Questioning Conventional Wisdom - The virus

[dneal]

To start with a couple of asides:

1. The interviews Peter Robinson does at the Hoover Institution are very diverse and amazingly well done. He is a master. I recommend adding the “Uncommon Knowledge” pieces to your weekly schedule.

2. Since some of the more emotional posters should have me “ignored” now, hopefully a respectful conversation can take place. Please move on if you only have smug, smarmy comments.

Here is an intriguing discussion with Dr. Jay I’mgonnabutcherhislastname. He’s an MD and a fellow who contributes to economic policy research.

The points he makes regarding the “denominator” are crucial, but the whole thing is highly informative and great food for thought.

[mhosea]

I don't think Fauci or Birx would disagree with the assertion that we don't know the true mortality rate. There was a question at one of the press conferences, maybe 3 or 4 days ago (who can remember days anymore), where a CNN or other anti-Trump person was trying to manufacture evidence that Trump had "fiddled while Rome burned", i.e. if Trump had raised the alarm sooner and without ambiguity, could lives have been saved. Both Dr. Fauci and Birx responded that it was unknowable whether earlier mitigation would have helped precisely because we have no idea whether the virus was present and prevalent at earlier dates or not. Birx then emphasized the need for a test that determines whether someone has been exposed in the past and is now immune.

I think what's disturbing about this virus, and obviously different from non-novel influenza viruses in circulation, is the rate of hospitalization among those who develop enough symptoms to feel like they're fairly sick, as you would with the flu. If the rate were no worse than the flu, then we would not see hospitals filling up in Italy, nor shortages of ventilators, or anything of that sort. A paper I was reading the other day, which was just a run-down of statistics collected, implied (if I was reading it correctly) that for adults without serious comorbidities, the rate of hospitalization was around 10%, which is huge, i.e. get sick and have nothing else wrong with you, and you've got a 10% chance of needing to be admitted to a hospital. I don't know about you, but I don't think three weeks in a hospital is very attractive prospect to entertain at that probability rate. If there is a treatment that will knock that down to a 1% probability, it would be game changer. I know Tamiflu helps with the flu, but paradoxically, it does not reduce the rate of serious complications. Nevertheless, I keep hearing generally positive things about hydroxychloroquine (sometimes with azithromycin). I think they are focusing mainly on seriously ill patients, but I have to wonder whether it might help if prescribed after people develop symptoms and before they develop shortness of breath. There are other treatments in the works as well.

One area where I vociferously disagree with Fauci, and I do so as a scientist, is the notion that we have to prove treatments safe and effective before employing them at a time like this. This is parochial thinking. We're not talking about an anti-hypertensive or some other drug which will ostensibly be taken for life. If the treatment can reasonably be expected not to do serious, lasting harm, and it isn't expensive, if in the worst case it is no better than placebo, then not having solid proof that it is better than placebo should be no obstacle. Sure, a placebo would be cheaper, but expense is not a factor when you've shut down the economy because you do not have a cure. Anecdotal studies do not prove efficacy, but the only thing we really need to know in a time when it makes sense to act on imperfect knowledge, like now, is that it will likely do no harm. If it doesn't work, we'll stop suspecting that it does PDQ, because it won't.

[ilikenails]

I don't think Fauci or Birx would disagree with the assertion that we don't know the true mortality rate. There was a question at one of the press conferences, maybe 3 or 4 days ago (who can remember days anymore), where a CNN or other anti-Trump person was trying to manufacture evidence that Trump had "fiddled while Rome burned", i.e. if Trump had raised the alarm sooner and without ambiguity, could lives have been saved. Both Dr. Fauci and Birx responded that it was unknowable whether earlier mitigation would have helped precisely because we have no idea whether the virus was present and prevalent at earlier dates or not. Birx then emphasized the need for a test that determines whether someone has been exposed in the past and is now immune.

No, they really didn't. Because earlier mitigation always helps. If you restrict the spread at the point where the virus has infected 1% that's better than 2%. If you mitigate at 20% that's better than at 30%. Etc.

One area where I vociferously disagree with Fauci, and I do so as a scientist, is the notion that we have to prove treatments safe and effective before employing them at a time like this. This is parochial thinking.

I have to ask

1. Why being "a scientist" is relevant?

and

2. What sort of scientist doesn't know what "parochial" means?

Seriously - what sort of "scientist" are you??? I have a degree in theoretical physics but I'm not about to walk into the local hospital and tell them to change how they're treating people based on the first opinion I wake up with tomorrow morning...

if in the worst case it is no better than placebo

No one who knows anything about medical treatment would make that assumption. A *lot* of medical treatments have very high risks if even applied to healthy people who don't need them. If you give them to people already badly sick, the risks get much higher. To give one very simple example that you should have known about:

https://www.bmj.com/content/368/bmj.m1086
Scientists and senior doctors have backed claims by France’s health minister that people showing symptoms of covid-19 should use paracetamol (acetaminophen) rather than ibuprofen, a drug they said might exacerbate the condition.

In the case of chloroquinine, side effects side effects can vomiting, cramps, and diarrhea

https://www.buzzfeednews.com/article...rs-coronavirus

...If you give a drug with zero effectiveness to very sick people - many of who are old and have other medical problems - and it creates symptoms like this in some of them, then the mortality rate will go UP not down. This isn't quantum mechanics - it's basic stuff.

Again - I really am curious what sort of "scientist" you are, because most of the ones I know stuff like this as basic general knowledge and would NEVER assume that a active drug can only be as bad as a placebo. Come to think of it - if you'd ever watched a couple of episodes of House you'd know better than that.

[mhosea]

In the case of chloroquinine, side effects side effects can vomiting, cramps, and diarrhea

My impression was that experience with chloroquine has been negative for COVID-19. I did not mention this drug.

I think you have misapprehended my intention of saying "as a scientist". It was not intended as an appeal to authority. My intention was to indicate that the opinion to follow was, in some sense, against my nature. I also felt that, as a member of the club, I was entitled to my opinion. But it was stated only as an opinion, and if you disagree, you are entitled to say so. I have no objection whatsoever, though I would be happier to receive it if it were offered in a less caustic manner. I have been known to change my opinions when presented with sound arguments.

The premise I articulated was that the clinician determines that the proposed treatment will likely do no harm. I certainly never suggested that such medications be made available without a prescription. At the time I made that remark, Fauci had been advocating for a normal scientific approach of proving that the drug was effective in randomized double-blinded trials before utilizing hydroxychloroquine for COVID-19 treatment except for "compassionate use" circumstances. A little back-of-the-envelope math suggested that if hydroxychloroquine actually does help, it would be weeks at a minimum before any preliminary data was available, and even that would require a bit of magic in order to conjure up the administrative details to put a study in motion. I do not know whether he changed his mind or his preferences became irrelevant, because my understanding is that it is now being used more generally. Whether it is effective remains an open question, I suppose.

Generally, for a prescription medicine to be approved for something, it should be proven both safe and effective (relatively). We cannot rush the deployment of a vaccine, for example, because it would be a completely new vaccine, and we would have no way to know it was safe. It might or might not even be effective, but having no safety data makes the risk of doing harm very high. In the case of hydroxychloroquine, we do know the drug's side effects, so a clinician prescribing it for COVID-19 knows what to watch out for. While we don't know what dosage would be effective for COVID-19, if any, we do at least know some dosage information for on-label uses. Naturally in a given case it could be contraindicated. I'm not saying it should be used. Rather, that it should be up to the clinician, not the scientist, to determine whether to give it a try.

The word "parochial" is a segue into another way of looking at it. I used the word "parochial" to mean "having a limited or narrow outlook or scope." The "parish" I had in mind was that of the medical researcher operating in normal circumstances, the concept of the church and its dogma being replaced with the unbending requirements of the scientific method, which in this case mandates the use of double-blinded randomized controlled studies to determine safety and efficacy before approving of the use of a drug. Within this "parish", the scientist is concerned with proof, and he isn't wrong about what is required to establish that proof. While he may feel pressure to proceed as quickly as possible, he does not question his core assumption that proving efficacy is a prerequisite to using the drug. We do have the aforementioned "compassionate use" exception for exigent circumstances, but how can we apply that here, given the way COVID-19 kills when it kills? We don't know who will develop ARDS and who will not, and compassionate use only applies once a great deal of lung damage is done. We're not talking about a cure, rather a substance that is believed to reduce the viral load. You could restate my opinion as asserting that, for this drug, clinicians needed a broader exception than "compassionate use".

[manoeuver]

dneal, are you willing to bullet point or summarize the contents of that video for those of us who aren't able to watch it?

I believe it's important to have a good faith conversation that questions what's going on and the decisions we're all subject to, but I am not able to put a half hour into watching the video at present.

I could guess at what they're talking about but I don't suppose that would be in good faith.

thanks!

[dneal]

dneal, are you willing to bullet point or summarize the contents of that video for those of us who aren't able to watch it?

This is a summary, not a transcript; so I've reorganized some parts of the discussion to improve brevity.

Dr. Bhattacharya is an MD that has been working on the coronavirus nonstop, but also holds a Ph D in Economics. It's useful because he understands both sides of the coin, so to speak.

He wrote an article for the Wall Street Journal (published 24 March) titled "Is the Coronavirus as Deadly as They Say?"

Although it garnered both nods of approval and accusations of irresponsibility, he notes that although "experts" are viewed as "authorities"; they need to be as openly honest about what they do and don't know - and they don't know a lot right now (although they're learning rapidly).

Dr. Fauci from the CDC was quoted as saying (in early March) "The flu has a mortality rate of 0.1%. This [coronavirus] has a mortality rate of ten times that." Dr. B's opinion, published in his article is: "An epidemic seed on January 1st implies that by March 9th about six million people in the U.S. would have been infected. As of March 23... there were 499 Covid-19 deaths in the U.S... that's a mortality rate of 0.01%."

There is an order of magnitude difference here. Dr. B is clear that they don't know, are making educated guesses, and the discussion gets to what we're actually talking about. The term is "Measured Case Fatality Rate". That's:

Total number of new deaths due to disease
--------------------------------------------
Total number of incident patients with disease

The problem is that we don't really know the denominator, and current estimates are worst case based on a denominator of those whose illness was severe enough to warrant seeking treatment. The FDA approved a serological test a week or so ago. That will identify if a person possesses antibodies (indicating they had the virus and recovered). Until now, we were only able to identify the presence of the virus.

The media picks up on the numbers (particularly the worst case numbers) and tend to sensationalize them. Politicians respond to that. What we've seen is a very wide range, from an epidemic that will kill 2m-4m people, to one that will kill 50k-100k. That's an incredibly broad range and the policies you implement in either case are significantly different.

Holman W. Jenkins, Jr. (an journalist at the WSJ) had a quote referenced: "We are crushing our economy simply to meter out how quickly these consequences fall on our exhausted healthcare workers... I repeat: We are slowing the economy to a crawl to slot the rate of a thing happening that will happen anyway."

Dr. B points out that the virus is in fact deadly, there's value to "flattening the curve", and Italy is a case study when a healthcare system is overwhelmed. BUT, If the case fatality rate is actually much less than the worst case estimates, then this essentially "universal quarantine" we have is incredibly costly.

Although people make the argument that "it's dollars to lives", it's actually "lives to lives" and a global economic collapse will cost the lives of millions of people. The global rise in GDP has raised life expectancy everywhere. Countries are able to care for their populations. In poorer countries, cases of diseases have slowly been eliminated. That won't be the case as economies suffer or collapse. The last "great recession" alone documented lives lost to despair (opioid overdose, suicide due to depression, etc...). It will unnecessarily shorten life expectancy, particularly in poorer countries, if nothing else.

So what to do...?

A few weeks of quarantine will not eliminate the virus. We will need to evaluate healthcare capacity regionally and let people get on with their economic lives in those places where we can manage the infection. Widespread testing of the new serological test will help with this. There are several treatments being experimented with, and this raises the question mhosea alludes to with whether or not the ponderous bureaucracy is helping or hindering.

And the future...?

Dr. B thinks this is the new normal, and the cost of globalization. What we need is a 21st century approach to this happening again, and a method of "population surveillance" (not in a nefarious "big brother" sense), but routinely surveying blood samples, for example, just like we do with political opinion and other polls/surveys.

---

Here is the video description, which is informative as well.

Dr. Jay Bhattacharya is a professor of medicine at Stanford University. He is a research associate at the National Bureau of Economic Research and a senior fellow at both the Stanford Institute for Economic Policy Research and the Stanford Freeman Spogli Institute. His March 24, 2020, article in the Wall Street Journal questions the premise that “coronavirus would kill millions without shelter-in-place orders and quarantines.” In the article he suggests that “there’s little evidence to confirm that premise—and projections of the death toll could plausibly be orders of magnitude too high.” In this edition of Uncommon Knowledge with Peter Robinson we asked Dr. Bhattacharya to defend that statement and describe to us how he arrived at this conclusion. We get into the details of his research, which used data collected from hotspots around the world and his background as a doctor, a medical researcher, and an economist. It’s not popular right now to question conventional wisdom on sheltering in place, but Dr. Bhattacharya makes a strong case for challenging it, based in economics and science.

[dneal]

@mhosea - Great post. The thing that gets me about Italy is that it was a relatively high average age population, which appears to be more susceptible (but that goes for the flu as well); and that they have one of the smallest numbers of per-capita critical care beds. Even if it was a "perfect storm", you make a good point in raising the question of why they were affected so seriously. Perhaps it was a matter of exceeding capacity, which is the justification for the "flatten the curve" approach.

You did make me wonder about the hospitalization rate for influenza. Here's the link to the CDC. It varies year to year, but it's much higher than I thought (and that's with the availability of a vaccine). I wonder how the public would react if the media hyped it every year like they have this strain of coronavirus.

I agree with you about treatment. Hydroxychloroquine is prescribed as a preventative as well as a treatment for malaria, although the Army gave us Mefloquine for deployments. Anyway, it does seem odd that suddenly health organizations are hesitant about it. My understanding is that azithromycin is added for secondary (bacterial) infections.


@manoeuver - I suppose I could do that, but I'd need to watch it again and make notes. Give me some time.

[Chrissy]

According to what I've seen online some of those stats have changed. As of today there are 339,028 known cases of coronavirus in the US and out of those 9,687 have sadly died. That number has risen 2355 cases and 71 deaths from yesterday.
No cases were noted before February 15th, so IMHO we shouldn't be taking January 1st as the start point.

[dneal]

According to what I've seen online some of those stats have changed. As of today there are 339,028 known cases of coronavirus in the US and out of those 9,687 have sadly died. That number has risen 2355 cases and 71 deaths from yesterday.
No cases were noted before February 15th, so IMHO we shouldn't be taking January 1st as the start point.

Good point, and I have no idea when we would start counting a thing we weren't really looking for - let alone capable of testing for. I wonder how many people just thought they had the flu (or even died from it), when it could have been coronavirus. Of course we will never really know.

I'm reminded of the time I got Lyme disease from a tick bite at Fort Chaffee, AR. Symptoms showed some time later, and when I called my doctor with my suspicions, particularly the tell-tale "ring" around the site of the bite. He was on vacation, but his quack partner responded: "There's no way you could have Lyme, because no cases have been reported in this area". Well, with that logic there never would be; never mind that I wasn't in "this area" when I was bitten...

[Ray-VIgo]

We have two large unknowns: the first is how many people actually have gotten the coronavirus, and the second is what will happen to the law and economy. Where I am, in order to get tested, you need a doctor's order and to be pretty sick already. Otherwise, you are told to just presume you have coronavirus and quarantine yourself at home for two weeks. We have no clue how many people have actually gotten the coronavirus. At best, we're using the test data as a sort of crude "tip of the iceberg" multiplier. Then there is the question of whether people, as is happening now in China, become infected a second time in an asymptomatic way - how contagious is that?

Second, business has stopped or severely slowed for most entities and employees (not all, but most people). Meanwhile debts and overhead continue to accrue on a time basis, regardless of the coronavirus or people being out of work. Does the government continue to offer assistance like unemployment or SBA loans? If so, what if the processing time is so large as to render them useless - if someone goes on unemployment but does not see any money for 2 months, what does that mean? Does the government try to "freeze" debts (e.g., call for a moratorium on mortgage payments? Rents? etc?). What are the legal implications of such action (e.g., a "taking" of property without due compensation?). Some jurisdictions have put a moratorium on evictions - but what happens to the ball of rent or mortgage payments once the crisis has passed? What are the limits of governance by executive orders? Where I am located the governor has suspended whole swaths of state law by fiat - 200 years of statutes swept away by a signature. Which of these actions are constitutional? What is the remedy if there is an unconstitutional act, and how will it be handled (our state courts here are shut down to everything except emergency orders). Will all of the statutes go back into effect when this is over, or will some of them continue to be suspended? What role does the government have in combating hoarding or ensuring supply chain (e.g., N95 masks perhaps, but what about toilet paper and other secondary sanitary items that seem unrelated, but which cause panic)?

The United States will rise to the occasion and gain the upper-hand in due course. What concerns me is the initial phase of haphazard response, in looking at federal and state governments. Only in the week or so has the full machinery come to bear in expanding hospital capacity and allotting resources. I think we're finding our feet more and more as time goes on. But there needs to be hard lessons taken from the early response and lack of coordination and comprehension. In retrospect, the country needed to jump right onto testing prep, coordination production of vital machines, and allocating hospital resources as soon as we learned about the outbreak getting out of control in China (and certainly China willfully covered up the extent of the problem until it proved to be too much). The notion of denial that, "it can't or won't get as far as here" should go into the dustbin.

[mhosea]

I had been looking at https://covid19.healthdata.org/projections, which Massachusetts had been tracking pretty closely, actually just above the projection line. The latest update made it virtually useless, extending the confidence bands so high and so low that it almost can't be wrong, and worse, I can't even correlate their actual figure for the number of deaths in MA on April 4 with any official report. Previously I had been able to. At any rate, if anything about this model is useful, within 2 weeks it should be apparent what will happen in Massachusetts. Either they will be talking about hospitals being full and no respirators available, or they won't. My wife is a medical coder who works remotely for a hospital system that extends from NM to FL and up to TN. Because elective procedures have been put off, the coders don't have enough work. The hospitals must be at very low utilization. You have to wonder whether putting off elective procedures in states that have not been hard hit was the correct decision in hindsight. If it is about to get bad somewhere, then maybe start putting them off at that point, not weeks beforehand.

[manoeuver]

Everything about this epidemic is a lesson in how to act when you don't have information.

I understand that people are skeptical of the measures we're taking to contain the virus in the US.
These measures hurt-- I'm feeling it. My businesses are currently mostly demolished.

It's a double whammy, cause if the measures work as we hope they do, the numbers of infected and the numbers of deaths will stay low.
If we're able to keep casualties low, we'll never hear the end of it from the armchair critics.

Another criticism I hear is coming almost exclusively from Academia: the data we have don't support the measures we're taking.
As if that data exists somewhere. It's deadly nonsense. You don't wait for a DNA analysis to find out if it's a grizzly or black bear in your tent before you do something.
You don't put your seat belt on after you've determined that yes, your car has been t-boned.

Looking forward, I can't imagine Americans supporting measures that would make border lockdowns and contact tracing easy for fed and local governments to enact.
And I'm not sure they should anyway. We've lost faith in our institutions, and for damn good reasons.

I dunno. stay safe folks.

[welch]

We don't know the number of deaths from the Coronavirus. A cause of death has to be assigned by a medical examiner, at least in the US. Different ME's can have different standards. It not certain that medical people should be taking time from treating CV to assign an accurate cause of death.

The entire video seems to be yet another silly example of right-wing college boys who have an over-powering desire to defend Trump's inaction, before mid-March, and to defend Trump's wacky-toon daily meandering attacks on doctors, hospitals, experts, and states with Democratic governors.

Pointless.

[dneal]

We don't know the number of deaths from the Coronavirus. A cause of death has to be assigned by a medical examiner, at least in the US. Different ME's can have different standards. It not certain that medical people should be taking time from treating CV to assign an accurate cause of death.

The entire video seems to be yet another silly example of right-wing college boys who have an over-powering desire to defend Trump's inaction, before mid-March, and to defend Trump's wacky-toon daily meandering attacks on doctors, hospitals, experts, and states with Democratic governors.

Pointless.

Thanks for contributing absolutely nothing worthwhile to this thread. Here’s the other one, feel free to go be an ass in there. I’ll even play.

See Dave’s post for an example of how to present the other side of the argument. Thanks Dave.

[mhosea]

The entire video seems to be yet another silly example of right-wing college boys who have an over-powering desire to defend Trump's inaction, before mid-March, and to defend Trump's wacky-toon daily meandering attacks on doctors, hospitals, experts, and states with Democratic governors.

You might want to watch the video before trying to characterize it.

[Dave]

Sentinel surveillance already exists for influenza (it is a reportable disease), so setting one up for SARS-CoV-2 should be fairly straightforward.

Incidentally, in the video the speaker mentions EVD* in the same breath as the current pandemic. EVD never achieved pandemic status. However, lessons learned from attempts to contain and treat this much more dangerous infection are valuable. Typically those measures included PPE for health workers, isolation, quarantine and contact tracing. All methods that have been tried and/or are in place for dealing with SARS-CoV-2 in countries other than the US, with good results in many places.

There is now a vaccine for EVD - which took nearly 5 years to develop.

So what is to be done now? Hard to say.

H1N1, swine flu or US flu if we use Trump's logic behind naming these things, was reported by the WHO as a pandemic two months after the first cases were reported in the US. About the same length of time it took to achieve significant infection levels in all 50 States. H1N1 resulted in approximately 61 million infected Americans and 12,469 confirmed disease-related deaths (fatality rate 0.02%). Current SARS-CoV-2 confirmed deaths in the US has just passed 10,000.* These are scary numbers.

There is now a vaccine for H1N1 - which took about 7 months to develop.

If people continue working, if non-symptomatic people may be carriers, and if the infection rate and mechanisms are correct and the death rate fits to current modelling, then it can be expected that the sheer number of deaths in the US will escalate geometrically. This will have a knock effect in general industry, to say nothing of the potentially catastrophic burden to the health services - which will further exacerbate the situation.

There will be a vaccine for SARS-CoV-2 in due course.

One point to consider is that the Great Depression (1929-37) is not a good indicator of what an economic downturn would look like today. Mortality rates as a total remained more or less steady, although there were shifts in rates across mechanisms of death - for example, vehicle related deaths dropped sharply while suicide rates rose (the former by a much greater number). Also, that period of history (globally) is marked by a number of innovations and improvements in healthcare, which will affect the statistics. In addition, during the Great Depression there wasn't anywhere near the level of federal reserve that there is today, so a bailout was much less, and was more or less was addressed afterwards by the New Deal. At present the US has this massive bailout going, but nothing has been yet said about what happens later - at least not that I've read.



Edited to add two points of clarification:

EVD = Ebola viral disease.

In the death rate comparison between H1N1 and SARS-CoV-2, as the video shows, the incidence of the SARS-CoV-2 is unknown, but it is perhaps reasonable at this stage to predict it is less than the 61mil seen in H1N1, meaning the measured case fatality rate (MCFR) will be higher for now. However, this doesn't say anything about the MCFR in the future. Incidence may decline and overall death rate may be adjusted to a much lower figure.

[dneal]

Sentinel surveillance already exists for influenza (it is a reportable disease), so setting one up for SARS-CoV-2 should be fairly straightforward.

I think that was the point he was making, but I wasn't clear if he meant that we randomly sample things like lipid draws just to check. I don't even know how that would work if it's another novel virus. Perhaps its just limiting to symptoms present, and sending a blood sample off to a research lab. The DOD was supposed to stand up three (I think, maybe four), but that's been a bureaucratic hole money has been dumped into with no worthwhile results so far.

If people continue working, if non-symptomatic people may be carriers, and if the infection rate and mechanisms are correct and the death rate fits to current modelling, then it can be expected that the sheer number of deaths in the US will escalate geometrically. This will have a knock effect in general industry, to say nothing of the potentially catastrophic burden to the health services - which will further exacerbate the situation.

I agree to a great extent. It seems that resources need to be invested in identifying 3 general groups:

1. Those with antibodies present, who are assumed to have had the disease. They go back to their normal lives.
2. Those with the active virus. They quarantine and are treated appropriately.
3. Those with neither. I'm not sure what to do about them. Some are easier sub-categories, like those more vulnerable. But shouldn't we assume the inevitability of catching the virus? The Spanish Flu ran for about 3 years.

One point to consider is that the Great Depression (1929-37) is not a good indicator of what an economic downturn would look like today. Mortality rates as a total remained more or less steady, although there were shifts in rates across mechanisms of death - for example, vehicle related deaths dropped sharply while suicide rates rose (the former by a much greater number). Also, that period of history (globally) is marked by a number of innovations and improvements in healthcare, which will affect the statistics. In addition, during the Great Depression there wasn't anywhere near the level of federal reserve that there is today, so a bailout was much less, and was more or less was addressed afterwards by the New Deal. At present the US has this massive bailout going, but nothing has been yet said about what happens later - at least not that I've read.

Great points, but I think it misses a couple of things. The society during the Depression was largely self sufficient with food production. That's not the case anymore. Hungry people are dangerous people. The other thing is how the Depression affected the world outside of the U.S. There are lots of reasons for WWII, ranging from the shoddiness of the Treaty of Versailles to the adjustment from an Imperial Europe to a Democratic one; but the hyperinflation exhibited during the Weimar Republic weighed heavily. It will be interesting to see how relations between countries pan out when this is over, particularly the EU.

[TSherbs]

This video presents the conventional wisdom; it doesn't question it. The math was basic, and both presenters admitted that no one knows accurate morbidity rates. This is what everyone says, if you pay attention past the headlines and sound bites. Everyone already knows that we are instituting measures now to prevent worst-case scenarios, even while we don't know accurate infection rates. The interviewee did not question the merits of flattening the curve, either. Flattening the curve has never meant that fewer people are exposed in total. I didn't see any unconventional wisdom here at all. Everyone already knows that IF we find out that certain people are immune or that the medical systems can handle the serious case load, then we will ease restrictions. Second and third waves of disease spread are not uncommon, which we also already know. Our restriction lifting will likely be in stages and with purposeful planning. We already know this, too. Many industries will alter how they manage worker and customer space. We already know this too. Some people haven't thought about it all much, but that is just some people.

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[dneal]

This video presents the conventional wisdom; it doesn't question it. The math was basic, and both presenters admitted that no one knows accurate morbidity rates. This is what everyone says, if you pay attention past the headlines and sound bites. Everyone already knows that we are instituting measures now to prevent worst-case scenarios, even while we don't know accurate infection rates. The interviewee did not question the merits of flattening the curve, either. Flattening the curve has never meant that fewer people are exposed in total. I didn't see any unconventional wisdom here at all. Everyone already knows that IF we find out that certain people are immune or that the medical systems can handle the serious case load, then we will ease restrictions. Second and third waves of disease spread are not uncommon, which we also already know. Our restriction lifting will likely be in stages and with purposeful planning. We already know this, too. Many industries will alter how they manage worker and customer space. We already know this too. Some people haven't thought about it all much, but that is just some people.

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In fairness, it's a fast moving train and the article they're discussing was published two weeks ago. The interview was a week ago. Doesn't seem like much, but those are light years of learning about this thing. The conventional wisdom at that time was anywhere from 3-8% fatality rate (or more, depending on who was asked).

[TSherbs]

This video presents the conventional wisdom; it doesn't question it. The math was basic, and both presenters admitted that no one knows accurate morbidity rates. This is what everyone says, if you pay attention past the headlines and sound bites. Everyone already knows that we are instituting measures now to prevent worst-case scenarios, even while we don't know accurate infection rates. The interviewee did not question the merits of flattening the curve, either. Flattening the curve has never meant that fewer people are exposed in total. I didn't see any unconventional wisdom here at all. Everyone already knows that IF we find out that certain people are immune or that the medical systems can handle the serious case load, then we will ease restrictions. Second and third waves of disease spread are not uncommon, which we also already know. Our restriction lifting will likely be in stages and with purposeful planning. We already know this, too. Many industries will alter how they manage worker and customer space. We already know this too. Some people haven't thought about it all much, but that is just some people.

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In fairness, it's a fast moving train and the article they're discussing was published two weeks ago. The interview was a week ago. Doesn't seem like much, but those are light years of learning about this thing. The conventional wisdom at that time was anywhere from 3-8% fatality rate (or more, depending on who was asked).

You posted it two days ago, right? I'm simply pointing out that there is actually much agreement after you cut through journalistic and political polarity, which revolts me on the television and on these threads. That gentleman doing the interview kept trying to amp up the guy he was interviewing. I was pleased with how the interviewee resisted hyperbole and cheap zingers.

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