Slitherine

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ORIGINAL: Chickenboy

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ORIGINAL: Chickenboy

Just read the Belgian report guys:

https://www.bloomberg.com/news/articles/2020-04-25/why-the-world-s-highest-virus-death-rate-is-in-europe-s-capital

It's all about the nursing homes. It's all about the nursing homes. Everything about the mortality is about the nursing homes. Everywhere.

Yeesh. This is what happens when you're reading about the impact of COVID-19 globally and you've had too many glasses of wine.

But I was struck with just how much of the mortality globally is in nursing homes and how disproportionate the effect seems to have been. Sweden, Canada, Belgium, etc.-if you you can account for / control exposure in your nursing home populations you go a long ways towards reducing the impact of this disease. And maybe we can all figure out a way to get back on with life for everyone else that's not in a nursing home.

The article I linked also expounded on why Belgium has the highest rate of deaths in Europe and globally. As we've talked about here numerous times, it's all in how you record 'deaths'. Belgians are casting a broad net and calling everything about 'excess mortality' 'presumptive COVID-19 deaths'. The German methodology caught some flak here-they apparently are still only calling confirmed virus positive deaths as 'COVID-19' deaths.

IMO, both lead to distorted pictures of the impact-the Belgians are probably overcounting and the Germans undercounting. The article discussed a pan-European effort to standardize how mortality will be counted or restated. But it is unclear when or if this will be adopted.

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ORIGINAL: Lowpe

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ORIGINAL: obvert


Actually, its been quite demonstrably proven by a number of countries having flattened the curve through lockdowns. Without lockdowns you'd see what happened in the initial stages in Italy, with hospitals being overwhelmed.

There are plenty of places that didn't lockdown and aren't overwhelmed. How do you explain that?

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ORIGINAL: Chickenboy

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ORIGINAL: Chickenboy

Just read the Belgian report guys:

https://www.bloomberg.com/news/articles/2020-04-25/why-the-world-s-highest-virus-death-rate-is-in-europe-s-capital

It's all about the nursing homes. It's all about the nursing homes. Everything about the mortality is about the nursing homes. Everywhere.

Yeesh. This is what happens when you're reading about the impact of COVID-19 globally and you've had too many glasses of wine.

But I was struck with just how much of the mortality globally is in nursing homes and how disproportionate the effect seems to have been. Sweden, Canada, Belgium, etc.-if you you can account for / control exposure in your nursing home populations you go a long ways towards reducing the impact of this disease. And maybe we can all figure out a way to get back on with life for everyone else that's not in a nursing home.

The article I linked also expounded on why Belgium has the highest rate of deaths in Europe and globally. As we've talked about here numerous times, it's all in how you record 'deaths'. Belgians are casting a broad net and calling everything about 'excess mortality' 'presumptive COVID-19 deaths'. The German methodology caught some flak here-they apparently are still only calling confirmed virus positive deaths as 'COVID-19' deaths.

IMO, both lead to distorted pictures of the impact-the Belgians are probably overcounting and the Germans undercounting. The article discussed a pan-European effort to standardize how mortality will be counted or restated. But it is unclear when or if this will be adopted.

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ORIGINAL: RangerJoe

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ORIGINAL: Chickenboy

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ORIGINAL: Chickenboy

Just read the Belgian report guys:

https://www.bloomberg.com/news/articles/2020-04-25/why-the-world-s-highest-virus-death-rate-is-in-europe-s-capital

It's all about the nursing homes. It's all about the nursing homes. Everything about the mortality is about the nursing homes. Everywhere.

Yeesh. This is what happens when you're reading about the impact of COVID-19 globally and you've had too many glasses of wine.

But I was struck with just how much of the mortality globally is in nursing homes and how disproportionate the effect seems to have been. Sweden, Canada, Belgium, etc.-if you you can account for / control exposure in your nursing home populations you go a long ways towards reducing the impact of this disease. And maybe we can all figure out a way to get back on with life for everyone else that's not in a nursing home.

The article I linked also expounded on why Belgium has the highest rate of deaths in Europe and globally. As we've talked about here numerous times, it's all in how you record 'deaths'. Belgians are casting a broad net and calling everything about 'excess mortality' 'presumptive COVID-19 deaths'. The German methodology caught some flak here-they apparently are still only calling confirmed virus positive deaths as 'COVID-19' deaths.

IMO, both lead to distorted pictures of the impact-the Belgians are probably overcounting and the Germans undercounting. The article discussed a pan-European effort to standardize how mortality will be counted or restated. But it is unclear when or if this will be adopted.

How about getting every worker tested to see if they have had and for those who have not, give them plasma therapy for protection. If I remember correctly, one donation of plasma will treat one person who is seriously ill but for those who get it as a precaution, they need one twentieth of the dose. It can also be used for the people who are first responders as well as medical staff.

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Significance

COVID-19 is currently a big threat to global health. However, no specific antiviral agents are available for its treatment. In this work, we explore the feasibility of convalescent plasma (CP) transfusion to rescue severe patients. The results from 10 severe adult cases showed that one dose (200 mL) of CP was well tolerated and could significantly increase or maintain the neutralizing antibodies at a high level, leading to disappearance of viremia in 7 d. Meanwhile, clinical symptoms and paraclinical criteria rapidly improved within 3 d. Radiological examination showed varying degrees of absorption of lung lesions within 7 d. These results indicate that CP can serve as a promising rescue option for severe COVID-19, while the randomized trial is warranted.

Abstract

Currently, there are no approved specific antiviral agents for novel coronavirus disease 2019 (COVID-19). In this study, 10 severe patients confirmed by real-time viral RNA test were enrolled prospectively. One dose of 200 mL of convalescent plasma (CP) derived from recently recovered donors with the neutralizing antibody titers above 1:640 was transfused to the patients as an addition to maximal supportive care and antiviral agents. The primary endpoint was the safety of CP transfusion. The second endpoints were the improvement of clinical symptoms and laboratory parameters within 3 d after CP transfusion. The median time from onset of illness to CP transfusion was 16.5 d. After CP transfusion, the level of neutralizing antibody increased rapidly up to 1:640 in five cases, while that of the other four cases maintained at a high level (1:640). The clinical symptoms were significantly improved along with increase of oxyhemoglobin saturation within 3 d. Several parameters tended to improve as compared to pretransfusion, including increased lymphocyte counts (0.65 × 109/L vs. 0.76 × 109/L) and decreased C-reactive protein (55.98 mg/L vs. 18.13 mg/L). Radiological examinations showed varying degrees of absorption of lung lesions within 7 d. The viral load was undetectable after transfusion in seven patients who had previous viremia. No severe adverse effects were observed. This study showed CP therapy was well tolerated and could potentially improve the clinical outcomes through neutralizing viremia in severe COVID-19 cases. The optimal dose and time point, as well as the clinical benefit of CP therapy, needs further investigation in
larger well-controlled trials.
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Convalescent plasma (CP) therapy, a classic adaptive immunotherapy, has been applied to the prevention and treatment of many infectious diseases for more than one century. Over the past two decades, CP therapy was successfully used in the treatment of SARS, MERS, and 2009 H1N1 pandemic with satisfactory efficacy and safety (9⇓⇓–12). A meta-analysis from 32 studies of SARS coronavirus infection and severe influenza showed a statistically significant reduction in the pooled odds of mortality following CP therapy, compared with placebo or no therapy (odds ratio, 0.25; 95% confidence interval, 0.14–0.45) (13). However, the CP therapy was unable to significantly improve the survival in the Ebola virus disease, probably due to the absence of data of neutralizing antibody titration for stratified analysis (14). Since the virological and clinical characteristics share similarity among SARS, Middle East Respiratory Syndrome (MERS), and COVID-19 (15), CP therapy might be a promising treatment option for COVID-19 rescue (16). Patients who have recovered from COVID-19 with a high neutralizing antibody titer may be a valuable donor source of CP. Nevertheless, the potential clinical benefit and risk of convalescent blood products in COVID-19 remains uncertain. Hence, we performed this pilot study in three participating hospitals to explore the feasibility of CP treatment in 10 severe COVID-19 patients.
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Results
Neutralizing Activity of CP against SARS-CoV-2.

The neutralizing activity against SARS-CoV-2 was evaluated by classical plaque reduction test using a recently isolated viral strain (1). Among the first batch of CP samples from 40 recovered COVID-19 patients, 39 showed high antibody titers of at least 1:160, whereas only one had an antibody titer of 1:32. This result laid the basis for our pilot clinical trial using CP in severe patients.
General Characteristics of Patients in the Trial.

From January 23, 2020, to February 19, 2020, 10 severe COVID-19 patients (six males and four females) were enrolled and received CP transfusion. The median age was 52.5 y (interquartile range [IQR], 45.0 y to 59.5 y) (Table 1). None of the patients had direct exposure to Huanan Seafood Wholesale Market. The median time from onset of symptoms to hospital admission and CP transfusion was 6 d (IQR, 2.5 d to 8.5 d) and 16.5 d (IQR, 11.0 d to 19.3 d), respectively. Three patients were affected by clustering infection. The most common symptoms at disease onset were fever (7 of 10 patients), cough (eight cases), and shortness of breath (eight cases), while less common symptoms included sputum production (five cases), chest pain (two cases), diarrhea (two cases), nausea and vomiting (two cases), headache (one case), and sore throat (one case). Four patients had underlying chronic diseases, including cardiovascular and/or cerebrovascular diseases and essential hypertension. Nine patients received arbidol monotherapy or combination therapy with remdesivir (in one case not included in the current clinical trial), or ribavirin, or peramivir, while one patient received ribavirin monotherapy (Table 2). Antibacterial or antifungal treatment was used when patients had coinfection. Six patients received intravenous (i.v.) methylprednisolone (20 mg every 24 h).
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Effects of CP Transfusion.
Improvement of clinical symptoms.

All symptoms in the 10 patients, especially fever, cough, shortness of breath, and chest pain, disappeared or largely improved within 1 d to 3 d upon CP transfusion. Prior to CP treatment, three patients received mechanical ventilation, three received high-flow nasal cannula oxygenation, and two received conventional low-flow nasal cannula oxygenation. After treatment with CP, two patients were weaned from mechanical ventilation to high-flow nasal cannula, and one patient discontinued high-flow nasal cannula. Besides, in one patient treated with conventional nasal cannula oxygenation, continuous oxygenation was shifted to intermittent oxygenation (Table 2).
Reduction of pulmonary lesions on chest CT examinations.

According to chest CTs, all patients showed different degrees of absorption of pulmonary lesions after CP transfusion. Representative chest CT images of patient 9 and patient 10 are shown on Fig. 1. Patient 9, a 49-y-old female admitted 1 day postonset of illness (dpoi), showed the most obvious pulmonary image improvement. At 10 dpoi, one dose of 200-mL transfusion of CP was given. The SARS-CoV-2 RNA converted to negative at 12 dpoi. Compared with the result at 7 dpoi, massive infiltration and ground-glass attenuation disappeared on CT image performed at 13 dpoi, accompanied by a much better pulmonary function. Patient 10, a 50-y-old male, was admitted 3 dpoi and was given a 200-mL transfusion of CP at 20 dpoi. His chest CT presented massive infiltration and widespread ground-glass attenuation on admission and started to show a gradual absorption of lung lesions 5 d after CP transfusion. The SARS-CoV-2 RNA became negative at 25 dpoi.
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Outcome of patients treated with CP as compared to a recent historic control group.

A historic control group was formed by random selection of 10 patients from the cohort treated in the same hospitals and matched by age, gender, and severity of the diseases to the 10 cases in our trial. Baseline characteristics of patients between CP treatment group and control group showed no significant differences, while clinical outcomes of these two groups were different: three cases discharged while seven cases in much improved status and ready for discharge in CP group, as compared to three deaths, six cases in stabilized status, and one case in improvement in the control group (P < 0.001; SI Appendix, Table S1).
Adverse Effects of CP Transfusions.

Patient 2 showed an evanescent facial red spot. No serious adverse reactions or safety events were recorded after CP transfusion.

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ORIGINAL: mind_messing

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ORIGINAL: Lowpe

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ORIGINAL: obvert


Actually, its been quite demonstrably proven by a number of countries having flattened the curve through lockdowns. Without lockdowns you'd see what happened in the initial stages in Italy, with hospitals being overwhelmed.

There are plenty of places that didn't lockdown and aren't overwhelmed. How do you explain that?

Examples, please?

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SEOUL: Two elderly South Korean coronavirus patients recovered from severe pneumonia after being treated with plasma from survivors, researchers said Tuesday (Apr 7), offering hope in the face of the global pandemic.

Scientists have pointed to the potential benefits of plasma - a blood fluid - from recovered individuals who have developed antibodies to the virus enabling the body's defences to attack it.
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Plasma therapy could become "an alternative treatment for patients in critical condition who do not respond to antiviral drugs", said Choi Jun-yong, a doctor and researcher at Severance Hospital in Seoul, where both patients were treated.

But large-scale clinical trials were needed to prove its effectiveness, he added.

One of the two patients was a 71-year-old man with no underlying conditions who only improved when treated with plasma from a recovered patient in his 20s, along with steroids.

He was initially given malaria drugs and a respirator for severe pneumonia.

The other patient, a 67-year-old female, also did not respond to initial treatments including malaria, HIV drugs, and oxygen therapy. She began to recover after receiving plasma therapy and steroids at the same time, researchers said.

Their findings were published in the peer-reviewed Journal of Korean Medicine.

Kwon Jun-wook, an official at Seoul's Central Disease Control Headquarters, said plasma therapy was "important" when there was "currently no vaccine or treatment available" for the virus.

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n 1934, a doctor at a private boy’s school in Pennsylvania tried a unique method to stave off a potentially deadly measles outbreak. Dr. J. Roswell Gallagher extracted blood serum from a student who had recently recovered from a serious measles infection and began injecting the plasma into 62 other boys who were at high risk of catching the disease.

Only three students ended up contracting measles and all were mild cases.
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During the pandemic influenza outbreak of 1918 known as the “Spanish flu,” fatality rates were cut in half for patients who were treated with blood plasma compared to those who weren’t. The method seemed particularly effective when patients received the antibodies in the early days of their infection, before their own immune systems had a chance to overreact and damage vital organs. In the 1930s, doctors like Gallagher used convalescent plasma effectively against measles.
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By the 1940s and 1950s, antibiotics and vaccines began to replace the use of convalescent plasma for treating many infectious disease outbreaks, but the old-fashioned method came in handy yet again during the Korean War when thousands of United Nations troops were stricken with something called Korean hemorrhagic fever, also known as Hantavirus. With no other treatment available, field doctors transfused convalescent plasma to sickened patients and saved untold numbers of lives.
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One of the best-known modern uses of convalescent plasma is for the production of antivenom to treat deadly snake bites. Antivenom is made by injecting small amounts of snake venom into horses and allowing the horse’s immune system to produce antibodies that neutralize the poison. Those equine antibodies are isolated, purified and distributed to hospitals as antivenom.

In March 2020, doctors at Johns Hopkins University began testing convalescent plasma as a promising stop-gap treatment for COVID-19 while the search continued for a permanent vaccine. The advantage of convalescent plasma is that it can be drawn from recovered patients using the same plasma separation technology used at blood banks.

"It's all doable,” says immunologist Arturo Casadevall, lead researcher on the COVID-19 study, “but to get it done it requires effort, organization, resources… and people who have recovered from the disease who can donate the blood."

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ORIGINAL: Chickenboy

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ORIGINAL: Sammy5IsAlive
Ok that makes much more sense. I'm still not sure which careers have gone permanently so that people can't go back to them once the lockdown has lifted. In terms of the commitment in terms of training etc that would have put in to get going in their career I guess the big one would be airline pilots. Maybe chefs also? Finding it hard to think of other specific examples.

One of my college roommates also served as groomsman at my wedding. Good friend still. He worked for a very well known wafer fabrication design software company in silicon valley. 51 years old. Been with this company for 25 years. He and his entire team let go en masse last week. Since nobody is buying anything (including the largest companies in the world), they had no use for sales and service teams. They got a small severance package.

Ageism is rampant in silicon valley. An 'old timer' like him may be eventually replaced. But it won't be by a 51 year old. It'll be by a twenty-something from India most likely. The mature leavening he provided his teams won't be reproduced. He will look for something, but odds that he can get back to where he was are nil. So his career is effectively over in this industry. It's a hard pill to swallow, but it is what it is.

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ORIGINAL: Lowpe

WATCH: E.R. Doctors Urge A Reopening: Lockdown Creating Public Health Crisis, Doctors ‘Pressured’ To Add COVID To Death Reports, Quarantining Healthy ‘Never Seen’ Before

https://www.dailywire.com/news/watch-e-r-doctors-urge-a-reopening-lockdown-creating-public-health-crisis-doctors-pressured-to-add-covid-to-death-reports-quarantining-healthy-never-seen-befor

I found this interesting.

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ORIGINAL: Cap Mandrake

Over 90F Friday and yesterday. Mid 80's today. Brilliant blue sky, hills all green from recent rains, wildflowers. Grey whales all over the place. 100 miles visibility

I just want to go to beach before it's back to grind. It's only 6 miles away. State beaches are open for walking and surfing but parking is shut down. Local governments are going to have open insurrection soon.

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ORIGINAL: Cap Mandrake

Over 90F Friday and yesterday. Mid 80's today. Brilliant blue sky, hills all green from recent rains, wildflowers. Grey whales all over the place. 100 miles visibility

I just want to go to beach before it's back to grind. It's only 6 miles away. State beaches are open for walking and surfing but parking is shut down. Local governments are going to have open insurrection soon.

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ORIGINAL: Lowpe

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ORIGINAL: obvert


Actually, its been quite demonstrably proven by a number of countries having flattened the curve through lockdowns. Without lockdowns you'd see what happened in the initial stages in Italy, with hospitals being overwhelmed.

There are plenty of places that didn't lockdown and aren't overwhelmed. How do you explain that?

To ascribe lockdowns as the culpable factor in flattening the curve, which is not a scientific proven fact but rather a hypothesis, at this stage is wrong. Sure, we have all gone thru extensive pain from the disease and lockdown and want to believe it is working as advertised.

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ORIGINAL: pbiggar

What is the view of this group on the impact of easing the lockdown in the US? Given around 30,000 new infections daily and about 2,000 deaths per day, do you expect this number to be higher or lower a month from now?

If it remained stable it would result in another 900,000 infections and 60,000 deaths.

I have the impression that Italy and Spain waited to see their numbers come down more before easing up.

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ORIGINAL: witpqs

Listening to the radio when driving, it seems that every large and medium sized company in the country, plus all car dealers and numerous others, have advertisements about how they are taking measures regarding COVID-19. So all the marketing resources necessary to produce those ads are obviously considered 'critical' in states where they are produced.

An acquaintance in Kansas is trying to get their vegetables planted, and he usually orders seeds online. The seed company is located in Michigan, and they are not allowed to ship product because of the state order lock down measures.

Advertising is critical but planting food is not.

Stupid, stupid, stupid.

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ORIGINAL: Chickenboy

Doing a little more digging on state by state CFR rates. Found some interesting insights.

Most states are still testing only symptomatic people or those most at risk to extended exposure (e.g., first responders, medical staff, etc.) by RT-PCR. A 'case' per most domestic testing programs then represents the presence of virus in a symptomatic person or a person most at risk from exposure.

I'm not hearing of much conflation of what constitutes a case between states or counties or whatnot. I'm seeing more conflation regarding how mortality figures should / should not be lumped in to related mortality.

There are many legitimate questions for 'how widespread is this' based upon asymptomatics or untested or sick-recovered-no longer shedding virus instances, but the 'case' definition as it stands now seems to be pretty straightforward and unifying. Because of seemingly uniform testing criterion, these asymptomatics, because they are not being tested by RT-PCR wouldn't constitute defined cases for CFR calculation. It will take some time to get a grasp on Infection Fatality Rate (IFR), because we aren't measuring statistically meaningful numbers of people for whether they've ever been exposed to this-ever-.

Sticking to CFR and not conflating it with unknown / unknowable IFR:

I thought that using these definitions and with these caveats in mind, looking at CFRs for the states may shed some light on regional issues and standouts. Most states (I haven't run this calculation on all, but many) are around a 2.5%-4.5% CFR.

Connecticut 7.6%. Minnesota (surprisingly) 7%. Louisiana 6.2%. New York (surprisingly) 5.8%. New Jersey (surprisingly) 5.5%. Nebraska 2.2%. Georgia 3.9%. California 4.0%. Texas 2.6%. Pennsylvania 3.8%. Ohio 4.7%. North Carolina 3.3%. Florida 3.5%.

These rates were higher than I would have thought at first blush across the board. I get that the press bandies the term "CFR" about when in fact they mean "IFR". But there was less variation between states than I was anticipating and some unexpected standouts: Minnesota and Connecticut.

Despite larger numbers of cases in New York and New Jersey, they seemed to fare better than Minnesota cases. And the Connecticut numbers-likely related to the spread in NYC environs-were higher than NY/NJ overall. And what about Texas' victims makes them better candidates for survival?

Some puzzlers.

https://covidtracking.com/data

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ORIGINAL: mind_messing



Which is why I'm banging on about the international comparisons being largely worthless. Cases and deaths are not by default directly comparable.

Even within the UK, Scotland is counting the deaths markedly different (mentions on death certificate, even if not confirmed) from England (died in hospital, tested positive).

Of course, that was handwaved way.

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ORIGINAL: obvert

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ORIGINAL: Lowpe

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ORIGINAL: obvert


Actually, its been quite demonstrably proven by a number of countries having flattened the curve through lockdowns. Without lockdowns you'd see what happened in the initial stages in Italy, with hospitals being overwhelmed.

There are plenty of places that didn't lockdown and aren't overwhelmed. How do you explain that?

To ascribe lockdowns as the culpable factor in flattening the curve, which is not a scientific proven fact but rather a hypothesis, at this stage is wrong. Sure, we have all gone thru extensive pain from the disease and lockdown and want to believe it is working as advertised.

The only large European country I know that didn't lock down is Sweden, but they're recommended distancing measures and the populace has complied in large part. There are still criticisms that they have increased mortalities unnecessarily and failed to protect the vulnerable effectively. They're mortality rates are significantly higher than other countries nearby.

Japan didn't lock down early, but was forced to more recently after numbers began to rise more quickly.

South Korea has had some recommended measures but largely got no top of the outbreak very early due to extensive testing and contact tracing. As reported by Commander Cody, this has been accomplished after these strategies were put in place over the last years due to earlier outbreaks like SARS.

Are there other you know about?

This page from the BBC shows the lockdowns across the globe.

https://www.bbc.co.uk/news/world-52103747

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ORIGINAL: Lowpe
Be careful in saying that Sweeden has a higher mortality rate, as in the BBC article I reference above, they might be counting differently than others.

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ORIGINAL: RangerJoe

There was a Minnesota legislator, I think that I posted this before, who is also a doctor and he said that there is pressure to call every case CoVid-19 and every death is due to CoViD-19.