Fear and Loathing, a Rat Flu Odyssey

[MultiVerse]

Interesting point about Fauci again--his ability to stay on the fences with the politicians may be less valuable these days than it was last year.

Yeah, the Trump admin received a lot of well deserved criticism for not having a national strategy. But if you read the "The Plague Year" New Yorker article everyone was passing around a month or so ago there was a behind the scenes strategy. From the very beginning the strategy was to manage the pandemic by hospital capacity.

Fauci couldn't say that outright without enraging his bosses so instead there was this balancing act between toeing the official line and saying what should be said. That's not as valuable as it once was.

[old goat]

The medical profession is more concerned with errors of commission than they are errors of omission. For a bunch of behavioral reasons failing to act is not perceived to be as bad as taking an action that subsequently causes some harm.

Ha!. You obviously know nothing about surgical training. : - ) No intern is ever asked why did you order that unnecessary test. Only why didn't you order that unnecessary test. No resident is ever applauded for not operating on a patient who gets better on their own, or ever criticized for promptly and decisively operating on someone who turned out not to need surgery. (Decisiveness and judgement are highly valued among surgeons. But judgement is making a decision without knowing all the facts, sometimes necessary, often not. My mantra was--"make no decision before it's time". The hard part is knowing when it's time).

What I would really like to see now is some planning and spending for the next pandemic. We are going to have to figure out how to build the infrastructure to make huge quantities of vaccine in a hurry, huge quantities of antiviral drugs and antibodies, huge quantities of PPE (I guess if we can make enough vaccine fast enough we won't need as much PPE)--and then we are going to have to figure out how to sustain that infrastructure between pandemics. We can't have a repeat of that Texas company that geared up to produce N95s for SARS and then nearly went out of business when demand disappeared. (One benefit of robots is that in manufacturing that his big ups and downs, you don't have to pay them or lay them off during the downs. Just lubricate them once in a while.)

In a broader sense, this country needs to figure out what products and technology we cannot depend on foreign adversaries for and then we need to subsidize and otherwise support the domestic production of it.

[truckeelocal]

In a broader sense, this country needs to figure out what products and technology we cannot depend on foreign adversaries for and then we need to subsidize and otherwise support the domestic production of it.

Like corn, oil, and stupidity ?

[Catfish]

Yes I do believe that literally every single young person’s life in the United States has been ruined by the coronahoax.

Also, Malice is amazing. Awesome to see liberals like him and rogan becoming more conservative by the hour.

[The AD]

Not to say it doesn't happened, but we're a year into this and I've yet to see anyone actually berated in public for not wearing a mask.

[jono]

My mantra was--"make no decision before it's time". The hard part is knowing when it's time).

....

We can't have a repeat of that Texas company that geared up to produce N95s for SARS and then nearly went out of business when demand disappeared. (One benefit of robots is that in manufacturing that his big ups and downs, you don't have to pay them or lay them off during the downs. Just lubricate them once in a while.)

The ability to lay off employees if things don't go as expected actually encourages manufacturing to ramp up. Not as nice for the employees but less binding on the bean counters. If you make a decision on a robot too early and have to pay to store it or walk around it on your production floor, or just keep paying the loan interest the thing winds up scrapped real quick. (Maybe that's the wrong approach, but that's how it generally goes--no idea if that's some accounting thing or what, but manufacturers don't survive in this country without going lean.)

We could just guarantee government buys at some nice, low price up to some eventual maximum quantity, though. That would have worked better than begging the Chinese to fly some of theirs over while ours were on the way to Asia.

[old goat]

The ability to lay off employees if things don't go as expected actually encourages manufacturing to ramp up. Not as nice for the employees but less binding on the bean counters. If you make a decision on a robot too early and have to pay to store it or walk around it on your production floor, or just keep paying the loan interest the thing winds up scrapped real quick. (Maybe that's the wrong approach, but that's how it generally goes--no idea if that's some accounting thing or what, but manufacturers don't survive in this country without going lean.)

We could just guarantee government buys at some nice, low price up to some eventual maximum quantity, though. That would have worked better than begging the Chinese to fly some of theirs over while ours were on the way to Asia.

I'm guessing that for vaccines and drugs especially and maybe for N95's you can't just hire people off the street like Macy's at Christmas. It may turn out that we just have to pay companies to be on standby to ramp up production in a hurry. It's not unprecedented to have expensive technology sitting unused just in case--think hydrogen bombs.
We can continue to grow a stockpile of stuff like PPE but vaccines have to be made fresh to fight the latest pathogen of concern.
Obviously the other thing we can do is simply put prohibitive tariffs on stuff like PPE so that there is no incentive for hospitals to buy the Chinese stuff. Free trade is only a good idea if it's among friends (and in a pandemic countries have no friends. I'm guessing there aren't too many otherwise progressive Americans who are in a hurry to send vaccines to Africa and South America before we've taken care of our own.)

[Casey E]

Good article on possible herd immunity scenarios

https://www.nytimes.com/interactive/...e=articleShare

Oodles of assumptions. Example:




Dunno if there is a paywall on this one.

[Mustonen]

The ability to lay off employees if things don't go as expected actually encourages manufacturing to ramp up. Not as nice for the employees but less binding on the bean counters. If you make a decision on a robot too early and have to pay to store it or walk around it on your production floor, or just keep paying the loan interest the thing winds up scrapped real quick. (Maybe that's the wrong approach, but that's how it generally goes--no idea if that's some accounting thing or what, but manufacturers don't survive in this country without going lean.)

It can take years for investment in automation to pay off, too. In my industry, it’s between 2 and 6 years for the capitalized expense to make sense against just hiring and maintaining an FTE. No idea what it would be here, but I’m sure they’re looking at capital expenditures that can’t be cheaply wound down.

[concretejungle]

Party of small government strikes again. I don't know how much more I've got in me. This is so fucking dumb and exhausting.

https://montanafreepress.org/2021/02...ates-advances/

[Kinnikinnick]

Party of small government strikes again. I don't know how much more I've got in me. This is so fucking dumb and exhausting.

https://montanafreepress.org/2021/02...ates-advances/

Montana is rife with Trumptards, many of whom I am related to.


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[MultiVerse]

Ha!. You obviously know nothing about surgical training. : - )

Heh, can I interest you in more info on the surgical placebo effect?

FWIW, commission (which medical ethicists hate) would involve voluntary human challenge trials with a few hundred people versus omission involving tens of thousands in a randomly controlled trial. For some reason it is better to run a slower trial risking orders of magnitude more people rather than a faster trial involving fewer people, potentially resulting in faster vaccine approval thus saving hundreds of thousands more lives.

In context, the medical community would rather run a months long trial (omission) instead of using the available evidence (commission) to determine whether a first-dose-first policy makes sense.

[Rasputin]

Party of small government strikes again. I don't know how much more I've got in me. This is so fucking dumb and exhausting.

https://montanafreepress.org/2021/02...ates-advances/

Yes, stupidly exhausting, if they were carpenters, they'd blame the hammer when they hit their thumbs. Sigh.

[riser4]

This was the view a year ago at Logan Airport where I was waiting with thing #2 for a flight to Madrid at the next gate over.

[old goat]

Heh, can I interest you in more info on the surgical placebo effect?

FWIW, commission (which medical ethicists hate) would involve voluntary human challenge trials with a few hundred people versus omission involving tens of thousands in a randomly controlled trial. For some reason it is better to run a slower trial risking orders of magnitude more people rather than a faster trial involving fewer people, potentially resulting in faster vaccine approval thus saving hundreds of thousands more lives.

In context, the medical community would rather run a months long trial (omission) instead of using the available evidence (commission) to determine whether a first-dose-first policy makes sense.

If they are going to consider a one dose policy they need to follow a subset of patients to see if and when cases start to rise, like I am sure Moderna and Pfizer are doing with their phase 3 patients. No need for a RCT, they can use historical controls or use the patients as their own controls over time, and they can do it simultaneously with mass 1 dose vaccination, but at some point we need to know if and when a second dose is needed.

[XXX-er]

“primum non nocere,” eh

[old goat]

“primum non nocere,” eh

that's what multiverse was talking about--physicians preferring to make errors of omission rather than commission. But both can be equally deadly. It is important to remember that at the time the phrase was popularized in the 19th Century, just about anything doctors could do made things worse. Doctors today still can make things worse, but in many cases they can make things better. Nowadays the phrase is invoked when doctors are debating a course of treatment and someone wants to end the argument. It usually doesn't work.

[funkendrenchman]

This author suggests herd immunity in April. Wishful thinking?

https://www.wsj.com/articles/well-ha...il-11613669731

[Bunion 2020]

^^^ < 60 days? The magic 8-ball says, "all signs point to yes"

[jono]

This author suggests herd immunity in April. Wishful thinking?

https://www.wsj.com/articles/well-ha...il-11613669731

Wishful thinking is one way to put it. Herd immunity threshold depends on behavior and interactions. It's like if we have five threads and some people read 1 or 2 but not all five: a meme or an article can get new life in a different thread among people who haven't seen it before.

Deebased WSJ article is ridiculously riddled with errors. What a hack. The author can't even get basic facts right.

For example, even with Brazil's high infection rates people there are still unprotected. In the WSJ article the Brazilian city of Manaus is presented as evidence of herd immunity but even with an estimated 76% infected they still recently experienced a resurgence.

Never mind other errors like arguing two thirds of the US population has been infected, never mind T-cells don't offer the kind protection described in the article, if 55% of people have natural immunity then why doesn't 76% of the population with acquired immunity offer herd immunity?

We don’t have herd immunity to the common cold and we won't have herd immunity for Covid until most of the population is vaccinated.

[old goat]

This author suggests herd immunity in April. Wishful thinking?

https://www.wsj.com/articles/well-ha...il-11613669731

You'd think that someone at the WSJ would understand that lines that go down can turn around a go up in a hurry. Or that past performance is no guarantee of future results--as the stock folks like to say.

[MultiVerse]

Yeah if Sweden, the poster child for herd immunity, is currently seeing a resurgence then why would we expect the US to be on the cusp of herd immunity:

Attachment 364132

Czechia is another example. They had low case counts due to precautions then they let their guard down and cases exploded; then it happened again. And now cases are surging once more.


Even so, it shouldn't be surprising to see what looks like normalcy this spring. Hospitalizations & deaths will fall thanks to vaccinations. It's already happening in the UK and Israel. Plus a seasonality effect, which received some ridicule this time last year, but turned out to be correct as case fell in the spring & summer only to surge in the fall & winter.

That's the danger with the WSJ's false narrative about herd immunity. If people believe cases and deaths are down because of herd immunity and not vaccines along with other things then we run the risk of people deciding against vaccination only to go through this again next fall & winter.

[seano732]

500,000 dead Americans and counting.......Just the flu, amirite? What a goddamn travesty.

[old goat]

LA Times story about herd immunity
https://www.sacbee.com/news/nation-w...249395835.html

I'm skeptical, especially since immunity from natural asymptomatic infection is likely to be short lived and not effective against variants due to lower antibody levels than from vaccine, especially 2 vaccine doses : -- )

[Ottime]

Meanwhile teachers say they can't go back to work until they have shots. But food workers and health care workers and first responders have been working in much worse conditions from day 1. The teachers deserve their shots. So do a lot of other people.

Huh. My wife has been working her ass off since March of last year creating new material that works via zoom calls. Same with all the teachers I know.