve already explained thisn I’ll explain again…

        > Rather, I disputed point (b) and challenged you to provide several examples of studies stating that T-cell reactivity was “unlikely to reduce transmission of the virus”. You have failed to produce a single such example.

        You truncated what I said and in so doing left off that what I said was that scientists doing the T-cell reactivity research have said that “T-cell immunity” providing protection against infection is unlikely. I have shown you where multiple scientists doing the research have said that.

        You can either deal with the uncertainty or not. Up to you.

        Shifting the burden to me having to show studies that show that T-cell reactivity doesn’t provide immuntiyy against infection is a distraction. Sbd it employs fallacious logic in the process of that distraction.

      • Nic –

        > Right now, I think everything is a possibility; we just don’t know.

        That’s a hand-wave, not a proper treatment of the uncertainties.
        ——————————————
        JOSHUA – IF YOU BOTHERED TO READ WHAT I ACTUALLY WROTE, YOU WOULD SEE THAT I WAS NOT EXPRESSING THIS VIEW MYSELF – IT WAS A DIRECT QUOTE FROM THE BMJ ARTICLE:
        “the article quotes Daniela Weiskopf (the senior author of the Science paper mentioned earlier) as commenting:
        Right now, I think everything is a possibility; we just don’t know”
        Nic Lewis
        ——————————————

        From what researchers in this area say, there appears to be two areas of uncertainty. One is with respect to T-cell reactivity reducing the severity of infections, and the other with respect to T-cell reactivity providing immunity from infection.

        You lump them together in an unsophisticated fashion that doesn’t properly respect either the science itself or the uncertainty surrounding the evidence.

        You should be clarifying Sbd highlighting those IMPORTANT differences in uncertainty, or explaining why there isn’t a difference, and why the researchers are wrong.

        You have displayed a similarly lax treatment of uncertainties when dealing with (or actually not dealing with) the potential influence of confounding variables when extrapolating from the impact of Covid policies in Sweden to advocate for specific Covid policies in other countries.

      • BTW – speaking of Sweden, unfortunately the chances of that recent rise in infection rate being a blip are looking somewhat less likely:

        -snip-

        Sweden’s daily COVID-19 cases hit highest level since June

        The Scandinavian nation — which became a pandemic focal point when it refused to implement lockdowns earlier this year — reported a total of 752 new COVID-19 cases.

        The country hasn’t seen such a dramatic infection rate increase since June 30, when it reported roughly 800 cases.

        […]

        “It’s very unevenly spread across Sweden, hitting different parts of the country to varying degree,” Tegnell, of Sweden’s Public Health Agency, said at a press conference Thursday. “Stockholm once again accounts for a very large part of the new cases in Sweden.”

        -snip-

        https://nypost.com/2020/10/01/swedens-daily-covid-19-cases-hit-highest-level-since-june/

      • I should note that deaths are still down (don’t know about hospitalizations). Let’s hope they stay that way.

      • Joshua, you’re not going to persuade non-experts ideologically-committed to misrepresenting branches of science (ex: epidemiology and immunology) outside their range of expertise. Some people are just hopeless. I know that from years of experience dealing with anti-vaxxers, HIV/AIDS denialists, etc. right-wing COVID-19 contrarians are just another iteration of that.

        “Cross-reactive memory T cells and herd immunity to SARS-CoV-2
        […]
        Cross-reactive T cell memory may or may not affect COVID-19 disease severity in individuals. However, given the implications of the possibility, it is worth considering specific immunological and epidemiological scenarios. Four distinct immunological scenarios were considered herein. In each of the three scenarios that we consider plausible, the reduction in viral spread potentially afforded by pre-existing immunity is already accounted for by the empirical observational data available and factored into epidemiological models of spread and herd immunity — with the key caveat that if T cell immunity varies geographically and affects transmission, the extrapolation of epidemiological parameters across populations may not be fully valid.”

        https://www.nature.com/articles/s41577-020-00460-4

    • Mark Silbert: thanks for the link. it’s good to see that some politicians have a decent understanding of these important issues, and terrifying to see how poor the understanding of them is by supposed scientific experts who control or influence polic policy, and how unwilling such ‘experts’ are to change their views as the evidence against them builds.

      • Nic, we are starting to see some movement towards more rational policies in the U.S. but the current elections are politicizing everything to a high level.

        Florida’s Governor DeSantis has sought and is heeding advice from the non-entrenched bureaucratic experts and has moved to largely open Florida. He held a roundtable discussion and included Dr. Jay Bhattacharya, a professor of Medicine at Stanford University, Dr. Martin Kulldorff, a professor at Harvard University Medical School, and Dr. Michael Levitt, Professor, Structural Biology, Stanford University and Nobel Laureate. A video is available here: https://rationalground.com/the-end-of-covid-hysteria-in-florida/. and a transcript here: https://rationalground.com/governor-desantis-roundtable-experts-advocate-for-normal-life-for-young-people/

        Several other States are moving in the same direction.

        Unfortunately the Governor of my State, New Mexico, continues to impose ridiculous restrictions on business and schools in spite of having few new cases and deaths, virtually no hospital issues and a testing positivity rate of just around 2%.

        Dr. Scott Atlas of Stanford and the Hoover Institute has been named as an advisor to the President and he is shaking things up a bit. He is being vilified by the left and the media for daring to criticize the CDC. He seems to be taking it in his stride and pushes on.

      • Mark –

        Check out Michael Levitt’s predictions for Brazil (he said 98k deaths, currently at 144k, ), Iran (he said it was past the halfway mark at 24k cases, it’s at almost 500k cases now), Switzerland (he said 250 deaths, now at 2,074) Israel (he said likely no more than 10 deaths, currently at 1,600), Italy (he said 17k-20k) and the US (said the pandemic was over on August 22)

        And check out his comments about vaccines.

        But I like the appeal to authority with the Nobel mention,.

    • RationalGround is an ideologically-motivated joke, like citing Answers in Genesis in a discussion of evolutionary biology. This is the level they operate on:

  42. HCQ again: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2771265?guestAccessKey=443e2fbe-7acb-4228-8763-07511dfae0ab&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamainternalmedicine&utm_content=olf&utm_term=093020

    snippet: Among hospital-based HCWs at high risk of exposure to SARS-CoV-2, hydroxychloroquine, 600 mg, daily, for 8 weeks did not reduce the incidence of SARS-CoV-2 infection compared with placebo. Our findings are consistent with what is to our knowledge the only other randomized COVID-19 prophylaxis trial published to date.14 In that study, Boulware et al14 randomized 821 asymptomatic adults to hydroxychloroquine or placebo following a postexposure prophylaxis strategy in which participants self-identified as having a significant exposure and were treated with a 5-day course of hydroxychloroquine or placebo. The treatment protocol allowed for therapy initiation up to 4 days after exposure; more than 50% of participants started taking medication 3 to 4 days after exposure. This time variability prompted a critique15 that delayed initiation of hydroxychloroquine may have missed a key biologic window to prevent transmission. We elected to follow a pre-exposure prophylaxis strategy under the presumption that (1) prevention might depend on the timing of therapy, and (2) clear identification of a true exposure likely to result in transmission is challenging.

    • Mathew Marler, did you see this?
      “Results Of the 132 randomized participants (median age, 33 years [range, 20-66 years]; 91 women [69%]), 125 (94.7%) were evaluable for the primary outcome. There was no significant difference in infection rates in participants randomized to receive hydroxychloroquine compared with placebo (4 of 64 [6.3%] vs 4 of 61 [6.6%]; P > .99). Mild adverse events were more common in participants taking hydroxychloroquine compared with placebo (45% vs 26%; P = .04); rates of treatment discontinuation were similar in both arms (19% vs 16%; P = .81). The median change in QTc (baseline to 4-week evaluation) did not differ between arms (hydroxychloroquine: 4 milliseconds; 95% CI, −9 to 17; vs placebo: 3 milliseconds; 95% CI, −5 to 11; P = .98). Of the 8 participants with positive results for SARS-CoV-2 (6.4%), 6 developed viral symptoms; none required hospitalization, and all clinically recovered.”

      8 and all asymptomatic or mild symptoms. Was there a difference in the two arms?

      Someone knowledgeable with PCR tests needs to define the difference with: ” 4 milliseconds; 95% CI, −9 to 17; vs placebo: 3 milliseconds; 95% CI, −5 to 11; P = .98).” Also, ” 6 developed viral symptoms; none required hospitalization,” were the 2 without symptoms of each arm?

      Furthermore, I don’t remember there were claims that HCQ PREVENTED Covid-19, but yet this test was for:
      “Objective To evaluate the efficacy of hydroxychloroquine to prevent transmission of SARS-CoV-2 in hospital-based HCWs with exposure to patients with COVID-19 using a pre-exposure prophylaxis strategy.”

      This test was closed early because of lack of participants.

      I would put this test in the inconclusive category, and typical for Boulware the other negative RCT. And yet, these tests have drive policy.

      I follow this aggregation site of the studies released: https://c19study.com/

  43. UK-Weather Lass

    British Professor Sunetra Gupta talks about herd immunity, individual immunity (and reasons why), the effects of speaking out against Government and consensus policy in this day and age, sexism in science, and generally returning the whole SARS-CoV-2 debate to sober, wise and calm ground level thinking. (sound only <10 mins)

  44. Joe - the non epidemiologist

    Nic – I have had several posts on the effectiveness of masks with mesocyclone at the Micro level. You have dealt extensively with herd immunity at the macro level. Steve McIntyre has had numerous posts on his climateaudit twitter feed addressing the trajectory/cycle of the covid infections/deaths in the various states. I have seen several graphs showing the time frame for when lockdowns and facemask requirements were implemented and the effect on the trajectory / cycle of the virus in the population. The observation is that the mask mandate/lockdowns had very little, if any, effect on the trajectory. Almost as if the virus completely ignore any human mitigation attempts.

    So speaking at a very broad macro level, – any insight from your prospective

  45. This could be the right stuff. Testing so far in a small number of very sick sepsis and covid patients:

    https://www.timesofisrael.com/liveblog_entry/5-serious-virus-patients-cured-in-experimental-drug-trial-in-jerusalem/

    “5 serious virus patients cured in experimental trial in Jerusalem
    Enlivex Therapeutics says five coronavirus patients have recovered from the virus within days after being administered the Allocetra immunotherapy in a clinical trial at Jerusalem’s Hadassah hospital.

    “The clinical trial included five COVID-19 patients, three in severe condition and two in critical condition. All five patients had complete recovery from their respective severe/critical condition and were released from the hospital after an average of 5.5 days (severe) and 8.5 days (critical), following administration of AllocetraTM, at which time they were all COVID-19 PCR negative,” a statement says.”

    https://drug-dev.com/enlivex-announces-positive-final-safety-efficacy-data-from-clinical-trial/

    “The Acute Physiology and Chronic Health Evaluation (APACHEII) score of the Allocetra OTS-treated group was 12.3, and the corresponding phttps://www.timesofisrael.com/liveblog_entry/5-serious-virus-patients-cured-in-experimental-drug-trial-in-jerusalem/robability of mortality of at least one patient in that group was predicted at 85% based on the hospital’s ICU staff’s clinical assessment of each patient’s overall condition at admission. However, none (0%) of the Allocetra-OTS-treated patients died during the 28-day study period, as compared to 27% 28-day mortality in the matched controls group.”

  46. lovely

    • Relatively limited impact in Sweden – because of the factor right-wing policy advocates conveniently overlook when they lobby for other countries to follow Sweden’s policy choices:

      -snip-

      A potentially overlooked factor in Sweden’s coronavirus strategy: more than half of households consist of just 1 person

      Take Sweden, where more than half of households consist of just one person. Roughly one-third of Sweden’s elderly population lives alone, compared to one-fifth of elderly residents in Greece or Spain. Sweden also has a lower proportion of multigenerational households than most other European countries, and one of the smallest average household sizes in Europe: about 2.2 people per home.

      -snip-

      https://www.businessinsider.com/sweden-housing-crowded-lowered-coronavirus-death-rate-2020-9?amp

    • They put the majority of it behind them. They may be caving to public pressure. Look on this page for the flatline deaths.
      https://www.worldometers.info/coronavirus/country/sweden/
      For two months they’ve been at flatline. Effective herd immunity.
      They’ll be Okay.
      We are strong, we are brave, we are resilient.

    • Mark,
      Thanks; it’s from Senetra Gupta’s group. The original version came out several months ago, but there is a new version just out that I downloaded a day or two ago but haven’t yet read.

      • Nic –

        From the paper that Steven linked:

        >> The last scenario is included for completeness, although we consider it implausible.

        Immunological knowledge and epidemiological data make scenario 4 very unlikely.

        >>> In human CCC challenge–rechallenge experiments, even with the same or closely related CCC strains and the benefit of antibody-mediated immunity33,34, reinfection was frequently observed (although not necessarily symptomatic disease), making it implausible that cross-reactive CCC T cell memory alone would routinely abort SARS-CoV-2 infection

        >>>
        Perspective
        Published: 06 October 2020
        Cross-reactive memory T cells and herd immunity to SARS-CoV-2
        Marc Lipsitch, Yonatan H. Grad, […]Shane Crotty
        Nature Reviews Immunology (2020)Cite this article

        529 Altmetric

        Metricsdetails

        Abstract
        Immunity is a multifaceted phenomenon. For T cell-mediated memory responses to SARS-CoV-2, it is relevant to consider their impact both on COVID-19 disease severity and on viral spread in a population. Here, we reflect on the immunological and epidemiological aspects and implications of pre-existing cross-reactive immune memory to SARS-CoV-2, which largely originates from previous exposure to circulating common cold coronaviruses. We propose four immunological scenarios for the impact of cross-reactive CD4+ memory T cells on COVID-19 severity and viral transmission. For each scenario, we discuss its implications for the dynamics of herd immunity and on projections of the global impact of SARS-CoV-2 on the human population, and assess its plausibility. In sum, we argue that key potential impacts of cross-reactive T cell memory are already incorporated into epidemiological models based on data of transmission dynamics, particularly with regard to their implications for herd immunity. The implications of immunological processes on other aspects of SARS-CoV-2 epidemiology are worthy of future study.

        Download PDF
        Introduction
        The concept of the herd immunity threshold, which refers to the fraction of the population that needs to be immune to prevent an ongoing epidemic spread of an infection, has been a major focus of research and discussion since the early days of the SARS-CoV-2 pandemic. The herd immunity threshold is reached when an infected individual infects fewer than one other person, on average. For a novel infection for which there is no pre-existing immunity, herd immunity can be generated either through infection with the pathogen or through vaccination. The effect of pre-existing cross-reactive T cell immunity on the SARS-CoV-2 herd immunity threshold has been a matter of debate1,2, partly because of differing or unclear assumptions about the underlying biology. For SARS-CoV-2, a member of the coronavirus family that also includes the common cold coronaviruses (CCCs) HCoV-OC43, HCoV-HKU1, HCoV-229E and HCoV-NL63, the extent and nature of cross-reactivity of immune responses are variables that can influence the near and long-term trajectory of the current pandemic3.

        SARS-CoV-2 infects epithelial cells of the upper respiratory tract (URT; including the nasal passages and throat) and the lungs (bronchi and lung alveoli). These sites are involved in different aspects of SARS-CoV-2 pathology and transmission. Severe COVID-19 involves extensive lung infection, whereas SARS-CoV-2 URT infection is important for viral transmission and is associated with milder disease symptoms. Recent reports have shown that SARS-CoV-2 cross-reactive memory T cells are detectable in ~28–50% of individuals not exposed to SARS-CoV-2 (refs4,5,6,7,8,9,10). These studies consistently found cross-reactive CD4+ memory T cells in blood samples, but there was little evidence of cross-reactive CD8+ memory T cells.

        Memory T cells can be classified according to their anatomical location and trafficking patterns. Recirculating central memory T cells (TCM cells) and effector memory T cells (TEM cells) traffic through the blood and lymph nodes and are recruited to sites of infection by inflammatory signals11. Tissue-resident memory T cells (TRM cells) permanently reside within a given non-lymphoid tissue, such as the lung or URT12. TCM/TEM cells respond more slowly to infections than TRM cells and usually undergo proliferation for several days before trafficking into an infected tissue. CD4+ T cells can also be divided into distinct functional subtypes. For example, T follicular helper cells (TFH cells) are a specialized subtype of CD4+ T cells required for B cell help and thus almost all neutralizing antibody responses13. T helper 1 cells (TH1 cells) and CD4 cells with cytotoxic activity (CD4-CTL cells) are subtypes of CD4+ T cells with direct antiviral activities in infected tissues. CD4+ T cell-mediated memory responses to a virus may involve TFH cell, TH1 cell and/or CD4-CTL cell types.

        With regard to potential cross-reactive humoral immunity, it has been found that circulating antibodies directed at the SARS-CoV-2 spike protein are uncommon in individuals not exposed to SARS-CoV-2, and, notably, cross-neutralizing antibodies appear to be very rare14,15,16,17,18. Based on animal studies to date, it appears that neutralizing antibodies are of central importance to antibody-mediated protection against SARS-CoV-2 infection. The difference between anti-spike antibody and CD4+ T cell cross-reactivity is not unexpected, owing to the nature of neutralizing antibody epitopes versus peptides recognized by T cells from conserved portions of proteins. The difference in the abundance of CD4+ versus CD8+ cross-reactive memory T cells likely reflects the basic differences in antigen recognition between these T cell types. In a study examining T cell responses to different flavivirus species, it was found that cross-reactivity for CD8+ T cells was limited to peptides carrying one or two substitutions, whereas cross-reactivity for CD4+ T cells could be detected for peptides with far lower degrees of homology19. In sum, the cross-reactive immune memory to SARS-CoV-2 appears limited largely to one of the three major arms of adaptive immunity, the ‘helper’ or CD4+ T cells. Critically, CD4+ T cells generally do not, on their own, prevent infections. Instead, they limit disease severity, reduce the viral burden and/or limit the duration of the disease.

        Although we emphasize that any functional role for cross-reactive T cell memory in COVID-19 remains unproven1,7, given the amount of discussion in scientific, public and political spheres, it is useful to undertake a thought experiment examining the effects on COVID-19 disease severity and herd immunity should cross-reactive memory T cells confer some form of protection against COVID-19. We propose four scenarios for the impact of cross-reactive CD4+ memory T cells (Fig. 1), assess their plausibility and describe how the different immunological models may impact SARS-CoV-2 transmission and herd immunity. It is possible that different scenarios could apply to different individuals. These hypothetical scenarios are discussed in order from the most subtle effects to the most substantial. The last scenario is included for completeness, although we consider it implausible.

        Fig. 1: Schematic models of the three major scenarios wherein cross-reactive CD4+ memory T cells have a positive impact on control of SARS-CoV-2 replication in an individual and reduce COVID-19 disease severity.
        figure1
        Timelines of viral burden in the lungs and upper respiratory tract (URT) and of immune responses, which differ according to the magnitude and type of pre-existing cross-reactive CD4+ T cell memory. Model 1 makes no specific prediction about antibody response kinetics or magnitude, because it could be mediated by different types of immune response with equivalent disease outcomes (see main text). Under scenario 4, there would be no infection in individuals with cross-reactive immunity (scenario therefore not shown). Each of these models is currently hypothetical for SARS-CoV-2. TFH cell, T follicular helper cell; TRM, tissue-resident memory cell.

        Full size image
        Models of cross-reactive immunity
        1. Reduction of lung burden
        Cross-reactive CD4+ memory T cells reduce COVID-19 symptoms and lung viral load but have minimal impact on URT viral load. In this scenario, we assume that SARS-CoV-2 cross-reactive CD4+ memory T cells are sufficient to modulate disease severity but are not capable of eliminating the virus from the URT any faster than a primary immune response. This would be analogous to how the current acellular pertussis vaccine likely functions20 and in line with findings from candidate SARS-CoV-2 vaccines in rhesus macaques21,22. This form of partial protection could be mediated by any of several mechanisms involving CD4+ TCM/TEM cells, TRM cells and memory TFH cells. In this scenario, we assume that the cross-reactive memory T cell population is relatively small at the time of infection, the response post infection is relatively slow and the CD4+ memory T cell response is unable to control the URT viral load without responses from other branches of the adaptive immune system.

        Implications for individuals
        Expected outcomes for individuals infected with SARS-CoV-2 who have pre-existing cross-reactive CD4+ memory T cells, compared with infected individuals without such memory, would include the following: (a) a reduction in the magnitude and duration of symptomatic/clinical disease; (b) no change in URT viral loads; and (c) no change in the generation of immune memory compared with people without pre-existing cross-reactive cells.

        Epidemiological implications
        Compared with a population including fewer individuals harbouring such memory, a population with more individuals with pre-existing cross-reactive CD4+ memory T cells would experience the following, all else being equal: (a) lower probabilities of hospitalizations and deaths per SARS-CoV-2 infection; and (b) no reduction, or potentially an increase, in viral spread. An increase could occur if the reduction in symptoms made infection harder to identify and trace and thus increased the frequency of undetected cases while not reducing infectiousness.

        2. TFH cell-accelerated antibodies
        Cross-reactive memory TFH cells trigger a faster and better antibody response, resulting in accelerated control of virus in the URT and lungs. In this scenario, we assume that memory TFH cells facilitate a faster, better, stronger neutralizing antibody response against SARS-CoV-2 than would occur in the absence of memory TFH cells. A variation of this scenario would occur if TCM/TEM cells, memory TH1 cells or CD4-CTL cells were the functionally important CD4+ memory T cell compartment. After activation and proliferation of these T cells over a period of days, control of the SARS-CoV-2 virus in the lung and URT would follow. Data consistent with both of these scenarios have been observed for influenza23,24,25.

        Implications for individuals
        Expected outcomes for individuals infected with SARS-CoV-2 who have pre-existing cross-reactive CD4+ memory T cells, compared with infected individuals without such memory, would include the following: (a) a reduction in the magnitude and duration of symptomatic disease, all else being equal (for example, an individual of a given age and co-morbidities, exposed to a given viral inoculum, would tend to have lower severity — as measured by, for example, risk of hospitalization, ICU or death — with such T cell memory than without); (b) SARS-CoV-2 viral loads in the URT would not be affected during the pre-symptomatic phase, but would be somewhat reduced thereafter, because of the intermediate kinetics of the immune response; and (c) robust immune memory would likely be generated.

        Epidemiological implications
        Compared with a population including fewer individuals harbouring such memory, a population with more individuals with pre-existing cross-reactive CD4+ memory T cells would experience the following, all else being equal: (a) fewer hospitalizations and deaths; (b) a modest to moderate reduction in viral spread, as the pre-symptomatic period plays a substantial role in spread26 — the reduction in URT viral load under this scenario would mean a modest to moderate reduction in spread in a population in which cross-reactive T cell memory was relatively common; and (c) greater heterogeneity (assuming a minority have such cross-reactive memory) in infectiousness, as variability between those with and without memory would enhance overall variability. Heterogeneity in infectiousness, all else being equal, increases the chance that a virus introduced into a population will fail to spark a large epidemic (although this can be overcome by multiple introductions)27,28.

        3. TRM cells in the URT
        Cross-reactive CD4+ TRM cells at the site of infection enable rapid control of virus in the URT and lungs. This scenario would occur via CD4+ TRM cells in the URT at the site of infection. These CD4+ memory T cells would restrict viral replication in the URT in the days after infection and possibly also restrict viral replication through the rapid activation of the innate immune system. In the case of SARS-CoV, the causative agent of severe acute respiratory syndrome, an intranasal vaccine formulated to induce CD4+ T cell responses elicited airway CD4+ TRM cells that provided substantial protective immunity in mice, but the protection was against fatality and did not prevent early SARS-CoV viral replication29. The CD4+ TRM cells controlled virus replication over a period of ~5 days.

        Implications for individuals
        Expected outcomes for individuals infected with SARS-CoV-2 who have pre-existing cross-reactive CD4+ memory T cells, compared with infected individuals without such memory, would include the following: (a) a short, asymptomatic infection; (b) low SARS-CoV-2 viral loads, with a rapid decline to undetectable levels within days; and (c), possibly, reduced generation of new memory to SARS-CoV-2, owing to the limited antigen load.

        Epidemiological implications
        Compared with a population including fewer individuals harbouring such memory, a population with more individuals with pre-existing cross-reactive CD4+ memory T cells would experience the following, all else being equal: (a) fewer hospitalizations and deaths, owing to modified symptoms; (b), potentially, a considerably lower degree of spread owing to lower viral loads and shorter duration of shedding, which both presumably contribute to a lower basic reproduction number (R0)26,30; and (c), even more than in scenario 2, enhanced heterogeneity in infectiousness.

        4. Transient infection
        TRM cell immunity ‘blitzes’ viral replication in the URT. This scenario is an unlikely, extreme variation of scenario 3. Immunologically, this outcome would be unprecedented. ‘Sterilizing immunity’ refers to antibodies preventing any cells from being infected. Given that T cells can only respond after cells are infected, the closest T cells could come to sterilizing immunity would be a massive TRM cell ‘blitz’ in the tissue, leading to the elimination of all infected cells within a day of the initial infection, at the portal of entry. Such T cell events have only been reported in the presence of large numbers of CD8+ TRM cells in certain animal models12. There is no example where this has been observed for CD4+ T cells, and the available data indicate that CD4+ TRM cells can only blunt infection over a period of several days31,32. This is also consistent with the fact that CD8+ T cells recognize antigens presented on essentially any infected cell (MHC class I presentation), whereas CD4+ T cells recognize antigens presented by only a subset of cells (MHC class II presentation). As noted above, in the case of SARS-CoV, a CD4+ T cell intranasal vaccine elicited airway CD4+ TRM cells that provided substantial protection from the disease in mice, but only eliminated virus replication after ~5 days29, not supporting scenario 4.

        As a thought experiment, if the pre-existing CD4+ TRM cell immunity was so extreme as to preclude significant viral replication, seroconversion (that is, a de novo antibody response to SARS-CoV-2) would not occur. Such individuals would not be detectable by virological or serological diagnostic tests and would not shed virus; effectively, these individuals would be immune to infection and not reported as cases. This appears inconsistent with human coronavirus challenge studies. In human CCC challenge–rechallenge experiments, even with the same or closely related CCC strains and the benefit of antibody-mediated immunity33,34, reinfection was frequently observed (although not necessarily symptomatic disease), making it implausible that cross-reactive CCC T cell memory alone would routinely abort

        So, will that prompt you to deal more comprehensively with the uncertainties of “T-cell immunity” as I suggested earlier – instead of just assuming that T-cell reactivity would imply immunity to infection?

        I will you continue to skirt the uncertainties by hiding behind asking that others prove a negative?

      • Nic –

        I’ll try that again:

        Noting that it is one paper only, and there are likely a variety of views…. from the paper that Steven linked:

        > The last scenario is included for completeness, although we consider it implausible.

        >> Immunological knowledge and epidemiological data make scenario 4 very unlikely.

        >>> In human CCC challenge–rechallenge experiments, even with the same or closely related CCC strains and the benefit of antibody-mediated immunity33,34, reinfection was frequently observed (although not necessarily symptomatic disease), making it implausible that cross-reactive CCC T cell memory alone would routinely abort SARS-CoV-2 infection

        >>> Four distinct immunological scenarios were considered herein. In each of the three scenarios that we consider plausible, the reduction in viral spread potentially afforded by pre-existing immunity is already accounted for by the empirical observational data available and factored into epidemiological models of spread and herd immunity

        —————

        So, will article that prompt you to deal more comprehensively with the uncertainties of “T-cell immunity” as I suggested earlier – instead of just assuming that T-cell reactivity would imply immunity to infection?

        Or will you continue to skirt the uncertainties by when challenged to deal more comprehensively with the uncertainties, hiding behind asking that others prove a negative?

  47. UK-Weather Lass

    The flaws in the UK Government’s response to SARS-CoV-2 keep on coming, the latest being the suggestion that had seasonal influenza policy been followed within the NHS and by public health authorities there would have been greater chance of isolating symptomatic people. It would, of course, have benefitted from Nightingale Hospitals being available for the infected from the very start and would have, for example, helped to protect care homes from the spread.

    “The priority for the government should be to find symptomatic people early and to follow the statutory notification system, which requires medical practitioners to notify suspected cases to local authorities,” Professor Allyson Pollock (a member of SAGE) said.

    “This can only be done by integrating testing into clinical care in primary care settings and through local contact tracing.”

    Professor Pollock further suggested “The problem is, the government has carved testing out of health services and general practice and public health and created a centralised, ineffective, privatised testing and contact-tracing system instead of rebuilding public health and primary care and NHS lab capacity locally.”

    This needs no further comment from me.

  48. Adding to the logical problem with the arguments that NYC and Stockholm have reached a “herd immunity threshold” by virtue of the population infection rate in those communities…

    Recently, positivity rates (and #’a of infected) are increasing in some of the very neighborhoods where the highest % have already been infected. That’s right, having a higher % of the local population infected in some cases is associated with a HIGHER rate of ongoing infection currently.

    The same pattern is playing out in Sweden, where there is a increasing rate of infection in Stockholm in comparison to other areas of the country with significantly lower population infection rates.

    Clearly, while higher population infection rates *might* indeed tamp down ongoing infection rates, there are other key variables that have a significant impact on ongoing nfection rates – to the point where, at least at the current level of population infection rates in those communities, population infection rate does not explain whether ongoing infection rates will rise.

    • Joshua
      Can you provide the data for the neighborhoods in NYC and Stockholm that you are referencing or are you just arm waving yet again?

      • All the Swedish infection, ICU and deaths data is in a daily (Tuesday-Friday) Excel spreadsheet downloadable at https://www.folkhalsomyndigheten.se/smittskydd-beredskap/utbrott/aktuella-utbrott/covid-19/statistik-och-analyser/bekraftade-fall-i-sverige . Breakdowns are given both by region and (for cases) by municipality.

        The increase in cases in Stockholm region looks spread over a number of municipalities. For Sweden as a whole, the increase in cases over the last month or two is mainly in younger age groups. There has been essentially zero increase in COVID intensive care cases or deaths in Stockholm, which suggests that almost all the increase in infections there has been in younger people – maybe linked to the start of university and school term as well as much more socialising by the young generally.

      • Robert Starkey

        Thank you. My Swedish is lacking. Are they showing data at a district level for both new infections and the overall infection percentage of the district?

      • Nic –

        > For Sweden as a whole, the increase in cases over the last month or two is mainly in younger age groups.

        Exactly my point. You posted a picture months ago of young people partying, to bolster your argument that “herd mentality” had been reached. Presumably that means that young people, as a group, are those who have most been infected.

        Now you’re saying that younger people – who presumably are a group among Swedish citizens who have among the highest rates of infection – are the ones who are getting newly infected at the highest rate.

        Of course, that doesn’t prove that “herd immunity” hasn’t been reached, but it does seem a bit problematic to your theory if the group that has the highest rate of infection, living in the areas with the highest rate of infection, are the people who are most getting new infections and most spreading the virus to others.

        > There has been essentially zero increase in COVID intensive care cases or deaths in Stockholm, which suggests that almost all the increase in infections there has been in younger people…

        Wow. Your ability to exclude any variety of possible explanations to home in on the one that you’re seeking to confirm is quite good. There can be any number of reasons why the rate of ICU cases and deaths have not risen in line with the doubling plus more of new infections in a population you say has reached “herd immunity.” Of course young people comprising the bulk of those newly infected would be one factor. But so would better care, and more effectively policies targeting, specifically, older people at other people at higher risk. I have little doubt that you know that public health officials in Sweden have spoken about the necessity of their improvement in those areas.

        Once again, you treat uncertainties in a selective fashion.

        Please start giving the uncertainty monster more respect.

  49. In the Veckodata Kommun_stadsdel sheet of the Folkhalsomyndigheten_Covid19 workbook, I think the tot_antal_fall_per10000inv and antal_fall_per10000_inv columns show cumulative and weekly infections / 10000 inhabitants. The 2020 week number these relate to is in column A.

  50. Can self-isolation keep an area free of covid-19 on a longer-term basis Using New Zealand as an example, will their actions keep the infection rate low, or will it eventually rise to be similar to the rest of the globe.

    • Rob –

      >… or will it eventually rise to be similar to the rest of the globe.

      Obviously, if there is an effective vaccine distributed widely, then the answer is no.

      Even if one isn’t developed, then even if the rate of infection were to equalize, the rate of deaths wouldn’t as treatments have advanced.

      But at any rate, it would likely take decades for the rate of infection in New Zealand to equal that in a place like the US or Sweden.

      As for economic damage, so far it seems to be a more than some (including Sweden) and less than others – but their hardest hit industry is tourism, an industry upon which they are highly dependent and one which would have taken a huge hit regardless of their domestic policy for addressing Covid (given that obviously tourism and air travel is down everywhere and a getting there requires a long flight from pretty much everywhere).

      • Joshua

        Yes, Tourism is of vital importance to NZ as is film making and other derivatives of that sector. They have just forged an air corridor with Australia, but as you say they are way off the beaten track and could probably keep themselves covid free if they tried hard, but the fact they are isolated from much of the rest of the world would have an effect.

        Presumably they will also be prepared to open links with other countries that are essentially covid free, such as Taiwan, but the public would at present probably demand a quarantine period.

        Let us also not forget that many kiwis and Aussies have substantial family ties with the UK and that will increasingly weigh on policy

        tonyb

      • Robert Starkey

        Joshua
        Is it fair to assume that everywhere will ultimately reach an infection rate of between 25% and 70% before the virus burns out? A vaccine is unlikely to get any country there unless it is mandatory.

  51. I wonder if the “just protect the vulnerable” crowd are just a bit chagrined by the failure of the Trump administration to protect a 74 year old obese man who is at high risk, and whose infection presents an extremely high security risk.

    They have all the resources in the worldz and not only 5 did they fail to protect him, they failed to protect a whole bevy of people associated with him.

    I heard Jason Miller on TV yesterday saying they didn’t need to change their protective procedures because they test people every day

    Unreal.

    • Doesn’t it demonstrate that social distancing only works temporarily regardless of caution. Probably true for individuals, states and countries.

      • Rob –

        > Doesn’t it demonstrate that social distancing only works temporarily

        “Temporary” can mean decades, with millions of years of life saved, and huge economic benefits.

        > regardless of caution

        No, it doesn’t mean that it works “regardless of caution.” Caution matters. It means that relying on “protecting the vulnerable” includes, within reason, minimizing infections among the non-vulnerable.

      • It doesn’t demonstrate that, because the White House wasn’t doing social distancing among the top tier – and arguably, really couldn’t do enough even if they were wearing masks, since they had to spend a lot of time together indoors. But it does highlight how hard it is to protect the vulnerable, given that the White House was doing daily testing.

        Vulnerable people simply cannot avoid interacting with others – over the long term. For one thing, they are more likely to need medical care than healthy people. Also, they have to get food, get appliances fixed, cars fixed, etc.

      • Robert Starkey asks: “Doesn’t it demonstrate that social distancing only works temporarily regardless of caution. Probably true for individuals, states and countries.”

        What idiocy! Pandemics are controlled by one factor: The average number of new people infected by each infected person while infectious. When that number is greater than 1, pandemics grow. In the early stages of COVID, each infected person was infecting 3-4 new people in many locations. When people get scared or are ordered to shelter in place, they have fewer contacts with other people and the pandemic slows. If you want to re-open your businesses and schools, there will inevitably be more contacts between people. To prevent the pandemic from surging, those contacts MUST become increasingly safer. Ordinary masks make you safer (but don’t provide as much protection as the ones used in hospitals). Social distancing makes contacts either safer or less frequent, depending on how you look at it. Better ventilation dilutes aerosols, making indoor contacts safer. Physical barriers in stores between customers and staff make contacts safer. Above all, QUARANTINING everyone who has been in contact with an infected person completely eliminates contacts with potentially infected people, and works extraordinarily well in Asia.

        There is nothing complicated about pandemics that changes. People’s behavior IS complicated and changes. People get tired of social distancing. They get tired of masks. They get less cautious and sloppier. They become susceptible to propaganda. This causes the APPEARNCE that such measures stop working. Then the pandemic surges again. The Spanish flu arrived in THREE WAVES in 1918-1920 in many locations for this reason.

        When most of the people an infected person contacts are immune or somewhat resistant, then pandemics slow for a new reason.

      • Franktoo – very well said.

        Rob – there is no evidence that the virus is becoming less deadly. There are plenty of other explanations for the lowered CFR. Some pathogens become less deadly due to selection pressure. There really isn’t any selection pressure to make it less deadly here, unless having it cause relatively more asymptomatic infections (improving it’s ability to spread) also reduces its deadliness.

        Asia is doing extremely well based on their data. For example at South Korea, which has very good data.

        You can go to this site, go down to country data normalized by population, select South Korea. Then in “add data” add in the US if you want to compare. You can select deaths or cases. Be *sure* to have it normalized by population: http://91-divoc.com/pages/covid-visualization/

        “t seems inevitable that self isolation will only slow the spread (and to some degree reduce the % ultimately infected) ” – errr… given the likelihood of a vaccine early next year, “slow the spread” can save an enormous number of lives. Also, even without a vaccine, slowing the spread compared to “life as usual” prevents medical system overload which kills a lot more people.. Plus, the “to some degree” should be replaced with “to a very large degree” and “self isolation” should be replaced with “appropriate mitigation measures” – meaning, social distancing and mask wear, primarily. Social distancing includes not being indoors with strangers for any significant period of time unless there is appropriate ventilation.

      • The issue is covid19. A virus that is very tricky (since it can be transmitted by a person with no symptoms). Seeming to become less deadly as it inevitably mutates and treatment improves.

        Contact tracing is largely ineffective in the USA. The virus can be transmitted by someone with no symptoms. Judging that Asia is “doing extraordinarily well” is based on what? What countries data is reliable or at least collected similarly to what the US is doing.

        Self isolation measures stop working because: they are imperfect, highly expensive economically and socially, and can’t be maintained as a result. It seems inevitable that self isolation will only slow the spread (and to some degree reduce the % ultimately infected) but at a high social and economic cost.

      • One more comment: contact tracing requires low viral prevalence in order to achieve containment. Contact tracing in the US now doesn’t work because too many people have the virus to be traced. It also works best with widespread, rapid testing, and we are behind in that, too.

        Stubborn behavior by US citizens doesn’t help, but with adequate resources (due to lower prevalence) a lot of that can be overcome.

      • Mark this day, Oct. 5th. 2020, for posterity.
        Stunning discovery by CDC.
        COVID-19 can be transmitted via the air we breath!

        https://www.cdc.gov/coronavirus/2019-ncov/more/scientific-brief-sars-cov-2.html
        “The Centers for Disease Control and Prevention now says the coronavirus can be spread through airborne particles that can linger in the air “for minutes or even hours” — even among people who are more than 6 feet apart.”

        Should I trust this information?

      • Robert Starkey

        So there is agreement that contact tracing won’t work in the US.

        What is the evidence that social distancing will result in a given geographic location having a lower rate of infection in the long term. Pushing the curve to the right definately increases economic and social costs. You claim these offset.

      • > So there is agreement that contact tracing won’t work in the US.

        The world isn’t binary. It works less well here than it would if we had a competent federal administration.

      • Robert Starkey

        No federal administration is ever perfect since it is composed of a vast number of bloated bureaucratic processes.

        By all accounts, the current president is very detail oriented and holds agency heads to task privately for the bureaucratic inefficiency.

        Regarding contact tracing, the decision is largely binary. Do you implement widespread contact tracing or not?

      • Rob –

        > By all accounts, the current president is very detail oriented and holds agency heads to task privately for the bureaucratic inefficiency.

        By all accounts? Seriously. There are plenty of people with inside knowledge, some of whom were within the administration itself, who say the exact opposite. You may not trust their views but it’s absurd to say they don’t exist.

        > Regarding contact tracing, the decision is largely binary. Do you implement widespread contact tracing or not?

        The are degrees of competence. In this country, early on, contact tracing was essentially abanondedneseky on because of the horrible failures with testing. People who were reporting symptoms were told to stay home and self-isolate because the necessary tests didn’t exist. Even people who tested positive where not contact traced because the necessary resources were not allocated (and of course part of the reason why adequate resources didn’t exist was because the demand was so high because adequate testing didn’t exist – despite the lies that anyone who wanted a test could get a test).

      • jacksmith4tx wrote: | October 5, 2020 at 6:36 pm |
        Mark this day, Oct. 5th. 2020, for posterity. Stunning discovery by CDC.
        COVID-19 can be transmitted via the air we breath! “The Centers for Disease Control and Prevention now says the coronavirus can be spread through airborne particles that can linger in the air “for minutes or even hours” — even among people who are more than 6 feet apart.” Should I trust this information?

        Thanks for the link. Of course you should trust this information; these are scientists trying to provide you with the best information to keep you alive and end this pandemic. However, you should read the statement carefully:

        1) “The epidemiology of SARS-CoV-2 indicates that MOST infections are spread through close contact, not airborne transmission.”

        In other words, your main risk comes from other people spraying infected droplets in your face from within a few feet. Almost any kind of mask should do an effective job of providing significant protection, whether worn by the “sprayer” or “sprayee”. So should staying six feet apart.

        2) “Airborne transmission of SARS-CoV-2 can occur under special circumstances.” [Read about these circumstanced.]

        Super-spreading event are known to play a critical role in this pandemic and it has long been obvious to me that SOME super-spreading events must involve aerosols that remain in the air for a long time (“airborne transmission”). It is unlikely that the singer in the Washington choir who infected more than 50 others did so by spray droplets into faces across a few feet. That event and others likely involved airborne infection. An N95 mask that fits your face tightly can provide excellent protection against infectious aerosols, but more than 50% of aerosols can pass through ordinary masks. If your mask doesn’t provide significant back pressure as you exhale (N95s do), a mask may only modestly increase the amount of time you can be exposed to infectious aerosols without getting infected. (Transmission by sprayed droplets can occur in one second, but the chances of “airborne transmission” via aerosols increases with EXPOSURE TIME.)

        Since masks and social distancing are effective against sprayed droplets, it is a relief to know that this is the major threat in this pandemic.

        Could politics have been involved in these statements? Sure. The statement promotes masks and reduces the need for expensive increases in indoor ventilation and filtration (which would reduce aerosol transmission). Personally however, I’m fed up with all of the conspiracy theories about our government institutions. They are composed mostly of dedicated experienced individuals trying to do a good job for their fellow citizens, especially the scientists. Unlike the IPCC (which was founded by alarmists with an agenda), it isn’t obvious why CDC scientists should have a agenda. If an agenda were imposed upon them (as may be the case with a vaccine before Election Day), there will be publicity and pushback (as with a vaccine).

        https://www.cdc.gov/coronavirus/2019-ncov/more/scientific-brief-sars-cov-2.html

      • Rob Starkey wrote | October 5, 2020 at 3:16 pm |
        “The issue is covid19. A virus that is very tricky (since it can be transmitted by a person with no symptoms). Seeming to become less deadly as it inevitably mutates and treatment improves.”

        Really deadly pathogens like Ebola (and SARS and MERS) often quickly incapacitate their victims and therefore are not very transmissible. Such pathogens often mutate into a less deadly variants that are more transmissible and therefore dominates through survival of the fittest. Victims of SARS-CoV-2 can be asymptomatic or sick for a week or more before the virus prompts a life-threatening immune response or reach critical organs. So less-deadly SARS-CoV-2 mutations are unlikely to be more easily transmitted and eventually dominate through natural selection. There is one variant of SAR-CoV-2 that is being transmitted about 5-10% better than the original strain, and it has become the dominant strain in many regions.

        Rob writes: “Contact tracing is largely ineffective in the USA. The virus can be transmitted by someone with no symptoms. Judging that Asia is “doing extraordinarily well” is based on what? What countries data is reliable or at least collected similarly to what the US is doing.”

        Taiwan is beating COVID almost exclusively by contact tracing. (Their VP is an epidemiologist and they had a system in place after dealing with SARS.) IIRC, there have been only 7 deaths in Taiwan. Everyone who tests positive immediately reports all of their significant contacts in the past few days when the person was likely infectious. Those people are immediately quarantined (mandatory) for 14 days whether or not they show any signs of being sick or have tested negative. The idea is to get everyone who is potentially infected out of circulation BEFORE they become infectious. Outbreaks die out after being transmitted once or twice. Roughly 1% of the population has been subjected to mandatory quarantine so far. They stopped flights from China for awhile, but no other measures have been used. No shelter in place. No businesses closed. Korea does something similar, but they also automatically track credit cards and discover who was in the same restaurant with a person who has tested positive.

        Rob writes: Contact tracing is largely ineffective in the USA. The virus can be transmitted by someone with no symptoms. Judging that Asia is “doing extraordinarily well” is based on what? What countries data is reliable or at least collected similarly to what the US is doing.

        Contact tracing is failing in the US for a variety of reasons. My state recently bragged about hiring 50 contact tracers and is looking for 150 more. Obviously my state’s effort has been grossly understaffed for 5 months! We also have huge delays in testing. When it has been taking up to a week to return test results for Patient A, his some of A’s contacts B1, B2, B3, … are already infectious, and transmitting to C1, C2, C3 … And this is guaranteed to be the case when you don’t have enough contact tracers to deal with the case load. Contact tracing works if test results are returned quickly and if there are enough contact tracers to immediately deal with the positives.

        Here in the US it is legal to force contagious people to quarantine, but it may not be legal to force those who are possibly contagious to quarantine. In Taiwan, those in quarantine are tracked by cell phone and called regularly to see if their cell phone is in quarantine and they are with the phone. I think we could get most Americans to quarantine for $1,000/day plus a completion bonus. (To prevent cheating, those paid for contact information would authorize the government to their check cards and Google for location information.). Then everyone else can return to work and we’d save billions on unemployment.

        Rob wrote: Self isolation measures stop working because: they are imperfect, highly expensive economically and socially, and can’t be maintained as a result. It seems inevitable that self isolation will only slow the spread (and to some degree reduce the % ultimately infected) but at a high social and economic cost.

        Self-isolation? If you mean shelter-in-place orders that keep non-essential people home, they should only be used to halt exponential expansion of cases and keep hospitals from being overrun. SIP reduces contacts between people and therefore reduces transmission. Ideally, SIP would start reducing the number of new cases significantly before it is gradually removed. As the number of contacts increases, those contacts must be increasingly safer: Masks. Social distancing. Contact tracing to keep potentially infected people out of circulation.

      • This article has some interesting information about the steps they took in Taiwan early on:

        https://www.nbcnews.com/news/world/taiwanese-authorities-stay-vigilant-virus-crisis-eases-n1188781

      • BTW – in Taiwan the government coordinated with industry to make sure masks were available. Imagine that! And people started wearing them even before they had proof of the efficacy of doing so. Imagine that!

    • Joshua: In South Korea, I know from someone who lives there that people wore masks because the horrendous air pollution the blows in from Northern China and because of SARS and MERS. The Chinese, of course, wear masks for the same reason – and because they don’t trust their government to warn them when conditions are truly hazardous. (I don’t know much about masks in Taiwan.).

      According to a Frontline documentary, the US had contracts with 3M to deliver masks, but the 3M plant was in Shanghai and the government wouldn’t let those mask out of the country. (If the plant were in our country, Trump wouldn’t let the mask out either, at least until a court intervened.) And the Obama administration placed a large order for ventilators after the last flu pandemic, but the producer mostly failed to deliver. They also briefed the incoming Trump Administration about the lessons they learned from dealing with that pandemic and Ebola.

      Every culture has its strengths and weaknesses. At the moment, I personally think that we are suffering from partisan gridlock and placing too much emphasis on “less government is better government”. Others might logically conclude that the government is incompetent and that our only hope lies in self-reliance. According to Frontline, the Trump Administration placed an order for more ventilators with exactly the same company that failed to deliver on the earlier order, but with a price five times higher. (Perhaps we could all agree that less Trump government is better government?)

      • The Trump administration placed orders all over the place – it’s better to spend some money and have it turn out to be waste than to not try – in an emergency. The Obama Administration left the pandemic stockpile largely depleted. One can throw stones at either side, if one so chooses.

        I concluded that CDC and FDA were both way too bureaucratic and bungling. CDC hogged the testing, rather than letting others do it, and then sent out contaminated tests.

        The FDA restricted testing too much, holding tests to standards that make sense during normal times, but not in this kind of emergency. Even when FDA allowed lab developed tests, you had to *mail* them a *CD* with your application on it – they wouldn’t accept email. The task force team cut through a lot of red tape but there are limits on what you can do.

        Even lately, CDC messaging has been poor – they were very slow to catch on to the obvious transmission through the air (droplets or small aerosol particles). It was obvious from the start that this disease had transmission through the air, and there was an early Chinese contact tracing paper that demonstrated it. When CDC did message about this, they downplayed the danger from contaminated surfaces to where it sounded like there was zero risk – which is not true. If you read past the main meat of their press release, you find that they did not remove the risk – they just downplayed it to where anything but careful reading would make it seem to be zero. And, they were confusing about aerosols vs. droplets – it’s a confusing subject (the terminology is slightly arane) and should have been explained more clearly.

        To me, the CDC and FDA demonstrated that the laws of bureaucracy have not changed – bureaucracies are sometimes necessary, but don’t expect them to be nimble or smart. Put another way, they demonstrated why government solutions are often the worst choice.

        CDC, contrary to what most people think, gets most of its budget for things other than infectious diseases. That sort of thing, in a bureaucracy, leads to the less funded parts getting less attention and the leaders having less power – which can cause the more competent leaders (and staff) to depart for greener pastures.

        The FDA has seen its job to be avoiding all risk (a basic function of bureaucracy), to the point of routinely denying even dying people the choice of taking risky medicines. That should not be a surprise – it is normal bureaucratic behavior. A bureaucrat loses a lot more by a highly visible mistake than by letting things go to hell quietly by being too cautions. Bureaucracies are naturally risk avoidant to a fault.

      • Frank –

        There’s no doubt that there were significant cultural differences. The whole societal structure (with confusion roots) makes Koreans much more likely to follow the instructions of their government for the benefit of the society as a whole. That kind of nationalistic sacrifice is what made the “Korean miracle.”

        So sure, the Trump administration, CDC, FDA, etc. faced obstacles not presented to the Korean parallel institutions. But none of that excuses the obvious incompetence of the Trump administration, nor the CDC, FDA, etc.

        The Trump lying about “anyone who wants a test can get a test.” The constant dog and pony shows at the press conferences where a long list of promises were made that were never kept. The constant downplaying of the seriousness of the virus. The constant politicization, the constant focus on political expediency. All were squarely on the incompetent shoulders of the Trump administration.

        Another reasonable question might be whether any other particular administration would have done worse. We’ll never know. But whether other administrations would or wouldn’t do worse doesn’t alter the obvious incompetence that played out in this country.

        So yes, countries like Korea or Taiwan or Vietnam had a leg up. But there is no good reason why our leaders in this country couldn’t have followed their lead. There were tons of people pointing out what could have been done from day one. This administration chose their path – with tragic consequences.

      • Frank –

        That’s not to say that we haven’t had periods of great sacrifice for the sake of the country as a whole in the US as well – obviously the war effort was an incredible example of that.

        But we are now in a national frame of partisanship and tribalism and polarization above all. Of course, Trump isn’t singular a cause for that. He’s more a symptom of a larger problem than a cause. But he certainly is exacerbating the problem and I think it’s entirely possible that another leader might have been able to better mitigate the tribal tendencies. We’ll never know, of course. I don’t expect Biden to win (although lately I’m beginning to wonder), but if he does it will be interesting to see whether he can turn the trend around to any degree. I am beginning to think that the trend we’re on isn’t sustainable. But turning this ship of tribalism around is a tall order. So what might get us back on track? If a national emergency such as Covid only makes it worse, what could possibly make it better?

      • Joshua – when you go to talk about the failures of the Trump administration, only one of the things you mention qualify: his messaging should have been better.

        The rest is the usual rant about — his rants.

        I tell people: ignore what Trump says, look at what the administration actually *does*. As a conservative, I held my nose and voted for Trump in 2016 – a “Flight 93” vote – if i was wrong, we were doomed, but the alternative, to me, was doom. I have been very happily surprised at how good the actual achievements of his administration have been, even as his manner still grates on me.

        As for South Korea – they have done very well. I am not sure how to attribute their unity. It’s not just confucianism – they have a lot of Christians, too. In fact, we’re currently enjoying some (subtitled) Korean TV series that demonstrates the Christian impact in various ways (not the purpose of the show, just a side effect). Also, all of the shows I’ve seen so far show a belief that the authorities are corrupt, which is interesting.

        It’s a complex culture, I think. In my only visit there decades ago, I was very impressed with the ingenuity and capitalist drive I saw, but i also thought they were sort of a brutal people. I have no idea how right that was – but they were clearly very, very different from us in the west.

        All that said, I very much wish we had been able to respond the way they have, but I don’t think we have an adequate level of trust any more. I find that scary, as low trust societies inevitably end very corrupt, inefficient, nasty, and usually undemocratic.

        People on the right don’t trust the media (for extremely good reasons) but too often that leads to a distrust of anyone saying whatever they don’t want to believe. Many people are super-paranoid about privacy, hindering contact tracing. We have anti-vaxxers on both sides of the political spectrum. The knowledge of science, its limits and its methods, seems to be mostly lackikng on both sides. I see too many on the left saying “believe in science” because, to them, it is the religion of scientism, rather than a flawed process that eventually converges on truth. I see many on the right claiming that science is wrong, because it doesn’t instantly produce the right result.

      • meso –

        > The rest is the usual rant about — his rants.

        I wasn’t ranting about his rants. I spoke of the incompetence and his lies. His lies were of consequence. When you say something like “Anyone who wants a test can get a test” and you talk about how our testing is perfect and the best in the world, then you’re not in a position to provide leadership for correcting for your errors. When you not only don’t admit errors, but pretend that your reaction couldn’t have been better – and your supporters don’t hold you accountable, then you don’t correct for your errors. There is a long list of ways that theTrump administration could have responded better. The problem wasn’t simply a one of “messaging.” There were operational problems that they tried to cover over with messaging. Dismissing it as messaging is dangerous.

        > As for South Korea – they have done very well. I am not sure how to attribute their unity. It’s not just confucianism – they have a lot of Christians, too.

        Do you know much about South Korea besides having visited? I have lived and worked there, and I have worked very closely for years with many Koreans, for a couple of decades

        It isn’t a matter of their religion. It’s a matter of their cultural heritage. I think you’d be hard-pressed to find ANYONE who knows Korean culture well who would dismiss the importance of their Confucian heritage. In particular, I’m referencing the importance of the individual’s responsibility to (family first and then) the Korean society and the nation, as opposed to a more individual focus in the West (and the US in particular). Harmony, communality/homogeneity (conformity)…..

        > In fact, we’re currently enjoying some (subtitled) Korean TV series that demonstrates the Christian impact in various ways (not the purpose of the show, just a side effect). Also, all of the shows I’ve seen so far show a belief that the authorities are corrupt, which is interesting.

        I think you might want to research it more beyond watching a TV series before you confidently dismiss the importance of Confucianism for the Korean culture? How long were you there when you visited?

        At any rate, there’s nothing particularly mutually exclusive of some influence of Christianity with a long tradition of Confucian influence on the culture.

        > It’s a complex culture, I think.

        Of course it is. All cultures are.

        > In my only visit there decades ago, I was very impressed with the ingenuity and capitalist drive I saw, but i also thought they were sort of a brutal people.

        I would venture to guess that they thought you were pretty brutal also. One of the things I learned most about when I lived there was that assessing cultures is relative. I saw behaviors that I thought were rude, until I began to understand the Confucian influences. Then I realized that within the dominant paradigm there, I was the rude one.

      • also, I should have mentioned the importance of social hierarchy….

        Again, it’s not about religion.

      • Joshua, in the future, I will remember that posting casual observations and speculations (Korea) will result in unwarranted attacks by you. That is unfortunate, as I was finding parts of our dialogue constructive.

      • meso –

        > Joshua, in the future, I will remember that posting casual observations and speculations (Korea) will result in unwarranted attacks by you. That is unfortunate, as I was finding parts of our dialogue constructive.

        Sorry that you saw it as an unwarranted attack. My initial reading was that you were making an assertion more than merely speculating – but rereading I guess I misread that. I was questioning the basis for your speculation because the high level of importance of Confucianism roots to the Korean culture is generally considered as pretty axiomatic.

      • Joshua – thanks. Yes, my wife and I had been pondering the relative impacts of Confucianism and Christianity, while watching those TV series – we saw a lot more Christian influence than we expected.

        She spent a significant part of her childhood in east Asia, and is a student of Asian history and culture. I have much less experience but more countries – South Vietnam, Philippines (very different culture, of course), Japan a few times, South Korea – that’s it. I also have close relatives from east Asia.

  52. Cases in Sweden have dropped again over the last week – supporting the “blip” theory.

    • Oops. Seems that the numbers for Sweden over at worldometers is pretty variable. Last night the 7-day moving average was down quite a bit. This morning not at all. Now at about 3 X the rate of about a month ago. Not sure why the 7-day average would change so much after only a few hours have passed, but it is what it is. I guess it has something to do with how Sweden reports its numbers.

  53. Pingback: Herd Immunity to COVID-19 and Pre-existing Immune Responses | US Issues

  54. “Supporters of Sweden’s strategy say it’s better to allow immunity to build up among members of the population who are least at risk of dying from COVID-19, thereby reducing the rate of transmission and protecting those who are most at risk of dying from COVID-19…”

    https://www.msn.com/en-us/health/medical/sweden-developed-herd-immunity-after-refusing-to-lock-down-some-health-experts-now-claim-while-others-point-to-its-high-fatality-rate/ar-BB18jqdL

    Sweden is at about 600 deaths per million. MN is at about 400 deaths per million. MN took a stricter approach and will end up in the same place as Sweden. The same place most countries will end up. Read the quote above. You dilute this thing using the stronger members of society including children so that it’s safe for the older people. This is textbook science. And Walz went against this science while trying to hide behind his version of losing science.

    And all the fear people are peddling? That’s what losers do. Sweden is back to normal. Yes its economy still took a hit because they rely on international trade being a modern economy. But here in the U.S. And even in our blue state, we are better with economics because of capitalism. As much as our leaders tried to strangle it.

    Do not be afraid of the virus. Do not teach your children to be afraid of the virus. Old people die. People with pre-existing conditions die. Nothing is going to change that in the next 10 years. The government cannot control this virus, but it can control you. That’s what we got. An exercise in the their destructive authority.

    • The Chinese version capitalism is superior it ours. Lots more people lifted out of poverty with a better quality of life. We dropped the ball. In 10 years China will be the most powerful country in the world and we will be arguing over the 2nd. amendment and our god given right to shoot each other.

      • “The Chinese version capitalism is superior it ours. Lots more people lifted out of poverty with a better quality of life. ”

        China doesn’t have capitalism, it has fascism. Over half of the big companies are owned by the state. The government is an authoritarian dictatorship.

        China’s economic gains were so dramatic because they had so many in poverty. They also stole trillions of dollars in intellectual property from the developed world, and they engaged in non-free trade to monopolize entire industries.

        Today, they have more impoverished people than the population of the entire United States. The rest of the people live under an ever-increasing tyranny. The Chinese state is actively engaged in genocide against the Uighurs. They used imprisoned members of Falun Gong as organ farms. They are suppressing all other religions but the state religion – which is to worship the corrupt leadership. Christian churches are forced to teach state propaganda, and many are torn down.

        But you probably knew that, and are in the employ of their disinformation unit.

      • You are confusing morality with controlling the destiny of civilization.
        Everybody seems to have their own personal list of attributes of who’s government is fascist.
        Did you ever look closely at the Great Seal of the United States? Notice what’s in the eagle’s right claw? It’s a bundle of 13 arrows also known as a ‘fascio’ in Italian and from where the political movement derived it’s well known name, fascism. The symbolism is clear, a single arrow is weak, in unity there is strength.
        “in Latin called fasces and in Italian fascio, came to symbolize strength through unity, the origin of which rested with the Roman empire, where servants of republican officials would carry a number of fasces indicative of their master’s executive authority.”
        There’s a little bit of fascist in everybody.

    • > Supporters of Sweden’s strategy say it’s better to allow immunity to build up among members of the population who are least at risk of dying…

      >> MN took a stricter approach and will end up in the same place as Sweden.

      >>> Yes its economy still took a hit because they rely on international trade being a modern economy.

      1) assumes that a vaccine won’t arrest the ongoing deaths.

      2) ignores the improvement in therapeutics already, and assumes they won’t continue to improve.

      3) ignores the disparate impact in different communities.

      4) ignores the higher rate of illness in Sweden, and potentially higher rate of “long haul” sufferers.

      5) ignores the conditions in Sweden that predispose it to better outcomes from the pandemic – including far more people who inherently trust government and public health officials.

      6) ignores that at differential in the current rates of deaths per million it would take at least 6 months for the per capital death rates to equalize. 6 months of productive life among those 1,400 or so Minnesotans who would still be alive.

      7) ignores that there is very little evidentiary basis to conclude that there would be any economic advantage if Minnesota adopted a “herd immunity” approach.

      8) ignores that Swedish officials insist that they have not adopted a “herd immunity” approach.

      9) ignores that seden failed to protect those most at risk of death from covid.

      10) ignores that there are plenty of other countries who are equally as opened up as Sweden despite adopting drastically different policies.

      11) ignores the many factors that harmed the Swedish economy in addition to their reliance on international trade.

      12) ignores that the impact of Sweden’s reliance on international traded is irrelevant to whether their economy might have been less or more harmed if they had adopted a more restrictive approach to dealing with covid. Their reliance on international trade is irrelevant. Theiebdkmesric policies would not alter the degree to which their trade with other counties would be affected.

      But yeah, your comment is impressively macho.

      • Joshua

        Sweden’s approach is working and is being adopted in other countries as more recognize the logic and success. Why is it you can’t seem to accept what is obviously true.

        I’ll address a couple of your points but most are ridiculous.

        1) assumes that a vaccine won’t arrest the ongoing deaths.

        WRONG. The approach assumes reality. Vaccines take time to field and will only help in reaching HIT.

        2) ignores the improvement in therapeutics already, and assumes they won’t continue to improve.

        WRONG. Improved therapeutics will be fully utilized as soon as available. Waiting for some future magic bullet is a ridiculous strategy.

        3) ignores the disparate impact in different communities.

        It ignores the unimportant to the community as a hole.

        .

      • Rob –

        > WRONG. The approach assumes reality. Vaccines take time to field and will only help in reaching HIT.

        If an effective vaccine is developed and distributed, then it will mean that Sweden unnecessarily gambled and lost on many lives. Simple logic.

        > WRONG. Improved therapeutics will be fully utilized as soon as available. Waiting for some future magic bullet is a ridiculous strategy.

        You seem to have missed my point. More infections early on leads to more deaths than delaying the rate of infections whereby more people get infected after better treatments have been developed. Ragnaar’s comment employed a logic that it doesn’t matter whether more infections happen earlier or later if the same number of infections (per capita) is eventually reached. That isn’t logical – it does matter. More infections earlier leads to more deaths.

        > It ignores the unimportant to the community as a hole.

        Not sure what you mean. Do you think that the disparate impact in different communities is unimportant to the community as a [w]hole?

      • I shouldn’t have said “arrest ongoing deaths.” I intended to mean check the increasing/ongoing rate of spread. Obviously, yes, deaths would continue to some extent (in the sense that they do with the flu deosite vaccines).

      • Joe - the non epidemiologist

        Joshua – “If an effective vaccine is developed and distributed, then it will mean that Sweden unnecessarily gambled and lost on many lives. Simple logic.”

        Care to provide us with a little history on the prior successful efforts to develop a vaccine for any number of the 10k plus coronaviruses

        thanks

      • Joe –

        I’m not sure I understand your point. Are you saying thay Trump is absolutely full of it with his promises about a vaccine, and that he’s just trying to snooker his supporters?

        At any rate:

        > Care to provide us with a little history on the prior successful efforts to develop a vaccine for any number of the 10k plus coronaviruses

        Care to provide us with any prior attempts to develop a coronavirus vaccine that have involved even a tiny fraction of the energy and resources that have been devoted to developing a Covid 19 vaccine?

      • Joe – there are not 10k coronaviruses that infect humans – so far, there are only 7, four of which cause colds. A vaccine was developed for SARS-CoV, but that was halted when SARS was eliminated. There is are also vaccines for animal coronaviruses. COVID19 is caused by SARS-CoV-2.

        And, as Joshua points out, the effort to develop a SARS-CoV-2 vaccine is unprecedented in intensity. Vaccines are not magic, they have been used for over 100 years, and have been extensively studies.

      • joe - the non epidemiologist

        Jushua comment “Joe –

        I’m not sure I understand your point. Are you saying thay Trump is absolutely full of it with his promises about a vaccine, and that he’s just trying to snooker his supporters?”

        A) You have been the one stating that correct policy is to hide from the virus until a vaccine is developed.
        B) since you are the one advocating hiding from the virus until a vaccine is developed, you should be the one explaining the viability of developing a vaccine.
        C) not surprising, when the lack of the successful development of a vaccine for other coronaviruses, and when the viability of such a policy is pointed out, you resort to your usual TDS reply

        Best

      • Joe –

        > A) You have been the one stating that correct policy is to hide from the virus until a vaccine is developed.

        If I’ve given the impression that I think that is the correct policy, then I have given an incorrect impression. That isn’t what I think is the correct policy.

        > B) since you are the one advocating hiding from the virus until a vaccine is developed,

        If I have given the impression that I think that is the correct policy, then I have given an incorrect impression. That isn’t what I would advocate for.

        > you should be the one explaining the viability of developing a vaccine.

        Why can’t I just refer to Trump? He explains the viability of developing a vaccine, and I suspect that you would be much more receptive to what he says than what I say? I’d refer to Fauci (as his view seems much more reasonable to me than Trump’s), but I doubt that you’d be very receptive to his view either – and at least Trump’s view is somewhat overlapping within mine on this issue.

        > C) not surprising, when the lack of the successful development of a vaccine for other coronaviruses, and when the viability of such a policy is pointed out, you resort to your usual TDS reply

        Actually, since I don’t advocate the policy that you have described as the one that I advocate for I can’t really respond on the viability of the policy that you think is the one that I advocate for.

        But anyway – so do you think that Trump is just trying to snooker his supporters when he talks with great certainty about the viability? Or do you think he has some other reason for doing it? I notice that you didn’t answer my question.

      • Somewhere I linked to Trump kind of dancing to YMCA.

    • “Old people die. People with pre-existing conditions die. ”

      In the US, the average death results in a 10 year loss of life.

      Old people die, but not at the rate COVID19 is causing. Pre-existing conditions mostly kill slowly.

      As an old person, I find your cavalier approach to my life to be disgusting!

      • > As an old person, I find your cavalier approach to my life to be disgusting!

        For me, the more troubling aspect is the total indifference to the relatively higher impact in particular communities, and to the impact on the people making he most sacrifices for the sake of others. Aggregating the death rates across he entire population necessarily does that.

        It reflects an unfortunate sense of entitlement and privilege. I like to think that isn’t intentional – but given how many times I’ve pointed it out I’m beginning to wonder.

    • joe -the non epidemologist

      One thought on the high death count in Sweden was that Sweden had a lot more dry tinder than their neighboring countries. (ie higher number of age 70+).

      Swedish also recognized that eradication was not a viable long term strategy

      • FWIW – the argument is also made that their “dry tinder” was higher because of low flu deaths in earlier years.

        > Swedish also recognized that eradication was not a viable long term strategy.

        This logic assumes that there will be no vaccine developed. That is a gamble that might be a loser to be paid in many deaths. It also assumes that the fatality rate won’t drop significantly, which it has. Even if a vaccine isn’t developed, more infections early on means a higher rate of deaths than more infections down the road.

        And of course, long-term strategies should be made in association with relevant societal factors. Long term strategies best suited for Sweden should, necessarily, be different than long term strategies best suited for countries like the US.

      • All of Europe has a much higher average age than the US and government run or funded health systems that emphasize end of life care for octogenarians instead of efforts to prolong life.

        “Long term strategies best suited for Sweden should, necessarily, be different than long term strategies best suited for countries like the US.”

        Nobody ever wants to admit that their “logic” applies universally, and not just when it fits their political whims.

        If the above sentence is true, then any “US strategy” would be meaningless. The distance between Stockholm Sweden and Rome Italy is the same as the distance between New York City and South Dakota.
        The drive from Marseille France to Warsaw Poland is shorter than the drive from Boston to Disney World in Florida.
        Because of this we in the US could all thank goodness we live in a federalist system- where we give states leeway to craft their own policy. But alas, we cannot say this because a handful of people desperately need to be able to say “Drumpf failed to implement a national policy” and, for some reason unknown to sentient life, insist we all pretend that Govs Cuomo and Whitmer were models of covid success.

      • > If the above sentence is true, then any “US strategy” would be meaningless.

        I agree – to an extent. For example, a better testing and contact tracing/isolating strategy would have some national level ramifications. But that doesn’t mean that adaptations shouldn’t be made to consider local conditions

        Try to avoid binary thinking – it will get you further

  55. Nic,

    This is a link to The Barrington Declaration and video. Well worth a look.

    https://unherd.com/2020/10/covid-experts-there-is-another-way/

    FWIW I have signed.

    • Yes, thanks. A good declaration IMO.

    • Looking past their unfortunate framing of this as an issue of morality and science (as if they are the moral and scientific superiors of those who disagree with them), their “plan” makes some obvious sense in theory: separate the young and the old and encourage infections among the young until “herd immunity” is reached.

      It’s where reality intervenes that the problems crop up.

      They speak of a plan whereby the 60 year-old bus driver can just collect “social security” for 3 months, and the 60+ teachers can work from home while the younger teachers can go into schools to teach with the children present. The problem is that such an approach would require a comprehensive public health plan that is organized at the federal level, with federal funding, that would then filter out to the level of the individual school and the individual classroom and the individual teacher. Good luck with that. The reality is that there is no way that is a realistic goal for the US..

      They talk of how, in Sweden, they have been successful at keeping the seroprevalence lower in older people as compared to younger people when compared to, as an example, Spain where the seroprevalence levels are more or less the same. But they act as if that is just the result of policies in response to the pandemic, as opposed to it only being possible because of basic and fundamental differences between Sweden and Spain, differences that would be even more dramatic when comparing Sweden to the US – such as the ability of people to work from home, the % of single-person households, etc.

      They talk of how this approach would be temporary, and we’d only need to find a way to support the grandparent who is the primary caregiver for her school-attending grandchild for 3 months until we reach “herd immunity” by encouraging spread among young people. The argument is that it is a more humane approach because we’d only be placing stress on that grandmother and grandchild for 3-months rather than a more extended time with SIPs and NPIs. But they ignore that public health officials in Sweden say that they have not reached “herd immunity” despite Sweden following their prescribed approach for well more than double that period of time. And of course, they ignore the near total lack of infrastructure in the US as compared to Sweden for supporting such families. It’s certainly nice to handwave towards a plan that would involve supporting “grandfamilies” during this “spread the infection” phase – but what is the realistic plan that they’re suggesting for carrying out this plan? It is more than ironic that these kinds of ideas are particularly popular in the same political cohort as those who systematically opposed funding for exactly the kinds of programs that would enable support for the people who they claim should be the focus of Covid policy.

      They talk of how this approach is better because we’d reach “herd immunity” more quickly, and because the pandemic will only be arrested at the point where we reach “herd immunity.” It’s a nice theoretical construct, but the reality is that even if it’s true that a vaccine won’t reduce the # of infections needed to reach “herd immunity,” with a slower spread it allows time for the development of and improvement in therapeutics and standard care for those who are infected, which can greatly improve outcomes per # of person infected. Slower spread over a longer time – fewer deaths (and serious illness) for the same number of people infected. Why don’t they mention this? It’s a mystery wrapped up in an enigma, eh?

      In their theory, all the negative “external” outcomes, such as unemployment and psychological stress during the SIP and NPI periods are due to the SIPs and NPIs themselves – and with those measures lifted those negative external outcomes will be reversed. Reality shows that such a simplistic construct is unrealistic. Many of the negative external outcomes we’ve seen during SIPs and NPIs would be present just simply because of a viral spread of a serious virus. While it’s entirely likely that in some sense those external negative outcomes would be mitigated if the SIPs and NPIs weren’t in place, there’s also the possibility that with a faster spread some of those external negative outcomes would actually get WORSE.

      There’s more, but that’s all I remember right now after a quick skim of the video

      And just at a more basic level of rhetoric, they frame the entire discussion in terms as if the only outcome measure of importance is deaths. Obviously, illness, and in particular serious illness, is hugely important outcome measure. Their framing minimizes the seriousness of a more widespread rate of infections and at the same time exacerbates the differences across the age spectrum – which is a key factor in their rationalization for why we should be adopting their plan.

      The problem with advocacy such as theirs is that it is shallow and doesn’t address obvious, potential downsides to their preferred policy options. Such advocacy, arguably, doesn’t advance the ball very much because there isn’t even really an attempt to address the weaknesses in a serious manner. To the extent that it would make sense to adopt an approach along the lines of what they advocate, they should be that much more willing to engage with how their plan might play out in reality. Otherwise they will just be exacerbating the polarized aspects of the discussion. That problem is only exacerbated by Bhattacharya’s pretense of being disinterested, politically, even as he regularly chooses overtly political channels to advocate for his preferred policy outcomes. He’s part of the politicization problem.

  56. This is a good headline; I thought I”d pass it on:

    > In a few days, more people in Trump’s orbit tested positive for coronavirus than in all of Taiwan

    • Tks for posting this. I also like that they emphasize a point that is easily missed: the impact of cross-immunity (or other factors), if it modifies the rate of spread of the virus, probably also did so in the situations from which R0 estimates were derived. That means that it is probably already backed into R0.

    • Err… baked into, not backed into.

    • Thanks for that link, Steven.

      I asked Nic to deal more comprehensively with the implications of that article to the assumption that T-cell reactivity implies immunity from infection. I’m curious to see whether he will or not.

      • Steven Mosher

        welcome.

        I’m pretty sure none of these guys get that any cross-reactive PROTECTION is already baked in

  57. Joshua

    https://www.thelocal.se/20201005/swedens-coronavirus-measures-could-remain-in-place-for-at-least-another-year

    follow marc

    He’s a friend, does great work all open source

    • From the report:
      The percent of tests positive rose to 2.4%. In my blue state that’s below the state’s threshold to reopen.

      From the report- no increase in hospitalizations. The number of deaths reported is “within the normal range for the season.”

      In other words, your friend has reported that Swedes are in no more danger today than they were last October. Or any other October they’ve lived through.

    • I am happy for Sweden. They took the criticism, they moved on. This thing is like a shiny penny. There is more to life.

  58. Despite all the rhetoric from right-leaning folks on this blog, it seems obvious to me that without a significant fraction of people in the US and worldwide wearing masks and socially distancing to some degree, the number of cases would skyrocket. Furthermore, having been on a ventilator in the past, I can assure you that a week or more on a ventilator is almost as bad as dying.

    • Without masks and social distancing cases will skyrocket. As a result the HIT will be reached far sooner. The total number of people ultimately infected won’t change much but the economic and social costs will be reduced by reaching the HIT sooner.

    • And there is the the child whose parents are poor. They deserve more consideration. More than older people. I do not know how old you are. I am a parent and know the sacrifices I have made, would make and will continue to make on their behalf. Even if they are undeserving. Is meaning found in what I do? I don’t know. A case in itself part of some set of outcomes. For young people it averages to a good outcome. Tracking cases in some repects, is a make work project. We each judge the value of that. If it leads to not fully open schools, it has a negative value. Knowledge is good. How is case knowledge making our lives better? It is a sword used by the left in very general terms. A tool of fear. Wosre yet, it is off target. We should have vision and not stare at the wrong thing. We should look at the poor people trying to make it.

      • > We should look at the poor people trying to make it.

        Polling makes it clear that the general public as well as the poor prefer a more strict approach than your macho preferences. What makes you think you shold decide for them?

        Yah, look at them trying to make it and listen to them about what’s in their best interest.

      • J:
        They can decide for themselves.

    • “it seems obvious to me that without a significant fraction of people in the US and worldwide wearing masks and socially distancing to some degree, the number of cases would skyrocket.”

      Agreed – without mitigations, our cases will probably* skyrocket. BTW… your stereotype isn’t quite right, since I’m pretty right-leaning.

      *Probably: it is possible, although I’m skeptical, that there is enough immunity in some populations that the cases will just go up, but not skyrocket. I hold an open mind on that, but I am acting personally as if that is not true, and it probably isn’t. I still have some thinking and maybe modeling to do regarding Nic’s assertions.

  59. Joe - the non epidemiologist

    Interesting group of charts showing the effectiveness of masks in various countries, states and cities.

    https://rationalground.com/mask-charts/

    • Not really

      MANDATES that are NOT FOLLOWED
      cannot be used as evidence of mask USAGE.

      That’s WHY it important to look at places where
      A) people actually follow the mandate
      B) the government actually OBSERVES and MONITORS whether
      they are or not.

      Next

      you have a COUNTERFACTUAL Problem.

      masks dont ELIMINATE infection we know this.
      They REDUCE infection and reduce disease severity.

      So, suppose you had no masks. The cases might climb from 10 to 1000
      use masks? they might climb from 10 to 500.

      your charts can show the counterfactual. They dont help your case

  60. More evidence of the statist, consensus enforcing, lefty, cancel cultu….

    Oh, wait. Maybe not:

    -snip-

    > The group’s criticism has not been welcomed—indeed, some of the critics say they have been pilloried or reprimanded. “It has been so, so surreal,” says Nele Brusselaers, a member of the Vetenskapsforum and a clinical epidemiologist at the prestigious Karolinska Institute (KI). It is strange, she says, to face backlash “even though we are saying just what researchers internationally are saying. It’s like it’s a different universe.”

    Multiple levels of irony here:

    >> “Maybe Sweden has too much of a consensus culture. … It’s healthy for science to have discussions. One thing we don’t need in this situation is silencing of views, especially from those with expertise.”

    […]

    >>> Dorota Szlosowska, a pulmonologist who had been working at Sundsvall regional hospital, shared an email with Science stating that one of the reasons her contract wasn’t renewed was that “she walked around with a mask,” which the email said made her look unfriendly and made it hard for patients to understand her.

    >>>> FoHM’s decision to keep schools open despite surging cases may also have added to the spread. A report from the agency itself, released in July, compared Sweden with Finland, which closed its schools between March and May, and concluded that “closing of schools had no measurable effect on the number of cases of COVID-19 in children.” But few Swedish children were tested in that period, even if they had COVID-19 symptoms. And the lack of contact tracing means there are no data about whether cases spread in schools or not. When new FoHM guidelines allowed symptomatic children to be tested in June, cases in children shot up—from fewer than 20 per week in late May to more than 100 in the second week of June. (FoHM reversed course in July and returned to recommending that children under 16 not be tested.

    Indirect data suggest children in Sweden were infected far more often than their Finnish counterparts. The FoHM report says 14 Swedish kids were admitted to intensive care with COVID-19, versus one in Finland, which has roughly half as many schoolchildren. In Sweden, at least 70 children have been diagnosed with multisystem inflammatory syndrome, a rare complication of COVID-19, versus fewer than five in Finland.

    -snip-

    https://www.sciencemag.org/news/2020/10/it-s-been-so-so-surreal-critics-sweden-s-lax-pandemic-policies-face-fierce-backlash

  61. -snip-

    He rejected claims that Sweden’s high level of deaths this spring compared with its neighbors was a result of authorities pursuing herd immunity. The deaths, he said, occurred despite and not because of government guidelines to protect nursing homes and to limit the spread of the disease.

    “This was definitely not a conscious decision, it was definitely not a question of sacrificing anybody or letting people die of this disease on purpose,” he said.

    […]

    An analysis of Stockholm’s wastewater suggested this week that the rate of coronavirus infections in the capital had doubled in September compared with the previous month and was on track to reach the level of this spring.

    […]

    While Mr. Tegnell said that Sweden wasn’t registering a rise in hospitalizations, he said that herd immunity had not materialized.

    […]

    “For Covid, it’s been difficult to measure the immunity…it’s been a mystery to me. We probably have some kind of level of immunity in Sweden,” he said. “For Covid-19, (herd immunity) is still a foggy concept, how important it is and how it really works over time.”

    -snip-

    https://www.wsj.com/articles/sweden-tries-to-isolate-covid-19-cases-without-a-lockdown-as-infections-surge-11602004646

  62. I was looking for that flatline cumulative deaths curve:

    These 3 states have it:

    https://www.worldometers.info/coronavirus/usa/new-jersey/

    https://www.worldometers.info/coronavirus/usa/new-york/

    https://www.worldometers.info/coronavirus/usa/connecticut/

    I didn’t look at all of the other states, but most of the other states are not done. The above state’s defense is that they are now Sweden. The idea that they actively obtained their flatline would be a test of the audience’s intelligence.

    These have hope for flatline cumulative deaths:

    https://www.worldometers.info/coronavirus/usa/arizona/

    https://www.worldometers.info/coronavirus/usa/district-of-columbia/

    https://www.worldometers.info/coronavirus/usa/delaware/

    https://www.worldometers.info/coronavirus/usa/nevada/

    Then we have Sweden:

    https://www.worldometers.info/coronavirus/country/sweden/

    Why has their deaths per million flatlined at a lower number than in the United States?

    Health of their population. Our number is higher with or without interventions. Yes there are other factors. What is not variable is the virus. There was the argument they do not have herd immunity or are not close to it. Look at the plot and say that.

    • Looking at the cumulative death curve is the least sensitive way to detect trends. Since some states had huge spikes early, of course their curve appears to be flat, and it will look pretty flat unless deaths go way up. The same is true of countries.

      It is far better to look at incremental deaths – such as 91-divoc’s 1 week average, and even better, for shorter term trends, to look at 1 week average case deltas. Deaths tell you the death toll, but they don’t show dynamics very well because of the very large influence of age, comorbidities and behavior changes. That people who are at high risk are better at isolating tells us nothing about herd immunity, it just says that the incremental death rate will go down. It also doesn’t mean that, in the absence of vaccine, that the total deaths will be low, unless one is certain (in the face of contradictory evidence such as Manaus, Brazil) that the herd immunity threshold is quite low.

      • Gompertz function

        The function was originally designed to describe human mortality, but since has been modified to be applied in biology, with regard to detailing populations.

        Someone smarter than I looked at Sweden’s plot and I had a new word to look up. I had a marketing proof use a phrase. An elegant solution. In nature we find elegance.

        As far as resolution, it’s turned up too high. We don’t have vision. Nature organizes itself if we can see it. They’re using us to play their games We’re pawns. Commanded.

        It’s like that book, All Quiet on the Western Front. The old people talk about war stategies while the young people die in their hell the old people came up with.

        Sweden read the book. They said you aren’t fooling us this time.

        I think the unambigous thing the plot says is, it’s over. How do we know when it’s over? The Swedish plot. We can argue about what happened. In Sweden, it’s dead. But we’ll see people wanting to drag it along. I don’t why? At the same site is the NY plot. You have their Einstien of a Governor dragging it along. He has issues. I think he’d benefit from counciling. The pandemic died in his state and he can’t let it go. He need’s grief couciling for the his dead pandemic. Is Trump ignoring him? He wants more attention? It’s a good thing we have such good politicans.

      • Dems in the US ignore the success in Sweden because the want the US to remain shut down until after the election. The strategy unfortunately has been largely successful.

      • Ragnaar – Gompertz function is irrelevant. Lots of folks have taken popular curves, noticed a similarity, and drawn weak conclusions from them.

        Rob – I’m far from being a dem, but I don’t see a success in Sweden, especially compared to neighboring countries like Finland. Their total deaths (adjusted for population) are far higher – 9X.

        The growth rate lately of cases in Sweden shows that herd immunity has not been reached. Their doubling time suggests an Rt of around 1.4 – worse than that for influenza. Herd immunity has Rt of <= 1.0.

      • Robert Starkey

        I would expect Sweden to have higher deaths early the curve. They should lower numbers of
        deaths as time passes as compared to areas still doing shutdowns. How did you adjust for the difference in Finland and Sweden’s population density and demographics.

        How did you weigh Sweden’s lower social and economic costs compared to those having shutdowns.

      • Ragnaar… the link you posted is a great way to avoid reasonable comparison. Also, Sweden does not have a drop in cases, it has a rapidly rising case rate. To be fair, Finland now has a rapid rise also, but look at the cumulative deaths for overall success – so far.

        So try this link: US Sweden Finland Cumulative Deaths

      • https://covid19.who.int/region/euro/country/se
        You mention cases. I am stuck on deaths. Herd immunity, effective herd immunity or no more deaths. The plot at the link shows their pandemic related to deaths has flatlined. Their cases are going up. The two are unrelated at this time. In MN I am sorry to report our deaths have not flatlined but have hopefully flattened. The slope is not there yet. When you’re a policymaker and everyone is throwing things at you, you show them the Sweden plot. Rationality is not in good supply so low resolution is called for. Versus high resoluation bickering. I think I am right, so I use the plot of Sweden. I don’t think one can argue against a low value flat line. Sweden can almost passively keep its flat line. Right or wrong, they can move on. The bickering itself (riots) is a problem. Should our society have a higher death rate so the rest of us can get on with our lives? Government should not make that decision. But they made the decision to pursue the lower death rate so they did make the decision. So we argue about this and Sweden is done. That is success.

      • BTW – any time you want to get reasonable comparison graphs, 91-divoc.com has the best options – it is a very powerful site for visualizing COVID19 trends. It takes some close reading to see all the options though.

        The key for most cases is to use the 2nd two set of graphs – those that are population normalized. If you want to mislead, continue to use graphs that don’t show comparisons.

        91-DIVOC

      • Steven Mosher

        Gompertz is wrong and misguided.

        See Willis’ debacle using it for Korea

        Gompertz MIGHT work in an area that practiced total isolation
        and if the area was sufficiently small.

        This is BECAUSE of the way the parameters are estimated.

        FFS

      • Thank you Steven Mosher for replying. I don’t understand math. So I need a story and/or a picture.
        The deaths plot here:
        https://covid19.who.int/region/euro/country/se

        God himself could not have made such an elegant distribution. Man working with nature, not against it. Here’s a suggestion their government opined. 300,000 years of human evolution has reached its zenith in Sweden. I suppose I have to say the same for New York. It’s a similar distribution. It was let out of the box, and they had the disadvantage of being the major node of the United States. And they had nursing home problems like Sweden. Perhaps the New York civilization gets the same answer by another route.

        Now I know what FFS means. The Lion King did not do functions. But he had vision. Pride Rock. Our leaders do not. I still don’t know what a Gompertz function is.

        “This study demonstrated that the progression of the COVID-19 epidemic did not follow an exponential growth law even in the very beginning, but instead, its growth is slowing down exponentially with time. More specifically, the results irrevocably show that COVID-19 cases grew in accordance with the Gompertz function, and not the sigmoid function.”

        I saw the Swedish Deaths plot, it said something to me, and I put it on Facebook. My engineer friend said one word: Gompertz. I looked it up. I looked for the same distribution in other places. I posted here. Someone did the study above previously.

        I guess my point is, it’s there to see. If we see it. Sweden whatever you want to call them, is done. Their future is bright.

        South Korea. I’d like to say there’s something wrong there. I can’t. They’re different. The United States is more like Western Europe and Scandinavia. We are learning from South Korea, but it’s too early to say, if Trump had done like South Korea…

      • “This study demonstrated that the progression of the COVID-19 epidemic did not follow an exponential growth law even in the very beginning, but instead, its growth is slowing down exponentially with time. ”

        All epidemics slow exponentially with time, even unperturbed. At the beginning, that slowing is very small, but it’s there.

        As to which function it best matches… please, in the presence of changing behaviors (mandated or otherwise), and with all the noise introduced, and before the epidemic is over, picking a match to a function is not very interesting. These epidemics did show roughly epidemic growth, which is why the doubling time is interesting. The growth slowed – but why? Was it because of growing immunity (the cause with an unperturbed epidemic), was it due to mitigations and behavior changes (which have the *same* mathematical effect as immunity, at least over some intervals)?

        Early on, before any mitigations other that travel closures in the US, I modeled this myself – just to get a feel for epidemic dynamics. I then thought that we’d hit herd immunity in a small number of months, and I had to hunker down for that period. My mistake? Not accounting for behavior changes, ironically even as I was voluntary changing my own.

      • mesocyclone:
        Sweden was closer to pure, with less mitigations. I am seeing similar distributions. Cook County IL., below. Elsewhere I think I said, low resolution. That’s better for policy makers and voters. And hacks like myself.
        I looked at Mars with my 4 incher the first time a week ago. I went up to a little over 100 mag. I forgot I had one more eyepiece to go to about 150. What do you think I’ll see at 150? It will probably be worse. I guess I am saying we have to do the best we can, from here. We poured trillions into this. We’ve had riots. Some places have the green light to do that. Maybe a lot of them. This thing is dying at the nodes.

    • Keep in mind that from what we’ve seen so far, “success” means equal economic damage as other Nordic countries, equal shutting down, higher death rates, and higher disease rates. And the comparison on this metrics with some Western European countries isn’t so good either. And with many Asian countries its even worse.

  63. This Science article based on interviews with internal critics and supporters of the Swedish response to pandemic is interesting and paints a very different picture from the one I had. Though relying on a single source can be dangerous, it is hard for me to view anything about the Swedish pandemic as a “success” after reading this article.

    https://www.sciencemag.org/news/2020/10/it-s-been-so-so-surreal-critics-sweden-s-lax-pandemic-policies-face-fierce-backlash

    “The country did not ignore the threat entirely. Although stores and restaurants remained open, MANY SWEDES STAYED HOME, AT RATES SIMILAR TO THEIR EUROPEAN NEIGHBORS, surveys and mobile phone data suggest. And the government did take some strict measures in late March, including bans on gatherings of more than 50 people and on nursing home visits.”

    Some things make it hard to see Tegnell as a genius: 1) “Until last month, Sweden’s official policy stated people without obvious symptoms are very unlikely to spread the virus. So instead of being quarantined or asked to stay home, family members, colleagues, and classmates of confirmed cases had to attend school and show up for work, unless they had symptoms themselves.” 2) “Swedish authorities actively discouraged people from wearing face masks, which they said would spread panic, are often worn the wrong way, and can provide a false sense of safety. Some doctors who insisted on wearing a mask at work have been reprimanded or even fired.”

    “And the virus took a shocking toll on the most vulnerable. It had free rein in nursing homes, where nearly 1000 people died in a matter of weeks. Stockholm’s nursing homes ended up losing 7% of their 14,000 residents to the virus. The vast majority were not taken to hospitals.”

    “In late February, during the school holidays, thousands of families went skiing in the Alps—just as reports surfaced about an outbreak in northern Italy. Many had asked whether they should stay home, but health authorities “kept saying, ‘No, don’t cancel your trip!’” Einhorn says. “It was the middle of that week when the cases in the Italian Alps went boom.” As vacationers returned, many asked whether they should quarantine, but FoHM maintained there was no reason to worry.” “When 30,000 music fans gathered in a Stockholm arena on 7 March for the national final of the Eurovision Song Contest,”

    For comparison, Italy reach 10 new cases/million/day on 3/7, Sweden on 3/13, and the US on 3/22. The largest US states issues SIP orders on 3/19 and 3/20 and NYC hospitals had long lines about 4/1. Confirmed new Swedish cases plateaued between 3/13-3/22, almost certainly because of limited testing.

    “On 12 March, as new cases outpaced test capacity, FoHM announced doctors should only test those with severe symptoms … ‘They are letting it loose. We are going to crash the health system. We are going to need 500 ICU [intensive care unit] beds and we have 90 in Stockholm.’” The Stockholm area has 25% of the population.

    “The next week [about 3/22], Tegnell announced Sweden would try to “flatten the curve” so the health system would not get overwhelmed with cases. The government limited gatherings to a maximum of 500 people, but day care and schools through ninth grade stayed open. (UPPER SCHOOLS AND UNIVERSITIES WENT ONLINE.) People should WORK FROM HOME if possible, FoHM said, but tests remained very limited, and CLOSE CONTACTS OF SUSPECTED CASES WERE NOT ASKED TO STAY HOME unless they had symptoms.” Tegnell failed to appreciate that asymptomatic people could transmit the virus, even though substantial evidence they did was known at this point.

    “By late March, more than 30 COVID-19 patients were being admitted to ICUs every day. By early April, Sweden was recording about 90 deaths from the virus daily—a significant undercount, critics say, because many died without getting tested. Hospitals did not become as overwhelmed as those in northern Italy or New York City, but that was in part because MANY SEVERELY ILL PATIENTS WERE NOT HOSPITALIZED. A 17 March directive to Stockholm area hospitals stated patients older than 80 or with a body mass index above 40 should not be admitted to intensive care, because they were less likely to recover. Most nursing homes were not equipped to administer oxygen, so many residents instead received morphine to alleviate their suffering. Newspaper reports told stories of people who died after being turned away from emergency rooms because they were deemed too young to suffer serious COVID-19 complications.” It seems to me that the early pandemic in the Stockholm area was significantly worse than in NYC and fear may have played a major role in Sweden’s success since then. Since testing was limited and deaths poorly documented, the rest of the world doesn’t realize that the early Swedish pandemic could have rivaled Italy’s.

    “from 7 to 9 April, more people per million inhabitants had died in Sweden from COVID-19 than in Italy—and 10 times more than in Finland.”

    The article discusses anecdotal stories of scientists who criticized the government’s policy were reprimanded, as were doctors who wore masks seeing non-COVID patients.

    “few Swedish children were tested in that period, even if they had COVID-19 symptoms. And the lack of contact tracing means there are no data about whether cases spread in schools or not. When new FoHM guidelines allowed symptomatic children to be tested in June, cases in children shot up—from fewer than 20 per week in late May to more than 100 in the second week of June. (FoHM reversed course in July and returned to recommending that children under 16 not be tested.)”. ” In Sweden, at least 70 children have been diagnosed with multisystem inflammatory syndrome, a rare complication of COVID-19, versus fewer than five in Finland” [with half the population].

    “Giesecke and Tegnell believed herd immunity would arrive quickly [though they claimed the goal of their policy was to keep hospital from overflowing, not reach herd immunity]. In the Lancet article, Giesecke claimed about 21% of residents of Stockholm county had already been infected by the end of April; Tegnell predicted 40% of them would have antibodies by the end of May. When initial studies showed the number was actually about 6% in late May, Tegnell said immunity was hard to measure. FoHM continued to say Swedes had built up immunity, but in September it backtracked, estimating that “JUST UNDER 12%” of Stockholm residents, and 6% to 8% of the Swedish population as a whole, HAD ANTIBODIES to the virus by mid-June.”

    “Some speculate that Sweden’s summer traditions may have helped [cases fall over the summer]: Hundreds of thousands leave cities and towns for remote cabins in what amounts to 3 months of national social distancing.”

    [Some aspects of] “the Swedish experiment [are] coming to an end, as its policies fall in line with those of its neighbors. FoHM officials are “quietly changing their approach,” Einhorn says. The country has boosted test rates; at roughly two tests per 1000 inhabitants per day, Sweden’s testing rate is almost on par with Norway’s [and the US] —although it is only one-quarter of Denmark’s. The recommendation against testing children between ages 6 and 16 was lifted for a second time in September…The drop in cases allows Sweden to start to use its contact tracing system, in place for other diseases, for COVID-19, Tegnell says: “Before, we just didn’t have the capacity.” And on 1 October, FoHM announced family members of confirmed cases should stay home for 7 days, even if they don’t have any symptoms—although children through ninth grade should still go to school.”

  64. Nic version 1 May 10th.

    ‘Very sensibly, the Swedish public health authority has surveyed the prevalence of infections by the SARS-COV-2 virus in Stockholm County, the earliest in Sweden hit by COVID-19. They thereby estimated that 17% of the population would have been infected by 11 April, rising to 25% by 1 May 2020.[5] Yet recorded new cases had stopped increasing by 11 April (Figure 1), as had net hospital admissions,[6] and both measures have fallen significantly since. That pattern indicates that the HIT had been reached by 11April, at which point only 17% of the population appear to have been infected.

    How can it be true that the HIT has been reached in Stockholm County with only about 17% of the population having been infected, while an R0 of 2.0 is normally taken to imply a HIT of 50%?

    HIT in Stockholm county?

    NOPE

    Morally indefensible to claim HIT in may for Stockholm county
    And then ignore your mistake

    https://www.svd.se/okad-smitta-i-stockholm–anda-inget-trendbrott

    • Steven –

      > Morally indefensible…

      Why morally indefensible and not just a motivated treatment of uncertainty?

    • “How can it be true that the HIT has been reached in Stockholm County with only about 17% of the population having been infected, while an R0 of 2.0 is normally taken to imply a HIT of 50%?”

      While I don’t think HIT was reached, some modelers (see Nic Lewis posts) believe it may be far lower than the standard formula gives, due to heterogeneity in transmission and susceptibility.

      I think there is probably something to this, but I honestly have no idea what the impact might be. So, it is not impossible that 17% was the HIT, but I suspect it is very unlikely.

      Also, mitigations can exactly mimic herd immunity, but only while they last. So if you drop the rate of infection below 1.0 by mask wear, social distancing, sanitation, etc, then you have a temporary “herd immunity” in that Rt <= 1.0. But, that's reeeaallly stretching that terminology. And, as soon as the mitigations ease, the HIT goes up, and the epidemic takes off.

    • “Cases going up are the 1st signs of a 2nd wave (not hospitalizations or deaths)…”

      The contention would be deaths will follow cases. And that’s true for some value. Sweden has 28 deaths for about 10,000 cases. Both numbers are from the last 3 weeks from here:
      https://covid19.who.int/region/euro/country/se

      At the worst they had about a 20% deaths to cases rate.
      Now it’s about 0.28%. About 15 times less. We expect it to drop further.

      0.28% is libertarian vote getting range. We know you’re right, but just go away.

      Here’s what they can’t model. Sweden has a covid network. It’s burnt out. It adapted as people’s behaviors changed. It became resilient. It was unprepared. But it adapted by sacrificing the weak and the old. Those that were going to get the most sick did or they hid sufficiently. Their network kept breaking connections and squeezing pathways. The old spreading pathways lost their spreaders and they were replaced by close enough immune people.

      The network is now rebuilding itself, that is opening back up. As all networks across the globe are trying to do. The things that support the network are now stronger. Such as our knowledge of covid and the options for treating it.

      The virus needs pathways and hosts. The increased cases in Sweden over the past 3 weeks shows pathways and hosts are sufficient. But some things are causing the low death rate. So the network is rebuilding in a safe way. Not for the 28 people who died in last 3 weeks but for most of their 10 million population. MN is sucking wind in that regard with 60 deaths (about 180 in the past 3 weeks) in the past week with a population of about 5.5 million. MN deaths, about 10 times Sweden per million for the past 3 weeks. I hope MN can match Sweden’s deaths but I don’t see the break to flat yet. We are at about 2200 deaths and need to flatline before 3300. But at 70/week that give us around 14 weeks.

      Cases are the last hope to keep the pandemic alive. I could be wrong and my flatlines could be a fake signal. But cases are hardly tracking deaths. Or the other way around. It would be better if I waited 3 more weeks to say this I know that. Decisions are being made now and if you don’t want to be a policymaker then don’t. But we can just spend more money and urge caution. Hold more press conferences and make grim faces. Be serious and concerned too.

  65. “I showed in my May 10th article Why herd immunity to COVID-19 is reached much earlier than thought that inhomogeneity within a population in the susceptibility and in the social-connectivity related infectivity of individuals would reduce, in my view probably very substantially, the herd immunity threshold (HIT), beyond which an epidemic goes into retreat. I opined, based on my modelling, that the HIT probably lay somewhere between 7% and 24%, and that evidence from Stockholm County suggested it was around 17% there, and had been reached. Mounting evidence supports my reasoning.[1]”

    Time to adjust your priors

    • I need to dig into this some more. But I was thinking about writing a simulator for the superspreader phenomenon – the inhomogeneity in spreaders – 20% produce all the cases (pick your number, it’s around there). But the more I think about it, the more it seems like that entire effect is baked into the R0 measurement. In other words, if R0 is the average spread per case, then in this sort of inhomogeneity, it just means that 80% or so don’t spread, and the remaining 20% spread at 5 times the R0 amount if had been applied uniformly. You don’t need any more sophisticated statistical distribution to arrive at that – but of course, I may be missing something. As for heterogeneity in susceptibility – how the heck does one know what that means, and again, aren’t we essentially just talking about the equivalent of pre-existing immunity, which is handled just fine with even trivial models.

      Social connectivity seems different, maybe, but I have no idea how one can come up with realistic parameters to simulate it.

      That said, I need to go over Nic’s early post more, and the paper he references.

      Thoughts?

    • But they are objective priors.

  66. I realized what the heck I was trying to say. Stop mulling over what happened. We need to decide what to do now. We lost the covid death Olympics. Stuff happened and the orangeman caused it. But that’s behind us. Of everything that going to happen with the virus most of it’s happened. We were reminded that old and sick people die. That nutrition and exercise are important. That scientists and politicians should be viewed with skepticsm.

    We will decide if we will make this virus, or some other virus what guides us through our lives.

    Cancer, heart disease, demenita, super bugs, you name it. Poor people living in Africa who probably said, what about us? What a self centered nationalist privileged people we are. A bunch of frauds.

    If we do move ahead with confidence, we can do some good. We aren’t doing any good right now.

    • > This Overlooked Variable Is the Key to the Pandemic
      It’s not R.

    • Tks – interesting article.

      • Yes, I think it really touches on some very important (and largely overlooked) points.

      • BTW –

        I was thinking about your comment that I was ranting about rants and overly focused on “messaging.”

        The problem is that with this administration, there is increasingly no distinction
        between public health policy and messaging. Messaging has largely replaced public health policy. Consider the debacle with Michael Caputo.

        Of course, political messaging about public health policy isn’t a completely new phenomenon, but I don’t think that you have to be afflicted with TDS to be convinced that the scale of overlap between public health policy and politically expedient “messaging” is happening on an unprecedented scale.

      • I wish I understood the magnitude of the effect in the article. Nic Lewis claims some results on that, but I don’t have confidence in the assumptions. On the other hand, at least the idea of the most productive networks being used up (via immunity) makes intuitive sense.

    • So there are nodes. Like travel nodes. It’s a weak virus so it needs these nodes to spread. The virus is taking the paths of least resistence. So masks and social distancng don’t work at these nodes. Take a Catholic church. The like Martin Luther stays open as before. That node burns itself out. And is removed from the network. Homes, they burn themselves out. Anything bad that doesn’t change and has a stable group of people, burns itself out. That’s herd immunity. If you close these nodes down before they ignite, a few stragglers or outsiders can later ignite it. A school would do what? Burn itself out. Opening that school half the time or at half the kid size, keeps it as a potential ignition node. Sweden burned its nodes. I found another:

      https://www.worldometers.info/coronavirus/usa/Connecticut

      Early it lit up. Later, such a small number of deaths. It has a population of around 3.5 million.

      What can I say about South Korea? Its nodes are not burnt out. It may not have nodes.

      https://www.worldometers.info/coronavirus/country/south-korea/

      Sweden has its old nodes. What’s the plan for South Korea? Not to have nodes. Sweden did not let the virus win.

      I don’t know if they talked about this in the article. It’s more than stable nodes. It also traveled pathways that have huge volumes. The other brute force method is to cut those. But we will not give them up. I imagine New Zealand did that. They hid. Until they stop hiding. They hope this goes away.

  67. https://www.worldometers.info/coronavirus/usa/pennsylvania/

    You can see in the daily deaths plot, For about 4 months, the same amount of deaths. Which is to say there are two separate things. The second part is a natural spread. Looking at the MN distribution:

    https://www.worldometers.info/coronavirus/usa/Minnesota

    Our 2nd part is higher relative to the first part. And it has a bounce back.

    Theory: Uncontrolled, you get PA. Controlled you get MN. The harsher the initial control, the bigger the bounce. PA being so close to NY, is more uncontrolled. Philadelphia is an air hub on the way to my son’s college in New England.

    Without suppression, the flash makes further control pointless. By suppressing, you’re only delaying. If people don’t really do what it takes, and they don’t, and they do it more at first, but that decays, you end up tending to the same place. All of the suppression is sort of flattening curve. And we could’ve left it at that.

    • As if it would make any difference at this point is debatable but we are about to witness a full scale test-trace-trap public health intervention done in real time as China attempt to crush a tiny COVID-19 outbreak.
      Hold my beer…

      “BEIJING (AP) — Chinese health authorities will test all 9 million people in the eastern city of Qingdao for the coronavirus this week after nine cases linked to a hospital were found, the government announced Monday.
      The announcement broke a two-month streak with no virus transmissions reported within China, though China has a practice of not reporting asymptomatic cases. The ruling Communist Party has lifted most curbs on travel and business but still monitors travelers and visitors to public buildings for signs of infection.
      Authorities were investigating the source of the infections in eight patients at Qingdao’s Municipal Chest Hospital and one family member, the National Health Commission said.
      “The whole city will be tested within five days,” it said on its social media account.
      China, where the pandemic emerged in December, has reported 4,634 deaths and 85,578 cases, plus nine suspected cases that have yet to be confirmed.”

      • You think it won’t make any difference there (because it’s too late) or here (because we have an incompetent federal government)?

      • We can not compete with the social unity of asian cultures. They will win this game every time.
        If Zuckerberg can give every US citizen a free Oculus VR we might be able to trick them into behaving rationally.

      • In the case of China, it’s not just cultural Asian unity (which is not absolute in other Asian countries), it is also a totalitarian dictatorship in a surveillance state. The latter does have advantages in an epidemic, but the dysfunctions inherent in that state, and the evil in its officials, is also why the world is facing this epidemic at all. Early coverups at all levels, and misinformation after that, gravely hurt the response of western countries. Taiwan, a free country with better intelligence on China, but excluded from WHO, responded promptly and prevented an outbreak there.

      • Robert Starkey

        What specific actions would you have had the federal government do to overrule what a state did?

        China has been unable to stamp the virus out despite unlimited power and draconian actions.

        ]

      • Robert,
        Without going the way China did maybe we could leverage the large number of households that have at least 1 or more cell phone users.
        First, using the existing OTA distribution system, install a system level program in every cell phone that would disable all communication (except 911 and the users personal contacts). To unlock the device, citizens would be instructed to report to a testing site where they (and their household) are rapid tested and immediately quarantined if positive. Do a rolling 7-10 day repeat of the process until new positives=0.
        In short, use our electronic device addiction to bypass our distrust of authority. I bet there are a dozen variations along these lines and plenty of government lawyers who could find a ‘national security’ loophole to shove it through.

      • As for your cellphone fix… that simply would not happen in the US, because we are not a totalitarian dictatorship.

      • “that simply would not happen in the US, because we are not a totalitarian dictatorship.”
        We have led the world in mass incarceration for decades. Either Americans really like to break laws or maybe the laws work like they were meant to?
        Remember, we still have most of the Patriot Act including the notorious ‘National Security Letter’.

  68. To jacksmith4tx

    Are you CRAZY? We have laws one is called HIPPA. It protects patient privacy. It was enacted BECAUSE folks were using the data to hurt patients in various ways.
    Where I live contact tracing is done by the LOW BID third party vendors. So who keeps your information? STATE, COUNTY, CITY, third party?
    All of this data might be a poison pill in 10 years when the results are actually in. Oh you got tested and the result was ????? So we are going to deny you ?????

    • Alan,
      That is a fantastic law. We need something like it for our digital identities. Some combo of biometric+crypto+blockchain to give us unique and exclusive control of who can access our data (health/financial/geolocation/web history).

  69. Infection rate in Sweden not looking terribly “blip”-like. Quadrupled over the last 6 weeks.

    At what point do the confident assertions of Sweden having reached “herd immunity threshold” status months ago get re-evaluated?

  70. Joshua | October 13, 2020 at 8:07 pm “Infection rate in Sweden not looking terribly “blip”-like. Quadrupled over the last 6 weeks.”
    Actual numbers would be helpful Josh,
    If the infection rate was 1 Swede a week 6 weeks ago and is now 4 Swedes a week it would not not really be worth a comment would it!?
    Which means your comment, without meaningful clarification, falls into the usual grab bag of pure and simple alarmism.

    I toss this out for your consideration and a more relevant and practical figure.
    Herd immunity was reached months if not years ago I believe.
    Sorry.
    Clarification.
    To your comments I mean And at this site.

    • angech –

      Sometimes theoretical mixing falls short of describing reality, right?
      All models are wrong but some are useful, eh?

      OK. I did a bit of cherry-picking.

      So over the past month the infection rate has steadily increased, to the point of being well more than double the rate that it was over the entire period of the previous month or so.

      When the rate first started growing the suggestion was offered that the bump up might be a “blip.”

      Of course, we can always expand and shrink the time period of interest to characterize these changes over time in the manner that confirms our ideological biases.

      But the longer the rate remains elevated and the longer it continues to rise, the less it looks like a “blip” to me.

      A steady increase over the past month, to reach a rate that is well more than double the rate over the period of the previous month, is not exactly what I’d expect in a population that reached a “herd immunity threshold” months ago.

      I wouldn’t say it disproves that Sweden reached a “herd immunity threshold” months ago, but I would say it decreases the likelihood of that having happened.

      How ’bout you?

      • Joshua | October 14, 2020 at 9:15 am | Reply
        ” I did a bit of cherry-picking.”
        No, not in this case.

        I do not know of any commentator or blogger who does not cherry pick points to point out flaws in arguments of others. Both sides do it incessantly.
        The problem with cherry picking is not the cherry pick itself, it is the context that it occurs in.
        That is the event described happened for other reasons than that that the argument was centered on.
        A cherry pick of data that may or does disprove a line of argument is a valid method. Look at the angst the “pause” caused.

        My comment was not directed to your valid cherry pick but to the actual importance of the cherry pick in this discussion.
        The problem being that percentages without actual amounts leads to manufacturing a statement out of proportion.
        In this particular case there is a world of difference between
        “If the infection rate was 1 Swede a week 6 weeks ago and is now 4 Swedes a week ” [ a localised outbreak of 4 people out of 10,117,599* and certainly not disproving a herd immunity level had been reached.]
        and
        “The number of swedes with corona virus jumped from 19% to 20% over the last 4 weeks.” [which would. if true, invalidate Nic’s hypothesis on a number of grounds. which is what 100,000 new cases in 4 weeks would show.]

        There is a problem for you in trying to to use insignificant, small or moderate increases to disprove his argument.
        His argument was over and he won months ago when he argued that a rate somewhere between 17% and 19% would most likely guarantee herd immunity in the Swedish setting only.
        That is what has happened. There has been no rapid ongoing increasing shift in numbers since then to a new state of 25% or 42%/
        Which is what must happen according to the standard models of numbers and spread.
        It did not happen.
        It slowed dramatically..
        Herd immunity is a moving target. The level it needed to reach to stop rapid spread was 17-19%.
        Months ago.
        Sweden’s numbers and % will slowly increase over the next1,3,5,and 20 years with no vaccine and despite herd immunity.
        Herd immunity is the stopping, at a certain level of infection, of virus spreading rapidly and increasingly through a population at a certain level of immunity at a certain time.
        That is life.
        Nic’s argument is valid and proven for the moment.

      • angech –

        As per usual, I find your comment very difficult to parse.

        What is happening in Sweden now does not look particularly like “overshoot.”

        It is a rapid increase in spread over an extended period. That is not what you would expect with a country that reached a HIT months ago

        You first express total confidence that Nic was right and a herd immunity threshold was reached. Yet you don’t actually know the causality behind the drop in infectiousness in Sweden. It could have been for many reasons just as there were dramatic decreases in infectiousness all around the world (before subsequent spikes). Many of the behavioral patterns contemporaneous with the drop in infections in Sweden were similar to the behavioral changes contemporaneous with drops in other countries.

        You say his argument thaf a HIT was reached months ago in Sweden is proven “for the moment.”

        You say that after saying it was proven.

        Saying it is proven “for the moment” (after saying it was proven with no such qualification) is meaningless as it is self-confrasicfing. They either reached a HIT months ago or they didn’t. Overshoot doesn’t change that. A rapid rise in infectiousness over an extended period would not be overshoot and it would mean that a HIT was not reached months ago. The only question is how long and how rapid the increase in infectiousness would have to be to make it certain that a HIT wasn’t reached months ago.

    • Numbers are readily available on the Internet. Using 1 week average: 40 days ago: 9.79 per million; today: 57.6. That’s almost 6X in 40 days. That translates into an Rt value of 1.3.
      See http://91-divoc.com/pages/covid-visualization/

      • mesocyclone
        98 people a week four weeks ago. 14 cases a day
        576 people a week now 82 cases a day
        I think most countries around the world would be happy to see such low numbers of cases.
        The rate of death is drastically reduced.
        You fail to put this up or point it out.
        This is due to the most elderly and vulnerable having recovered or died.
        17-19% of people now being immune including most of the people with superspreader behaviour.
        A lower risk population, a much lower risk of death in the remaining population.

        By the way, “That translates into an Rt value of 1.3.”
        It is very hard to translate an R value in this situation.
        Does it refer to the population as a whole which includes a 17-19% immune category or does it just apply to the roughly 80% of the population who are able to be infected?

        See http://91-divoc.com/pages/covid-visualization/
        thanks for this it shows Sweden as having very low infection rates.
        You did lookat the graphs, right?

      • angech –

        > 98 people a week four weeks ago. 14 cases a day
        576 people a week now 82 cases a day
        I think most countries around the world would be happy to see such low numbers of cases.

        What are these numbers?

      • Sweden has aproxx. 500 new cases a day the last week (7 – 14. oct)

      • Rune Valaker | October 14, 2020 at 11:31 pm |
        Sweden has aproxx. 500 new cases a day the last week (7 – 14. oct)
        Thanks Rune.
        My figures are out by x7 as I based them on mesocline using a weekly case number not a daily average
        “Using 1 week average: 40 days ago: 9.79 per million”

      • angech –

        Sweden, Denmark, Finland, and Norway all saw a similar pattern of initial spike in infectiousness followed by a dramatic drop and an extended plateau of low transmission rates. Except, of course, the scale of infections (and in particular resulting deaths) in Sweden was much greater.

        And now all are seeing a significant rise in transmission again. And actually, at this point the 7-day average in Sweden is higher per capita than either Finland or Norway, and comparable to Denmark.

        Now I can remember when Nic cherry-picked from short term patterns to conclude that transmission rates proved his thesis that “herd immunity” had been reached in Sweden. And your argument is that short term rates, now that they appear to be in contrast to the “herd immunity has been reached” proclamation, cannot disprove his assertion (that was based on short-term) rates. Funny.

        At any rate, if you want to stick to the longer term pattern from the beginning of the pandemic to now, we see similar patterns of transmission in all the Nordic countries (with the pattern playing out at higher levels in Sweden compared to its Nordic neighbors).

        Seems to me that the common sense conclusion is that despite somewhat different governmental policies, there is little to distinguish among them by looking at the consequences (except that Sweden has suffered much more death and more illness with little apparent economic advantage as if yet). And of coudse, the similarities in the behavioral patterns stand somewhat independently from differences in the government policies.

        The longer term pattern hardly makes a case for a determination that Sweden is distinguished among them by virtue of having reached a “herd immunity threshold” status months ago.

        It’s still early times. There is much uncertainty in the data w/r/t testing. Hopefully we’ll be able to reflect on this together some time hence. What looks like longer term patterns now may well turn out to be shorter term patterns after time has passed. Maybe in retrospect what is going on in Sweden right now is a “blip” (as compared to its Nordic neighbors) and going forward Sweden will see a much lower rate of transmission than its Nordic neighbors. For the sake of Swedes I hope it does.

        But your total certainty that “herd immunity” was reached months ago in Sweden, at this point, looks inconsistent with the evidence we’d expect from such an occurance – that Sweden would distinguish itself from other Nordic countries in terms of the patterns in transmission rates. Nic, and you, are the ones making the assertion thst Sweden should be distinguishable in its patten of transmission. Of course, maybe there are explanations for the patterns in the data that aren’t inconsistent with Sweden reaching a “herd immunity” threshold status months ago. But throwing post-hoc conjured up explanations at the wall to see if they stick amounts to little more than post-hoc rationalizations to avoid acknowledging error.

        I’ve never said that Nic’s assertion is disproven. What I have said is that he treats uncertainty in a selective fashion in order to argue that it has been proven. He may well prove correct in his assertions, time will tell – but from the patterns we see in the data thus far, that do not distinguish Sweden from its Nordic neighbors (let alone any number of other countries that saw a dramatic spike, followed by a dramatic drop, followed by a plateau at low transmission, followed by a spike) it looks like his certainty is not well grounded.

      • Angtech – I did not use a weekly case number. I used a 7 day average, as there tends to be noise at a sub-7 day level in data (weekends impacting reporting).

        Also, “Herd immunity is the stopping, at a certain level of infection, of virus spreading rapidly and increasingly through a population at a certain level of immunity at a certain time.” – that is not the normal definition of herd immunity, nor even a useful one except for its value in misleading arguments.

        Herd immunity has always meant when the “herd” is immune – meaning there is enough immunity that, with “life as usual” conditions, the epidemic will decline, or will prevent outbreaks from prospering.

        When the term is used conditionally, it just muddies the waters. Also, I agree with Joshua that the certainty of statements about herd immunity are unjustified.

        I think that the arguments about heterogeneity reducing the herd immunity threshold have merit, but I do not yet believe that herd immunity explains the case curves. In fact, the rapid, sustained rise in cases in Sweden proves (unless it is all testing artifact, which I doubt) that herd immunity was not reached earlier and has not been reached. Sweden’s casea re now 6.5X what they were 45 days ago, and over half their all time peak.

        Since you don’t seem to be actually using the site I recommended (91-divoc.com), here’s a link to the graphics for toay of Sweden, Finland and Norway. <

    • BTW… so far, the deaths per capita per day are roughly steady, suggesting that the rise at this point is among low risk people.

  71. -snip-
    Sweden and the U.S. are unique in their failure to reduce coronavirus mortality rates as the pandemic progressed

    -snip-

    https://time.com/5899432/sweden-coronovirus-disaster/

  72. This is the aspect of the data that franktoo keeps pointing out…

    -snip-
    On September 19, 2020, the US reported a total of 198 589 COVID-19 deaths (60.3/100 000), higher than countries with low and moderate COVID-19 mortality but comparable with high-mortality countries (Table 1). For instance, Australia (low mortality) had 3.3 deaths per 100 000 and Canada (moderate mortality) had 24.6 per 100 000. Conversely, Italy had 59.1 COVID-19 deaths per 100 000; Belgium had 86.8 per 100 000. If the US death rates were comparable to Australia, the US would have had 187 661 fewer COVID-19 deaths (94% of reported deaths), and if comparable with Canada, 117 622 fewer deaths (59%).

    While the US had a lower COVID-19 mortality rate than high-mortality countries during the early spring, after May 10, all 6 high-mortality countries had fewer deaths per 100 000 than the US. For instance, between May 10 and September 19, 2020, Italy’s death rate was 9.1/100 000 while the US’s rate was 36.9/100 000. If the US had comparable death rates with most high-mortality countries beginning May 10, it would have had 44 210 to 104 177 fewer deaths (22%-52%) (Table 1). If the US had comparable death rates beginning June 7, it would have had 28% to 43% fewer reported deaths (as a percentage overall).

    In the 14 countries with all-cause mortality data, the patterns found for COVID-19–specific deaths were similar for excess all-cause mortality (Table 2). In countries with moderate COVID-19 mortality, excess all-cause mortality remained negligible throughout the pandemic. In countries with high COVID-19 mortality, excess all-cause mortality reached as high as 102.1/100 000 in Spain, while in the US it was 71.6/100 000. However, since May 10 and June 7, excess all-cause mortality was higher in the US than in all high-mortality countries (Table 2).

    -snip-

    https://jamanetwork.com/journals/jama/fullarticle/2771841

  73. The Economist doubts the COVID success of Pakistan !

    https://www.economist.com/asia/2020/09/30/is-pakistan-really-handling-the-pandemic-better-than-india

    Indians cannot bear the pain of the success of Pakistan and Imran Khan.These Indian Parasites have proliferated in the Global Media – as Indian Corporates and the Indian State, sprinkle their ads,in the Global Media.

    The Right approach of the Economist,should have been to start from the Number of Tests per Million – which is just 16000 in Pakistan,vs around 65000 in India.That has some basis – but is also specious,as it is 30% higher than that of Indon-ass-eeah,which has a population, 20% HIGHER than Pakistan,and is next to PRC – with millions of Chinese in
    Jakarta and islands of that nation.dindooohindoo

    The Pakistani tests are also 30R higher (on a per million basis) w.r.t Nippon – which has a large population of Japanese in PRC,and also,has a very high frequency of air travel with the PRC.Several flights from Shang and Beijing,transit via Nippon.So the “Low Aggregate Tests” Theory of Pakistan,is busted.The Marginal Cost of each RTPCR test,is USD 10 and Pakistan cannot waste its funds on that

    Let us ASSUME,still, that the Pakistania are NOT coming for testing,AND that the Pakistani state is NOT testing.Therefore,the people are NOT showing symptoms – as else,by now,there would be a sharp SPIKE in deaths (young and old).There is 1 brilliant innovation by the Pakistani state – in that,they are testing the dead.AT the EOD,even if patients are not tested,AND THEY DIE – the virus would be in the dead body.

    The death rates in Pakistan,in general,are normal, and COVID rates in the dead,are also normal (w.r.t the age and morbidities of the dead) – so the STRATEGY of NOT doing random testing,TO AVOID scare mongering,has worked,as the bet is on the immunity of the Pakistanis, and a close monitoring of the generic death rates – with their COVID content.If it lasts the winter – then this could be a Harvard Case Study.

    India on the other hand,has a TEST COUNT of 60000 per Million.For the size of the Indian Pop,and the Intl flights transiting via India,in the pre Covid tenor,and the Tourists in India,in the pre-COVID tenor,this statistic is pathetic.Brazilw,ith a sixth of India’s Population,has 85000 tests per million ,and Chuna has 100000 plus

    The worst HIT nations are France and UK,with a DAILY CASE COUNT OF 18000,and a population of 65 million – which is 5% of the Indian population – and so ON A PER CAPITA BASIS, IT IS TYHE HIGHEST IN THE WORLD – far ahead of USA and Brazil.

    France sold the Rafael to the Indians,and UK has millions of Indians (who are also,the worst hit group)

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