
How This Ends. (The Pandemic) - gloriosoc
https://realscience.community/2020/08/26/how-this-ends/
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legerdemain
I'm a little surprised by the author's tendency of wondering abstractly and
suggesting cataclysmic shoot-from-the-hip solutions.

There still hasn't passed enough time for us to make confident statements
about immunity in patients who recover from acute COVID, not to mention make
grandiose plans, either as a state or as a society of individuals.

A popular blog post or article circulated earlier, plotting very simple
mathematical models of infection numbers based on some assumptions about the
durability of immunity. But even without visual aids, mathematical intuition
suggests that widespread immunity of short duration would lead to a relatively
high constant number of new cases, with relatively frequent small waves. In
contrast, widespread immunity of longer duration, on the order of a year or
two, would lead to lower background level of infection, punctuated by larger,
more severe, less frequent outbreaks, made worse if they are seasonal and
coincide with the flu.

And these are assumptions, things we don't know. Which of these scenarios
should we be making grand, nationwide plans for?

We saw a definitive report about an asymptomatic case of reinfection. That
patient managed to get tested twice, despite being reported as asymptomatic
the second time. Both times, the viral genome was sequenced, which is why we
now believe this is a case of reinfection.

In the US, this patient would likely not have been tested at all. Should we
update our expectations about the incidence of reinfection?

Are there differences in humoral and mucosal immunity to COVID? I don't think
we have consensus yet. Do asymptomatic carriers infect others? We have some
evidence that they do. Other diseases can be spread by asymptomatic carriers.
As an extreme example, Typhoid Mary was a real historical figure who infected
hundreds over a lifetime.

In this context, suggesting that we ship our most elderly and medically
fragile members to some kind of COVID-free zone is... staggeringly whimsical.

~~~
gloriosoc
The case of the person that got reinfected is grossly exaggerated. Don't you
think if this was really occurring frequently there wouldn't be only one or
two reported incidences of this world-wide? Asymptomatic carriers do
definitively infect others. Just because you personally are not sure of
things, doesn't mean that they are not known. And this "do nothing" approach
you are advocating for- which is what happens if you wait until everything is
fully and definitively proven- has resulted in the disastrous results the US
has had so far. Also please explain "suggesting cataclysmic shoot-from-the-hip
solutions"\- I don't think anything I suggested comes close to that. I said
that we shouldn't reopen colleges in places with rising cases. That doesn't
seem cataclysmic to me.

~~~
legerdemain

      > Don't you think if this was really occurring frequently there wouldn't be only one or two reported incidences of this world-wide?
    

No, for reasons I have already mentioned in my first comment.

The patient we think was reinfected was reported to have a mild case in the
spring. The US, at the time, had extremely limited access to tests for anyone
except the grievously ill. It is likely the patient would not have received a
test in the US, and certainly not had the infection genome-sequenced.

The second time the patient tested positive, he was asymptomatic. The CDC
currently recommends against testing asymptomatic individuals. It is likely
that, in the US, the patient would once again not have received a test.

Basically, the US tests sparsely and doesn't seem to test longitudinally on
any scale at all. Does any country in the world with more than a few thousand
cases test longitudinally?

If anything, I think it's more telling that this patient was identified in
Hong Kong, which only has 4.5 thousand cases total. Finding seemingly ironclad
evidence in such a small pool suggests that this isn't a rare phenomenon.

    
    
      > And this "do nothing" approach you are advocating for- which is what happens if you wait until everything is fully and definitively proven- has resulted in the disastrous results the US has had so far.
    

If I'm advocating anything at all (and I don't think I'm advocating anything
in my original comment), it's that we hold off on making aggressive policy
decisions based on our Swiss cheese "understanding" of COVID immunity. How
about working toward goals we set months ago and have since kept failing to
meet, such as ubiquitous access to testing and meaningful case tracing?

On the other hand, let's maybe hold off on jokes about sending Grandma to New
Orleans? The photo of the elderly woman wearing sparkly bangles is the joke,
but I think your suggestion right before that, that "we could send the highest
risk people to the places that are the most immune so they could be shielded"
is made seriously, right? Like, even moving an individual, medically fragile,
institutionalized elderly person leads to complicated and often negative
outcomes in the best of times, simply because of the complex and fragile
support systems their well-being relies on. Shipping "the highest risk people"
en masse and organizing care for them seems dramatically more complex than,
again, following through on testing and mitigation strategies that we, as a
state, have been paying lip service to for months now.

~~~
gloriosoc
It literally says "All joking aside" following that comment. I don't know how
much clearer I could have made that. I also advocate wearing masks,
distancing, protecting the vulnerable, and not opening schools. I don't know
how you can possibly be construing me as advocating for any of the extreme
things you are talking about.

~~~
legerdemain
The logical connection between our comments is pretty tenuous. I don't think
there is a need to continue the conversation. Good luck promoting your point
of view!

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pushcx
The user exists to promote this site. The author of this site admits they have
no expertise. This and previous posts make hyperbolic claims with little to no
evidence.

~~~
gloriosoc
I have an Md, a Phd, and I'm a computational biologist at MIT. I think this
qualifies as expertise.

~~~
pushcx
How does that relate to epidemiology? In a previous discussion here you made
basic errors like referring to a study from a single clinic as if it was
representative of all of New York.

~~~
gloriosoc
That's not an error. Epidemiologists are computational biologists. I don't
want to argue with you because that seems to be what you are solely after.

~~~
pushcx
I apologize, that didn't seem to be the case from the bio you give on the
site. the bio you link to, or your published research. Obviously you know your
background better than I do, but you're not putting your best foot forward to
build credibility.

I'm after pointing out that a self-promoted site on the front page makes
grandiose claims about public health with flimsy support.

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helen___keller
The only thing I have to contribute to this is a mention that social
connectivity should realistically be considered a function of covid caseload
(or more generally - community confidence). That picture of the big ol' party
in Wuhan is a great example (although china also follows up with massive
mandatory lockdowns whenever new hotspots are developing - a "luxury" we don't
have in the west)

This is the reason there _will_ be second, third, Nth, waves with a mere 20,
30% immunity

~~~
gloriosoc
Call me an optimist but I think the public can handle the nuance of cases have
dropped but still don't throw a crazy party until they are 100% gone or
everyone is vaccinated. Also levels are 20-30% now but will continue to rise
throughout the fall because there still are new cases and transmission even if
RT<1.

~~~
soganess
I really want to believe this. It neatly lines itself up with my worldview and
afford individuals the agency of being smart enough to do what is right 99% of
the time while also allowing for the freedom to make the rare "less than safe
choice" in situations that warrant it. That is the world I want to live in.

-BUT- I think to get there, we are going to need some serious education on this matter that actually penetrates the politics that have grown to dominate the pandemic. I don't think most people see it as "containment vs keep clam and hope everything is okay." Opting instead to see it as r-v-l.

To be clear, I don't blame anyone for thinking in those terms, that is the
narrative being presented. That said, I do ask that any theory hinging on
"people are able to handle nuance" provide some evidence for the claim that
can be directly applied to the now. In a world where individuals leer at each
other for not wearing masks in wide open outdoor spaces, while others yell
inside of Walmart about the constitution, it is hard to have belief in that
claim.

~~~
gloriosoc
I agree with your first two points whole heartedly. But I think we got into a
r-v-l place where the public has lost all trust BY paternalism. Trust means
giving people the truth. And my theory doesn't hinge on people behaving
responsibly at all. If people are irresponsible- this ends sooner with more
death. The theory is the same either way- the timeline and number of deaths
just change a bit.

