How’s the Economy Doing? Watch the Dentists
nytimes.com
nytimes.com
I'm probably just naïve about the challenges – or maybe it's happening and I'm just not aware. But I'm surprised my family (3 dental offices between us) hasn't gotten any emails from our dentists selling cleaning kits with elaborate instructions or offering Zoom consultations where they ask the same old questions they'd be asking at a cleaning, planning treatment, etc.
Yes, I realize these things are no replacement for regular cleanings or appointments, but certainly they'd be better than... nothing?
I'm not sure what remote cleaning would look like other than "Be particularly observant to your brushing and flossing." I imagine untrained people hacking around with dental tools would cause more harm than good.
If the US had reacted early and competently, like South Korea, New Zealand, Taiwan, or many other countries, people could be going to dentists without too much concern. But we didn’t, are on a bad and dangerous path, and now have to somehow pretend that we’re not, based solely on popular sentiment.
The reality of COVID-19, how it spreads, and what’s proven to quash it have absolutely nothing to do with how people feel about the pandemic.
https://en.m.wikipedia.org/wiki/COVID-19_pandemic_in_Vietnam
Map: https://www.google.com/maps/d/viewer?ie=UTF8&hl=en&source=em...
The reality is that COVID is a relatively minor ailment, which is not deadly for the vast majority of people - the CDC estimates its IFR at 0.26%:
https://in.dental-tribune.com/news/new-estimate-by-the-cdc-b...
There are already no excess deaths in the USA: https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm
I think its quite likely that without the media storm, we would have put it down as a really bad flu, once in a quarter century, and got on with life. Last time Sweden's death rate was this high was during their 1993 Flu pandemic (an event which is entirely forgotten).
If we value life, we are about to bring a huge amount of misery to the world from our lockdown policies, already pushing 71 million into extreme poverty: https://blogs.worldbank.org/opendata/updated-estimates-impac...
And allowing existing, mundane diseases to spread rapidly: https://www.nytimes.com/2020/06/14/health/coronavirus-vaccin...
The underlying factor is the aging of populations in the West. Look at the forecast age profile for Italy in 2050: https://www.populationpyramid.net/italy/2050/ about 13% of the population will be aged over 80! Mundane flu waves will kill scores of people, simply due to the demographics.
It is unfair to throw the rest of the planet's population under the bus to protect Baby Boomers in the West.
Its also remarkable that we can muster such effort to 'save' a fraction of the population, already sick and elderly, yet do very little to combat climate change which will impact humanity and the planet forever - not to mention the lives saved now from reducing air pollution.
[1] https://en.wikipedia.org/wiki/Disability-adjusted_life_year
Taleb has a good debate with Ioannidis about why his forecasting on the epidemic is wrong. I side with his view:
https://forecasters.org/blog/2020/06/14/covid-19-ioannidis-v...
Is your argument that at the moment there are no excess deaths? Because the CDC data you links says there have been a lot of excess deaths. Why do you think there won’t be a log more when we have uncontrolled spread in many regions in the US?
You've misunderstood this. Why didn't you link to the original CDC document? Please could you show where CDC estimates IFR at 0.26%?
https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scena...
> New data on COVID-19 is available daily; information about its biological and epidemiological characteristics remain limited, and uncertainty remains around nearly all parameter values.
> The parameters in the scenarios:
Are estimates intended to support public health preparedness and planning.
Are not predictions of the expected effects of COVID-19.
Do not reflect the impact of any behavioral changes, social distancing, or other interventions.If you consider their projection that 35% of all infected cases remain asymptomatic (same page), the overall infection fatality rate (IFR) drops to just 0.26 %.
https://twitter.com/Mary_Plastic/status/1274525635638149120?...
Because the ICU is full of covid patients that means there's less capacity for young people after road traffic accidents.
Your comment sounds to me like yet another assessment of the situation that is based on the implicit (false) idea that the situation is static. Or that many places are not already reopening and seeing the consequences.
It's not just that there are active cases, but there are more cases every day. It's not just that there are new cases every day, but that the daily new cases are increasing. It's not just that the daily new cases are increasing, but that the rate of increase is increasing. I think that's like...the third derivative?
The global daily death rate does, and would be expected to, lag new cases substantially, but it has stopped declining and looks to be picking up.
On the flip side we went utterly apeshit as a culture (and still have not recovered) over terrorism, which has killed only a tiny fraction of COVID or even the flu.
I don't quite buy your rosy numbers on COVID, but that being said this does show how irrational we are about risk. IMHO we way overreacted to 9/11, are possibly overreacting or at least mis-reacting to this, and are ignoring climate change which could be much worse than this.
Also, please can you post a link to the CDC document where the IFR is listed at 0.26%?
I’ve seen stuff comparing it to the flu but I’ll have to dig around.
https://www.hopkinsmedicine.org/health/conditions-and-diseas...
In the U.S, 119,131 people have died of COVID-19, as of June 20, 2020.
In the U.S., from Oct. 1, 2019 – Apr. 4, 2020, the CDC estimates that 24,000 to 62,000 people died from the flu.
So I’d entertain the idea that COVID is 2-4 times worse than the Flu. (But you could imagine a bad flu season coming close to that.)
However Flu targets more young people so perhaps if we look at years of life lost that gap would close further.
> In the U.S., from Oct. 1, 2019 – Apr. 4, 2020, the CDC estimates that 24,000 to 62,000 people died from the flu. (The CDC does not know the exact number because the flu is not a reportable disease in most parts of the U.S.)
Those estimates are complex statistical modelling that use a combination of laboratory confirmed cases, death certificates, excess mortality, but also sampling of calls to primary care for flu like symptoms.
The Covid-19 deaths talked about on the Hopkins page are complex, but they come from states and many states are reporting deaths for people who were confirmed by testing to have had covid-19, or where covid-19 was listed as the cause of death (but not just listed) on the death certificate.
Healthy middle aged person who wears a mask in public but goes about his life with his family as if nothing happened. Haven’t gotten COVID, but if I do, I’ll take sick days and move on. What else would you expect people to do, hide inside forever? Curve was flattened, there’s no appetite to do so further if necessary, life goes on (or it doesn’t).
Can’t fault people for responding to incentives and policy accordingly.
Are the policies and incentives so powerful that it's overriding your knowledge that you and your neighbors would be better off if you continued to self-quarantine as much as possible?
Not the least problem is that it implicitly assumes that others will take steps to reduce the worst effects, so that you don't need to bother. The basic anti-social anti-vax position.
In any case it's so easily dissected that I'm going to invoke Brandolini's Law [1] and decline to waste the time to refute BS.
Many are asymptotic, many have mild symptom, yes there is deaths but low in number. Is it not the same case as in Italy, Spain, NYC ?
>Not the least problem is that it implicitly assumes that others will take steps to reduce the worst effects, so that you don't need to bother
I don't assumes others will take steps to reduce the worst effects. Even in in the worst case situation where everyone eventually will get infected (including me), it didn't bother me.
Like I said, the unnecessary deaths of hundreds of thousands to millions doesn't bother you. That is repugnant, and sociopathic.
This is a once-a-century pandemic of a virus that is not at all the influenza or any other common virus. If left to itself it would kill, most likely, millions in the US alone. That's not millions who were going to die anyway, it is millions of avoidable deaths with 10's of millions of years of life extinguished.
The sociopathic narcissism of individuals who feel like that's fine as long as they personally don't feel at risk, which this exchange typifies, is deplorable.
A vaccine. This may well happen in under a year. How much of a difference this makes will depend on the efficacy of a vaccine and how many people get it.
Improved treatments. Some experts seem optimistic about monoclonal antibodies. Cost, production, and ability to administer early enough in the course of the disease are still unknown.
Living in a country that is actually suppressing the disease. Countries that have competently managed COVID-19 are not on a course that will eventually infect a large fraction of the population. It seems likely that if all countries were this competent, then COVID-19 could be eradicated without a vaccine.
> As of May 1, 23,430 people are estimated to have died out of a total population of 8,398,748 in New York City. This corresponds to a 0.28% crude mortality rate to date, or 279 deaths per 100,000 population, or 1 death every 358 people. Note that the Crude Mortality Rate will continue to increase as more infections and deaths occur (see notes under the paragraph "Herd Immunity" below for details).
From a Google search of “Covid mortality rate”. As a healthy person, I would remain comfortable even if the death rate is substantially higher under the assumption that one can’t self quarantine forever and infection is inevitable.
"Infection Fatality Rate (IFR) = Deaths / Cases = 23,430 / 1,694,781 = 1.4% (1.4% of people infected with SARS-CoV-2 have a fatal outcome, while 98.6% recover)"
So 1.4%, about 4.67 times higher than what you say.
That said I may have misunderstood so corrections welcome.
https://www.nytimes.com/2020/05/22/well/live/putting-the-ris... (New York Times: Putting the Risk of Covid-19 in Perspective)
She said: "We are seeing that patients are suffering from moderate to severe acute kidney injury in about 20-30% of patients and 30% of patients who are admitted to intensive care for Covid infection are requiring dialysis so the numbers are much bigger than we envisaged based on the data coming out of China." (published May 2nd)
It's not die-or-recover-completely.
I’m unwilling to live in my home as if it’s a moon base until a vaccine is developed, which could be 6-18 months from now, but as I mention elsewhere in this thread I wear a mask whenever I’m in public (to prevent impacting others if I happen to be a carrier but am asymptomatic). If you’re concerned for my health, appreciate it, but we’re all dead eventually.
You mention in another comment that you do wear a mask. Are there other things you would do if they were simple and were likely to, if done by a statistically substantial number of people, save lives?
Getting people to wear masks (not even all the time everywhere, just in public buildings/crowds) and stay home when they are obviously sick will make a huge difference, but we as a country seem to have said "fuck it, that's too hard".
Avoid dense crowds.
Etc.
How about temperature checks after potential exposure?
I also think you are missing my point. I'm not trying to enumerate all the possibilities, I'm pointing to there being quite a lot of options between quarantine and going back to life the way it was. If we talk about things like concerts being choices, more people look at them that way. If we figure out the small mitigations that make the biggest difference and get them widely adopted, everybody wins.
(note that we are on equal footing here, asserting opinions, I just did it more curtly)
https://www.marketwatch.com/story/why-do-so-many-americans-r...
https://slate.com/news-and-politics/2020/05/masks-coronaviru...
My favorite, from a Costco:
https://www.marketwatch.com/story/i-woke-up-in-a-free-countr...
> “I got every f—ing right to not wear a mask,” he said. “This isn’t about wearing a mask, it’s about control. I’m not the f—ing sheep ... I was one of the only people in that store not wearing a mask.”
The mistake you might make is to assume that this feeling is held by a single person. The data indicates there is a broad contingent of citizens who adhere to these views, therefore your suggestion (“If we figure out the small mitigations that make the biggest difference and get them widely adopted, everybody wins.”) would “impose on their freedoms”, making broad scale implementation untenable.
The first step to change is to want it. That some people in 10 and 20 years will still look back wistfully at the Trump years is disappointing, but it's no reason to give up on changing things that need changing.
And one thing that is worth considering is to work on the change so that it has happened, in whatever amount it has happened, if/when a more difficult pandemic comes along, one where analyzing your own fate doesn't leave you feeling comfortable.
I've been scheduled for an implant for ~4 months now, and waiting for things to calm down before getting it done - but it's not exactly "elective" - there are serious health consequences of not getting the work done - it will be more painful and more expensive the longer I wait. So I get to balance increased pain with increased risk of infectious disease. Compared to most things, it's absolutely a legitimate barometer of how safe I feel doing the riskiest activities _that I have to do_.
So, yes, it's a risk but it seems a reasonable calculated one. Others may of course disagree.
That's what "elective" means. Planned in advance, non-emergency.
“I’m obsessed with dentists because, if the only thing we’re doing is putting the economy on pause, and then going back to normal, all of them should be coming back,” Ms. Stevenson said. “We’re not really recovered until all the dentists are back to work.”
For these groups, Coronavirus might be a death sentence.
Now, you're certainly welcome to think that we should continue pushing those kind of visits/procedures out indefinitely but health officials in most places disagree.I'm being quite conservative in general but I have gone back to the dentist since they reopened.