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Old 04-15-2020, 09:04 AM   #1
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I'm interested in how people think this will end. Generally speaking, it could end with most people being infected and developing herd immunity through infection or from a vaccine giving enough people immunity to have her immunity. But it could end with massive testing, contact tracing, and strong isolation efforts. All of these have good reasons why they will and won't work.

1) Natural herd immunity. First off, with hygiene practices and social distancing keeping R0 around 1, this would take years potentially. Secondly, there's no guarantee of long lived immunity or any large percentage of of people gaining immunity after infection. This could just lead to wave after wave of pandemic.

2 Vaccine induced Herd Immunity. This is probably the Holy Grail, but it's going to be a while before a vaccine could be finished testing then approved, and there's serious doubt long lived immunity is possible even with a vaccine. The good news is there'll be no dollar spared in getting this completed. If a vaccine is 60% effective and lasts for only a couple years, we could still see waves of infection from time to time unless worldwide vaccinations improve. At best about a third of Canadians get the flu shot every year so attitudes would need to change if this was a recurring vaccination.

3. Extensive public health measures. This is/was what most governments and public health experts were/are banking on as early returns in Singapore and South Korea looked promising. Unfortunately, the second both places open even a little infections ramped up really fast and things shut down again. It may not be a long term solution after all.


Any other thoughts/ideas
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Old 04-15-2020, 09:14 AM   #2
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Much greater asymptomatic infection is a possibility, reducing the time to get to significant herd immunity dramatically.
Probability? 3/10
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Old 04-15-2020, 09:22 AM   #3
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I think a reasonable therapeutic will emerge in May/June. Not a cure, but like a Tamiflu, something that would protect vulnerable populations and treat existing cases. But hopefully a bit more effective. If it could lower severity we'd be in business. That plus public health mandates like masks, limiting crowds, limiting customers in businesses, and of course, golf, will help get things going.
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Old 04-15-2020, 09:23 AM   #4
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My bet is on the drug, now being tested, that stops the virus from replicating. If it works when you feel ill you run in , get tested, get a shot, and get back to work.
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Old 04-15-2020, 09:25 AM   #5
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Too early to say

Understanding the risk of reinfection, and ability to test for antibodies would be required to inform decision makers

Also, the overall strategy could be affected, pre vaccine, by emergence of effective treatment options. There are promising results so far from, for example, remdesivir and scientists are going through their libraries of available drugs that may also show potential.
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Old 04-15-2020, 09:27 AM   #6
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Long-term, some experts believe this will join our other recurring seasonal flues. That's maybe 5+ years out?

From what I've read, it takes around 70 per cent of the population to reach herd immunity. But does contagion slow significantly with 30 per cent immunity? 50 per cent? I have no idea, but it makes sense intuitively. So maybe we reach 30 per cent immunity in 2020 and 50 per cent in 2021 and that suppresses contagion substantially, even if the immunity lasts only a year or so.

Universal social distancing obviously can't be sustained for long. I think it's only a matter of time before we have gradiated social distancing based on vulnerability. That may last for a long time for the most vulnerable (until an effective vaccine is introduced).

In the meantime, drugs to mitigate the effects will reduce the pressure on the ICU of health care systems. So fewer hospitalizations and fewer of the hospitalized requiring critical interventions.

1. Next 12-18 months: Overall reduction of contagion, with seasonal upsurges. Gradual reduction in the severity of symptoms. Gradual strengthening of immunity.

2. 18+ months: Introduction of vaccine and big boost in herd immunity.

3. 24+ months: Occasional flareups for a few years until the virus becomes less dangerous and evolves into just another strain of the seasonal flu.
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Old 04-15-2020, 09:27 AM   #7
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My guess, if it's a drug, would be an existing IL6 inhibitor, or similar (not an antiviral), which essentially might end the cascade of over immune response. This may be the same thing mentioned above, idk

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Old 04-15-2020, 09:31 AM   #8
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Treatments will improve, testing will become more rapid and widely available, including both virus tests and antibody tests. I think we will stay in full lockdown until June and then slowly ease up. Things won't fully go back to normal, or at least the new normal, until a vaccine is widely available in a year's time.

When it is all said and done, I'm going to say 10M infected/750k dead world wide. The world will then be a post-COVID-19 world, similar to a post 9/11 world. This new normal will see all sorts of new pandemic prevention measures.
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Old 04-15-2020, 09:33 AM   #9
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My money would be on a treatment regiment mixed with contact tracing. The first glut would be the most difficult to manage. Nevertheless, infectious diseases are already being effectively treated using a combination of testing contacts, putting them on treatment and finding their contacts and testing them. This is how TB, the most deadly infectious disease world wide, is being managed very successfully in Canada.

The real hang up is whether or not a person is still infectious while they are on treatment, and whether or not reinfection is a possibility ( both of these are very unlikely with TB).
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Old 04-15-2020, 09:55 AM   #10
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Everybody dies.
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Old 04-15-2020, 10:06 AM   #11
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Quote:
Originally Posted by Geraldsh View Post
My bet is on the drug, now being tested, that stops the virus from replicating. If it works when you feel ill you run in , get tested, get a shot, and get back to work.
A few of you mentioned this and I totally missed this idea. This is quite easily done and feasible. If testing and treatments didn't require Dr visit it would be done best. Maybe a separate semi permanent public health clinic or public paid pharmacy service?

Swab, wait an hour for results, get treatment (after screening for therapeutic appropriateness), receive documentation covering 2 weeks off time of, go home and isolate


Something like that would put out the Sparks quickly.


The fly in the ointment of every solution is how to fix international travel
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Old 04-15-2020, 10:15 AM   #12
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My guess, if it's a drug, would be an existing IL6 inhibitor, or similar (not an antiviral), which essentially might end the cascade of over immune response. This may be the same thing mentioned above, idk
I'm not so sure. These are insanely difficult expensive to produce, available in iv infusion only (the ones I'm familiar with anyways), and would need to be timed appropriately.

The perfect medication would be oral, have low toxicity, have both protective and treatment effects so it could be given any time in the course of the disease, and be relatively cheap and easy to make.


I think it'll be an oral med in the end that wins out.

Convalescent plasma is likely to work, but there's no way to produce enough to
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Old 04-15-2020, 10:19 AM   #13
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Quote:
Originally Posted by Street Pharmacist View Post
A few of you mentioned this and I totally missed this idea. This is quite easily done and feasible. If testing and treatments didn't require Dr visit it would be done best. Maybe a separate semi permanent public health clinic or public paid pharmacy service?

Swab, wait an hour for results, get treatment (after screening for therapeutic appropriateness), receive documentation covering 2 weeks off time of, go home and isolate


Something like that would put out the Sparks quickly.


The fly in the ointment of every solution is how to fix international travel

Unessential travel will likely be the last restriction lifted.

Still, T.B is highly infectious, kills 1.5 million people a year, infects something like 11 million. yet does not stop travelling to and from hot spots. That is because treatment is available, as awful as it is.

My assumption would be that peoples anxiety about infection will go down, and things for most people will go to normal as soon as a widely available treatment is established.
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Old 04-15-2020, 10:43 AM   #14
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Rapid testing that gives accurate results, and everyone in your household gets tested once a week. Something like the Spartan Bioscience cube, and I would integrate it into a wireless network or a phone app, that reads green when you are out of the house. It also tracks your movement if it is red.

If you test positive you go in for some type of drug therapy (like Remdesivir) that speeds up your recovery. House isolation until you test negative.

A year down the road we all get vaccinated.
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Old 04-15-2020, 06:18 PM   #15
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Sweden’s current infection rates is probably the best no vaccine scenario.

School in place for up to 16 years of age. Limits on gatherings. Seated restaurants open, Nursing homes closed to public. Strong levels of social conformance to avoid exposure while symptomatic. Also lots of work from home and limited socialization.

Their ICU rates are holding.

https://www.google.ca/amp/s/www.lati...wn%3f_amp=true

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The softer approach means that schools for younger children, restaurants and most businesses are still open, creating the impression that Swedes are living their lives as usual.

Yet as Johan Klockar watches his son kick a ball around a field during a soccer practice in Stockholm, the 43-year-old financial analyst says it’s not like that. He and his wife work from home and avoid unnecessary outings. They socialize in a very small circle, and limit their son’s contacts to people he sees at school or soccer practice.

And while most businesses in Sweden are still operating, the economic cost of the pandemic is already being felt. Last week, 25,350 Swedes registered as unemployed, according to the Stockholm Chamber of Commerce — a larger increase than during the 2008 financial crisis.
So a little more open than we are but people are also maintaining good behaviours.

Their death rate per million is higher than neighbours, they still face significant economic impacts but health care looks sustainable. In a no vaccine no treatment scenario that’s probably what the world looks like
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Old 04-15-2020, 06:23 PM   #16
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A massive depression that doesn't abate for about 5 years?



Neighbors eating neighbors?


I still think that this thing is going to keep happening year after year until something is done about things like China's wet markets and their approach to dealing with the spread of disease.
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Old 04-15-2020, 06:28 PM   #17
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Quote:
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Sweden’s current infection rates is probably the best no vaccine scenario.

School in place for up to 16 years of age. Limits on gatherings. Seated restaurants open, Nursing homes closed to public. Strong levels of social conformance to avoid exposure while symptomatic. Also lots of work from home and limited socialization.

Their ICU rates are holding.

https://www.google.ca/amp/s/www.lati...wn%3f_amp=true

So a little more open than we are but people are also maintaining good behaviours.

Their death rate per million is higher than neighbours, they still face significant economic impacts but health care looks sustainable. In a no vaccine no treatment scenario that’s probably what the world looks like
I think that would really depend on the country. It may be similar for Canada, but countries with lots of dense population areas following Sweden's experiment probably wouldn't fare as well(if you want to call it that). It doesn't appear to take long to go from "ok, we can juuust manage this" to out of control.
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Old 04-15-2020, 07:27 PM   #18
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Old 04-15-2020, 07:39 PM   #19
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I think we enter into depression #2 with the world turning into a dust bowl. With no jobs to be found people will travel the country looking for any work they can find. Camps will be set up for those unemployed and they will be forced to live in rundown shacks and or tents.

Populations will begin to rebel against being caged up in the homes after a year and start to protest. Heavily armed police will patrol the streets telling residents they need to stay in their homes or face imprisonment. They will be greeted by angry protestors hurling rocks and bottles as the police try to contain them.

The dead will rise from their graves searching out the remaining humans who have survived to feast on their flesh.
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Old 04-15-2020, 07:50 PM   #20
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That's my kind of world. I want to be on the side of the oppressors and work for the government goon squad.


I think this is going to be an extremely tough recover that could take years. A lot of small and medium sized businesses are already gone, and people won't be as willing to take the chance if something like this can happen again.



I think its going to be a long time and track record of high unemployment and massive spending by the government to little effect.
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