Herd Immunity and Belgium

[GeneralVeers]

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I've been looking at raw Corona numbers for the past while as I've been completely away from all other forms of media.

The curves in most US states and European countries look similar, which suggests that the differing mitigation approaches likely have no effect on the curve.

The one standout is Belgium. They got blasted heavily in the first wave last Spring and have the highest deaths/million in the world at 1337. Unlike the rest of Europe, their curve has been declining rapidly since early November while every other European country is on fire. Some basic math may highlight why.

If we assume that the death rate is 0.2%, which I think is broadly accepted now, then we can calculate the total population who have had COVID. Antibodies look promising at first, however we now now that they fade after several months even though immunity may remain. Antibodies are not a reliable measure of population immunity., which means we have to use deaths. By extrapolating backward, in Belgium there should be 7.76 million infections total. That's about 67% of the population. If true, then this should correlate with the declining numbers as R should be approaching 0.

In the U.S. this has some important predictive value. As of today we have 791 deaths/million which is about 130 million infections. Based on the Belgium data, we will be at 67% immunity once we reach 400K deaths, and at that point the virus should gradually diminish. At present rate we are having 500K-1million per day infections, so 2-3 months and we will be there.

 

[bravotwozero]

have no data to back this up, but I also seem to get the impression that the virus may have mutated to a less lethal strain. I've been seeing a lot of covid+ cases, but very few that were severely ill or needed ICU. I know this is n=1, but clearly Trump isn't exactly a picture of health, and ended up making a full recovery. Sure, he got top notch care, but remdesivir and monoclonal antibodies have not been shown to work, and he did quite well with supplemental O2 and decadron.

 

[WheezyBaby]

have no data to back this up, but I also seem to get the impression that the virus may have mutated to a less lethal strain. I've been seeing a lot of covid+ cases, but very few that were severely ill or needed ICU. I know this is n=1, but clearly Trump isn't exactly a picture of health, and ended up making a full recovery. Sure, he got top notch care, but remdesivir and monoclonal antibodies have not been shown to work, and he did quite well with supplemental O2 and decadron.

I think we're just doing less harm, primarily from avoiding early intubation, in combination to some degree with identifying at least one efficacious therapy in decadron. Our hospitalized covid+ mortality rate while lower than early in pandemic has not been anything to write home about

 

[GeneralVeers]

I think we're just doing less harm, primarily from avoiding early intubation, in combination to some degree with identifying at least one efficacious therapy in decadron. Our hospitalized covid+ mortality rate while lower than early in pandemic has not been anything to write home about

No we've been exactly in the middle of the pack for Advanced Western countries. Even countries that supposedly did well like Canada and Germany are feeling the pain now.

 

[BAM!]

I like your analysis. However, where did you get the 0.2% mortality rate assumption? Everything I've seen has been higher, more in the 1-2%.

Take CA for example: 18,715 deaths / 1,110,000 cases = 1.7%.

Yes, there was an "early intubation" strategy, and must be a component of under-reporting of cases. So perhaps true mortality is a bit lower than 1-2%. Yet do we then make the assumption that there have been 10M cases in CA instead of only 1M? ie, 1/4 of CA's population has been infected? Doubtful.

Therefore if you assume a higher mortality rate, then we are much further off from covid independence than 2-3 months.

🙁

 

[GeneralVeers]

I like your analysis. However, where did you get the 0.2% mortality rate assumption? Everything I've seen has been higher, more in the 1-2%.

Take CA for example: 18,715 deaths / 1,110,000 cases = 1.7%.

Yes, there was an "early intubation" strategy, and must be a component of under-reporting of cases. So perhaps true mortality is a bit lower than 1-2%. Yet do we then make the assumption that there have been 10M cases in CA instead of only 1M? ie, 1/4 of CA's population has been infected? Doubtful.

Therefore if you assume a higher mortality rate, then we are much further off from covid independence than 2-3 months.

🙁

That's only if you are assuming you are catching every case. The "number of cases" is irrelevant except to look at general trends. It misses between 70-90% of overall infections in the community. If it had a 1% mortality, I'd have at least 10 dead friends/coworkers. I have none.

 

[WheezyBaby]

No we've been exactly in the middle of the pack for Advanced Western countries. Even countries that supposedly did well like Canada and Germany are feeling the pain now.

The point of my post was I think mortality has reduced somewhat but not particularly dramatically. I'm not comparing our (the us) mortality worldwide, and when I had initially said "our" I meant my institution

That's only if you are assuming you are catching every case. The "number of cases" is irrelevant except to look at general trends. It misses between 70-90% of overall infections in the community. If it had a 1% mortality, I'd have at least 10 dead friends/coworkers. I have none.

You know 1000 people who have had covid? You should tighten your coterie

 

[GeneralVeers]

The point of my post was I think mortality has reduced somewhat but not particularly dramatically. I'm not comparing our (the us) mortality worldwide, and when I had initially said "our" I meant my institution



You know 1000 people who have had covid? You should tighten your coterie

I've had about 30-40 friends/aquintances family have it, and combine with working at 9 different hospitals it's a reasonable estimate. We have tons of nurses out with COVID this month and not one has died.

 

[WheezyBaby]

I've had about 30-40 friends/aquintances family have it, and combine with working at 9 different hospitals it's a reasonable estimate. We have tons of nurses out with COVID this month and not one has died.

And what's the estimated mortality of that cohort based on age and comorbidity? Based on your age and healthcare employment I'm going to guess less than average

 

[GeneralVeers]

And what's the estimated mortality of that cohort based on age and comorbidity? Based on your age and healthcare employment I'm going to guess less than average

Essentially zero. Not sure what we are arguing about though.

 

[WheezyBaby]

Essentially zero. Not sure what we are arguing about though.

You're offering your anecdotal cohort as some sort of statement in a discussion on covid mortality trends and I'm trying to figure out what your point is

 

[GeneralVeers]

You're offering your anecdotal cohort as some sort of statement in a discussion on covid mortality trends and I'm trying to figure out what your point is

Point taken. I shouldn't have offered anecdotal evidence that didn't add to the discussion. Tough crowd today.

 

[Angry Birds]

No we've been exactly in the middle of the pack for Advanced Western countries. Even countries that supposedly did well like Canada and Germany are feeling the pain now.

Yes, but sometimes you luck out even if you don't follow expert advice or take things seriously... Doesn't make it excusable, let alone laudable.

 

[GeneralVeers]

Yes, but sometimes you luck out even if you don't follow expert advice or take things seriously... Doesn't make it excusable, let alone laudable.

True, however I'd postulate that regardless of the rules enacted every country seems to be heading in the same direction. Masks, etc might make a fractional difference around the edge, but it's prolonging the inevitable.

Australia set off a nuclear bomb on its economy in Victoria to wipe out a small outbreak of a few dozen cases. They've done an excellent job, but they are left now with a population with less than 5% immunity to this virus. They are going to be forced to stay shut to international travel indefinitely. The second they open they're going to get the same curve as the rest of Europe and America.

 

[alpinism]

Wouldn't be surprised if the Dakotas are getting close to developing herd immunity.

Never had a lockdown but cases have started declining the past couple weeks.

 

[GeneralVeers]

Wouldn't be surprised if the Dakotas are getting close to developing herd immunity.

Never had a lockdown but cases have started declining the past couple weeks..

You are right. N Dakota is 1102 deaths/million and S Dakota is at 926. That means both are around 50% infections in the state and infections are declining. Essentially at herd immunity.

Love the S. Dakota governor btw. She's my hero and presidential pick for 2024.

 

[thegenius]

I've been looking at raw Corona numbers for the past while as I've been completely away from all other forms of media.

The curves in most US states and European countries look similar, which suggests that the differing mitigation approaches likely have no effect on the curve.

The one standout is Belgium. They got blasted heavily in the first wave last Spring and have the highest deaths/million in the world at 1337. Unlike the rest of Europe, their curve has been declining rapidly since early November while every other European country is on fire. Some basic math may highlight why.

Worldometers shows every western european country is on the decline from a recent peak in mid to late october. Don't know where you get "on fire" from. Look at spain, UK, france, netherlands, germany. They all are now having declining rates. Happens to nicely coincide more or less to increase restrictions placed over the past 2-4 weeks in that area too.

 

[GeneralVeers]

Worldometers shows every western european country is on the decline from a recent peak in mid to late october. Don't know where you get "on fire" from. Look at spain, UK, france, netherlands, germany. They all are now having declining rates. Happens to nicely coincide more or less to increase restrictions placed over the past 2-4 weeks in that area too.

You are right. Thread delete.

 

[GeneralVeers]

Also interesting that the Dakota have similar decreases to Spain and Italy without lockdown or mask mandates. ND just put one in last week. But whatever! Masks and lock downs forever. I was trying to get a glimmer of hope this would be over, but all of you aren't having it.

 

[WilcoWorld]

Also interesting that the Dakota have similar decreases to Spain and Italy without lockdown or mask mandates. ND just put one in last week. But whatever! Masks and lock downs forever. I was trying to get a glimmer of hope this would be over, but all of you aren't having it.

Here's some hope - wide vaccine availability may be coming soon.

 

[turkeyjerky]

I don't live in south dakata, so it's hard to say. But maybe people there are modifying their behavior w/o mandates?

I think the current surge should put to rest the notion that widespread masking will get the pandemic under control. It's unfortunate but this is what a heavily mitigated curve looks like.

I'm pretty sure Belgium is an outlier in fatality rates because they count all deaths that occur in nursing homes as covid related. Most educated estimates for IFR I've seen range from 0.4-0.6%

 

[RustedFox]

South Dakota is gonna South Dakota, mandates or not.
The Rapid City area is awesome, if a bit isolated.

 

[bravotwozero]

Here's some hope - wide vaccine availability may be coming soon.

There's been some talk it might be available in my county of Texas by the end of the year! How they plan on doing that I have no idea, but apparently one of the vaccine distributors is located here.

 

[Rekt]

There's been some talk it might be available in my county of Texas by the end of the year! How they plan on doing that I have no idea, but apparently one of the vaccine distributors is located here.

From my understanding vaccines are supposedly being sent out to get ready for distrubution, but the meeting is December 10th(?) for Pfizer EUA.

 

[gro2001]

Love the S. Dakota governor btw. She's my hero and presidential pick for 2024.

Kristi Noem on the Issues

www.ontheissues.org

• Voted NO on reauthorizing the Violence Against Women Act. (Feb 2013)
• Supports Amendment to prevent same sex marriage. (Aug 2010)
• Protect anti-same-sex marriage opinions as free speech. (Oct 2013)
• Voted YES on banning federal health coverage that includes abortion. (May 2011)
• Supports prohibiting human embryonic stem cell research. (Aug 2010)
• Opposes federal abortion funding. (Aug 2010)
• Prohibit federal funding for abortion. (May 2011)
• No family planning assistance that includes abortion. (Jan 2013)

What's not to like?

Edit: I forget that the /s might be necessary on this forum these days.

 

[BoardingDoc]

Kristi Noem on the Issues

www.ontheissues.org

• Voted NO on reauthorizing the Violence Against Women Act. (Feb 2013)
• Supports Amendment to prevent same sex marriage. (Aug 2010)
• Protect anti-same-sex marriage opinions as free speech. (Oct 2013)
• Voted YES on banning federal health coverage that includes abortion. (May 2011)
• Supports prohibiting human embryonic stem cell research. (Aug 2010)
• Opposes federal abortion funding. (Aug 2010)
• Prohibit federal funding for abortion. (May 2011)
• No family planning assistance that includes abortion. (Jan 2013)

What's not to like?

I'm sure there are users on this forum that agree with most or all of those votes. Others likely disagree. Lets get back to Belgium.

 

[coachB]

I'm sure there are users on this forum that agree with most or all of those votes. Others likely disagree. Lets get back to Belgium.

Let's do that.

Curious as to where Veers gets his data. I thought the logic seemed reasonable but the numbers don't seem to add up.

I understand the multiple limitations, but a quick glance at the worldometers numbers info from yesterday shows a death rate for the day in Belgium nearly three times that in the US (0.83/100k vs 0.29/100k). Doesn't exactly seem like they are in the clear.

 

[GeneralVeers]

Let's do that.

Curious as to where Veers gets his data. I thought the logic seemed reasonable but the numbers don't seem to add up.

I understand the multiple limitations, but a quick glance at the worldometers numbers info from yesterday shows a death rate for the day in Belgium nearly three times that in the US (0.83/100k vs 0.29/100k). Doesn't exactly seem like they are in the clear.

I was looking at overall deaths as the indicator for how many infections are in the country. If it's a 0.2% fatality rate, then multiply total deaths in a country by 500 and you get the total number of population who's been infected. It's not an accurate number but could give guidance on the total population that's been infected. You are correct on the death rate, but that typically lags by about 2-3 weeks. I'd expect that to decrease shortly if it follows the other curve.

Also with all the curves in the world, looks like the "new cases" starts to level off and decline as you hit 900 deaths/million. We are about to hit that in the US in the next couple of weeks, so we'll see if things plateau then and begin to decline.

Interestingly, if the theory is correct, in about 3 months we should hit 200 million estimated infections. That's about the same time a potential vaccine will be distributed widely, and the politicians will all pat themselves on the back for what a great job they did with the vaccine when those number inevitably go down.

Of course if massive numbers of people can get re-infected, then none of the curves really matter. (Why are they re-quarantining the British PM?)

 

[robellis]

I'm sure there are users on this forum that agree with most or all of those votes. Others likely disagree. Lets get back to Belgium.

Who the hell would agree with not supporting the violence against woman act? LOL..the bill is literally called violence against women, that’s like opposing a bill called stop the eating of babies bill..it’s just funny

 

[GeneralVeers]

Who the hell would agree with not supporting the violence against woman act? LOL..the bill is literally called violence against women, that’s like opposing a bill called stop the eating of babies bill..it’s just funny

I'll say I haven't heard of the bill or know what's in it. Like every bill being contemplated it comes down to the specifics, and what other pork or unrelated nonsense they have put in. Politicians sometimes call things by benign-sounding names (Defense of Marriage Act) to cover up for truly awful policies.

I only admire her for her response to the pandemic. Sometimes the best actions are to do nothing even if it goes against the urge of every politician to "do something" in response to every crisis.

 

[WilcoWorld]

I'd prefer we reach herd immunity through an effective vaccination program that appears to be mere months in the future rather than by letting hundreds of thousands of vulnerable Americans die prematurely.

Strange times we're in that this is considered a controversial position.

 

[GeneralVeers]

I'd prefer we reach herd immunity through an effective vaccination program rather than by letting hundreds of thousands of vulnerable Americans die prematurely.

Strange times we're in that this is considered a controversial position.

I think we all would. I'm not certain we will be given the choice considering how long a vaccine will take to deploy even if we started today. Any vaccine will not be a panacea to end this. Likely it will be combination of herd immunity and partially effective vaccine. I hope we focus any vaccine distribution on the elderly population, and high risk people who have not had Coronavirus. Wasting initial doses on the 30-40% of Americans who have likely had this will only delay things. Let's hope the hospitals have a reasonable policy of not forcing the vaccine on employees who have already had the virus and recovered.

 

[WilcoWorld]

I think essentially all of us would prefer that as well. The reality appears and always did appear differently though. The vast majority of us are going to be exposed/infected before an effective vaccine is developed. It isn't very realistic to expect an effective, safe or even studied vaccine to be developed prior to 1.5 years time during a 2-3 year pandemic. We are at the point where most of society is being or has been exposed/infected. I don't find this in the least bit controversial, just a pragmatic viewpoint. I'm guessing by controversial you mean putting herd immunity vs. an immunization strategy on equal footing as competing arguments saying that we shouldn't even have this debate. The reality though is that the virus had a head start and is more effective at spreading quickly than we are at developing and distributing a vaccine. We were behind from the get go on vaccine development. So it isn't really a fair fight and no wonder a vaccine won't be available in time. To my knowledge no other viral disease has been discovered and then had a vaccine developed before it significantly spread throughout society as a pandemic. Sure medicine keeps getting better, but it might be progress that happens even slower than political change with 2 steps forward and 1.5 steps backwards.

But we now have good reason to believe that we will have millions of doses of two effective vaccines in the coming months.

 

[GeneralVeers]

But we now have good reason to believe that we will have millions of doses of two effective vaccines in the coming months.

That's great news. Probably too late still. Actually best scenario is that cases are declining anyway due to immunity, and thr vaccine gives an extra boost.

 

[NITRAS]

I think the best thing that could happen is that we get new-fangled mRNA vaccines that they can roll out very quickly in response to changing influenza so that we might actually have real improvement in mortality in a decade or so. . . When the public gets comfortable with it. . . . Or at least a big chunk takes it.

 

[xaelia]

Before the election, there were reasonable estimates ~10-13% of the U.S. population had been infected.

These days ~20-25% seems about right.

Agree we'll get to enough short-term immunity in certain locations to start driving down R values based on some aspect of herd immunity – hopefully durable enough to last until vaccine distribution (and uptake!).

Veers' IFR estimate is probably on the right order of magnitude at 0.2% – it was probably a little bit higher earlier in the year before dexamethasone, could be driven even lower if these antibody products are efficacious and become widespread. If 60-70% is herd immunity (that's an "if", and it doesn't account for any overshoot), I think we're looking at 500k+ dead from COVID (plus excess deaths from deferred/unavailable care in saturated healthcare systems).

I don't think Europe is yet instructive regarding herd immunity; they went with aggressive lockdowns again to regain control this fall. Sweden thought they'd gamed it correctly, turned out to be lucky/wrong.

Western pacific rim countries seem to have managed it best, to varying degrees, and with varying methods. Some of those may be translatable to the U.S. and Europe, but it does seem clear the culture gap is too wide.

 

[AMEHigh]

I think we all would. I'm not certain we will be given the choice considering how long a vaccine will take to deploy even if we started today. Any vaccine will not be a panacea to end this. Likely it will be combination of herd immunity and partially effective vaccine. I hope we focus any vaccine distribution on the elderly population, and high risk people who have not had Coronavirus. Wasting initial doses on the 30-40% of Americans who have likely had this will only delay things. Let's hope the hospitals have a reasonable policy of not forcing the vaccine on employees who have already had the virus and recovered.

Am I missing some new info that shows people can’t be re-infected?

I haven’t had any patients, but I’ve had colleagues with patients who tested positive in the spring and now in the fall and have had worse courses (hospitalized, intubated, etc).

Why wouldn’t we vaccinate people if they were infected a year plus ago?

 

[Rekt]

I'd prefer we reach herd immunity through an effective vaccination program that appears to be mere months in the future rather than by letting hundreds of thousands of vulnerable Americans die prematurely.

Strange times we're in that this is considered a controversial position.

Because realistically people know that an American lockdown won't do anything except destroy the economy. Even with our big shut down, many actual non-essential people/business considered themselves "essential". We got the wrong info early from China, WHO, etc saying it wasn't a big deal. Even the left news media said it wasn't either. By then it was too late. I don't think if there was someone else in the White House that it would have made a substantial difference unless you're okay with being in a pseudo-lockdown from March without an end date and still in it. Or you'd be okay with deploying the National Guard to gun everyone down in the streets because that's the only way you're getting a real lockdown. And the vaccine is weeks-to-months away only because we've been "open".

 

[AMEHigh]

I think you could be reinfected. Just because you got the flu one year doesn't mean you won't get the same or another strain of the flu during same flu season or the following year. Just like other viruses, this virus mutates and evolves. I'm going to guess that your anecdotal experience likely isn't universal. I'd bet that subsequent reinfections result in a better clinical course as you likely have some adaptive immunity and a more rapid immune response. I don't think anyone is arguing against vaccinating. I think a few of us are just pointing out that most people are going to be exposed/infected an initial time before a vaccine is available. Reinfections are probably less severe with or without a vaccine. Otherwise we wouldn't develop any immunity following an infection, which isn't how our immune systems work.

Yes I understand this. But the person I quoted said it’d be a waste to vaccinate their approximation of 40% of people who’ve had Covid.

I’m trying to figure out why it’d be a waste to vaccinate people who had Covid in March or April 2019 for example and it’ll be almost a year later when vaccine roll out starts. Thosea people are still at risk of getting and spreading Covid to my understanding, but that’s why I asked if I were missing some new info.

 

[wholeheartedly]

Also interesting that the Dakota have similar decreases to Spain and Italy without lockdown or mask mandates. ND just put one in last week. But whatever! Masks and lock downs forever. I was trying to get a glimmer of hope this would be over, but all of you aren't having it.

The local take is that numbers are going down because people quit getting tested, especially to avoid having to isolate over Thanksgiving. We have lots of people refusing tests in urgent care, lots of people whose kids have tournaments and won’t let them get tested so as not to quarantine the whole team if positive. We’re expecting an explosion after the holidays, but would be happy to be wrong since it’d be nice to have places to transfer patients in state. One day last week there were 7 open ICU beds in the state.

 

[doctalaughs]

Eh, the question of whether we’ve had 15 million infections or 150 million is speculation. It’s more than the 12 million recorded positives - but we have no idea how much more.

We should just all get vaccinated as fast as possible and get back to normal life.

I’d be fine if it’s “required” to travel, go to workplace, attend school etc. I’m sure some would protest and drag their feet- but once 10 million or so more people are vaccinated without turning into zombies, and it’s getting inconvenient for people’s lives, they will get it.

 

[VA Hopeful Dr]

Because realistically people know that an American lockdown won't do anything except destroy the economy. Even with our big shut down, many actual non-essential people/business considered themselves "essential". We got the wrong info early from China, WHO, etc saying it wasn't a big deal. Even the left news media said it wasn't either. By then it was too late. I don't think if there was someone else in the White House that it would have made a substantial difference unless you're okay with being in a pseudo-lockdown from March without an end date and still in it. Or you'd be okay with deploying the National Guard to gun everyone down in the streets because that's the only way you're getting a real lockdown. And the vaccine is weeks-to-months away only because we've been "open".

I think there are really 2 big things that Trump really screwed up, COVID wise.

First, he should have nationalized production of PPE. Decent quality surgical masks, face shields, and N95s are still pretty hard to come by. That doesn't have to be the case.

Second, and I recognize that this isn't entirely his fault, but this thing got amazingly polarized. There's no reason wearing a mask in public indoors should be contentious. It seems like there are more people saying COVID is a hoax than any other medical problem I've ever seen and he is in part responsible for that.

Everything else he's done is more debatable is to the harm.

Also, I think you're overreacting about what someone else could do. Even Biden's COVID plan doesn't call for national lockdowns (I suspect he knows he can't legally do that).

 

[VA Hopeful Dr]

I agree that the exact number is speculative. Just a few million more than reported though seems vastly underestimated based upon the data available and anecdotal experience. 10 fold higher seems much more likely.

I suspect we probably won’t be getting back to ‘normal’ until sometime in latter 2021 or 2022. I think we’ve ignored history and failed to recognize that this pandemic was likely to last 2-3 years.

Depends on vaccine numbers. 1918 flu lasted that long because we had no option but to wait it out until most people had contracted it. Fortunately we seem to have better options this time around.

 

[The Knife & Gun Club]

FYI vaccines are not that far off, at least for us frontline workers. Our hospital will be receiving their first shipment of Pfizer vaccines later this week, and will start the process of vaccinating all employees (voluntarily only) by Dec 15th.

We’ve had a vaccine “lottery” for 3 months now as part of moderna’s phase 3 trial. Everyone I know how’s gotten it has done fine, albeit early in the process.

 

[BAM!]

To my knowledge no other viral disease has been discovered and then had a vaccine developed before it significantly spread throughout society as a pandemic. Sure medicine keeps getting better, but it might be progress that happens even slower than political change with 2 steps forward and 1.5 steps backwards.

China developed the vaccine before they released the virus onto the world. Jeez, don't you watch documentaries?

 

[BAM!]

Therein lies the rub. How do you know who has had the disease if ~40-45% are asymptomatic, a huge percentage had mild symptoms and were never tested, false positive antibody testing from prior alternative corona virus exposure, as well as reactive antibodies fading with time after 2-3 months making testing unreliable. We don't have a test to look at B/T cell response. I think invariably the vaccine will be 'wasted' on many that already have some degree of immunity from prior exposure/infection. It should probably be offered though to anyone that wants it since we don't have a reliable way to determine underlying immunity. I'm sure the elderly and health care workers will be offered immunization first given their increased risk and the initial limited supply. Our hospital has already stated it won't be mandatory this year. I suspect most will follow suit. No one wants to take on the liability of mandating something not well tested. I'd bet in subsequent years though it might be incorporated into the yearly influenza immunizations that are frequently mandatory for health care workers.

Just to set the record straight, this is the US - land of the free. Vaccinations are not mandatory. Seriously. If you don't want the flu shot you don't have to take it. Not taking sides, just the fax.

 

[BAM!]

As of today 11/24/20 there are 12,900,183 reported cases in the US by Worldometer. Approximately 40-45% of cases are asymptomatic. Almost all of these people aren’t tested. I’d also guess north of 75% of people with mild symptoms aren’t getting tested. I’d strongly bet that at least 130M have been exposed/infected to date in this country. I’d also bet that prior to a vaccine becoming widely available that an additional 130M become exposed/infected over the next 2-3 months. That leaves about 70M left that could receive a vaccine that might offer some protection. That’s great, but ignores the reality that it’s not going to prevent most infections or deaths.

your bets and approximations went from guesses to "reality" in 3 sentences.

 

[VA Hopeful Dr]

I laid out the general basis for how 12M reported cases in the US is vastly underestimated. It’s completely up you if you choose to ignore reality and not to logically conclude the same based upon the available asymptomatic data, the data available showing the percentage that only develop mild illness, the numerous stories of people refusing testing, and the anecdotal false negative rate of testing to date.

NEJM Journal Watch: Summaries of and commentary on original medical and scientific articles from key medical journals

NEJM Journal Watch reviews over 250 scientific and medical journals to present important clinical research findings and insightful commentary

www.jwatch.org

 

[BAM!]

Because realistically people know that an American lockdown won't do anything except destroy the economy. Even with our big shut down, many actual non-essential people/business considered themselves "essential". We got the wrong info early from China, WHO, etc saying it wasn't a big deal. Even the left news media said it wasn't either. By then it was too late. I don't think if there was someone else in the White House that it would have made a substantial difference unless you're okay with being in a pseudo-lockdown from March without an end date and still in it. Or you'd be okay with deploying the National Guard to gun everyone down in the streets because that's the only way you're getting a real lockdown. And the vaccine is weeks-to-months away only because we've been "open".

Make no mistake, different leadership likely would have had DIRECT influences on all of our lives as EM physicians.

#1 PPE -- mandate companies to make ppe. Trump was a self-proclaimed war-time prez after all
#2 More PPE -- use the federal gov to bid on international PPE instead of letting the states bid each other up
#3 masks -- politicizing mocking mask-wearing was clearly detrimental to pandemic's spread
#4 not discouraging testing in order to artificially improve our numbers

 

[BAM!]

I think you could be reinfected. Just because you got the flu one year doesn't mean you won't get the same or another strain of the flu during same flu season or the following year. Just like other viruses, this virus mutates and evolves. I'm going to guess that your anecdotal experience likely isn't universal. I'd bet that subsequent reinfections result in a better clinical course as you likely have some adaptive immunity and a more rapid immune response. I don't think anyone is arguing against vaccinating. I think a few of us are just pointing out that most people are going to be exposed/infected an initial time before a vaccine is available. Reinfections are probably less severe with or without a vaccine. Otherwise we wouldn't develop any immunity following an infection, which isn't how our immune systems work.

influenza is the poster child for antigenic drift. this is a main reason for needing a flu shot each year. from my understanding coronaviruses don't drift as much and antibodies to coronaviruses stick around for approx 1-2 years. that's not to say that antibodies are the only factor of your immune system of course. and yes sars2 has been known to mutate. that said, if you follow historical patterns, it hopefully shouldn't mutate as much as influenza