I don't understand the Lockdown/shut down exit strategy?


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Develop a serology test to see who has had the virus.

Done. FDA approved this last week.

Scale up is relatively easy, since it's a western blot based test. Combo IgM / IgG testing allows some confidence about the date of infection, also helpful for confirmation testing for a PCR based active infection test.

https://www.fda.gov/media/136625/download

We need a diagnostic grade neutralizing antibody test (no small task). Those who are seropositive for Nab are most likely to be safe from further infection.

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I do understand what you are saying.  From my perspective, it would be hard to say that this is “overblown” though, because, as a doctor in the 21st century, I have never seen anything like this in my

I personally don't believe a damn thing coming from Wuhan as being credible. China has made most news organizations leave the country.

3 hours ago, dominattorney said:

I'll try to take us back on the right track. What say you to the following? 

Develop a serology test to see who has had the virus. If I am correct in my assumptions, I have already had it. These people should be tested further to determine the extent of immunity, if any, they have developed. Once these factors become more concrete, society would be safer to open up on a more limited basis to folks who feel more secure to work. It might be tough, but it is possible to develop some system where high risk people can be distanced until a vaccine can be developed to make them safer. This is all a pipe dream based upon the assumption that a vaccine can or will be developed. But it would allow people who feel they are not at risk to contract the virus because they already had it to be out in the world and start the economy off life support. Maybe this won't work, but if I don't get out of the house by may there are going to be other problems beside the virus on my horizon. 

That’s what some countries are trying to do, but a cheap and reliable serological test has thus far proved a holy grail. The question of immunity and re-infection hangs over this too - the data from China is mixed on this, and we still don’t know if the recovered (or those who were asymptomatic) are basically safe for a year.

 I think in order for serological testing to serve as the lynchpin to the endgame (the yearly one, anyway) it has to be a test that can be self-administered, at home.  The Brits thought they had one and were banking their recovery plan on it, but it turned out to be so unreliable it was unusable.

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3 hours ago, Deeg said:

Germany has done pretty darn well if you ask me. Basically followed the South Korea model.

Germany has not hit peak pandemic yet.  They were very lucky because the primary invasion route of the virus was via young people on skiing trips in the Alps.  In Italy, by contrast, the virus hit the oldest first.  Germany is also very lucky because their economic performance has allowed them the luxury of a 24-carat solid gold healthcare system which is now being put to full use.  

As for deciding which country did the best, we really will have to wait until the pandemic has run its course for a full postmortem.  

 

 

 

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1 hour ago, gweilgi said:

Germany has not hit peak pandemic yet.  They were very lucky because the primary invasion route of the virus was via young people on skiing trips in the Alps.  In Italy, by contrast, the virus hit the oldest first.  Germany is also very lucky because their economic performance has allowed them the luxury of a 24-carat solid gold healthcare system which is now being put to full use.  

As for deciding which country did the best, we really will have to wait until the pandemic has run its course for a full postmortem.  

 

 

 

Germany did what South Korea did - they started testing and contact tracing like crazy very early.  That's not luck, it's good public policy.  Does it help to have a great healthcare system?  Sure - but luck is not the primary factor here.

 

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I read somewhere Germany is only reporting deaths as Covid-related if the patient had no other factor or prior medical condition, thus potentially under-reporting Covid-related deaths...

Anyone more familiar with the facts on this?

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2 hours ago, Jeanff said:

I read somewhere Germany is only reporting deaths as Covid-related if the patient had no other factor or prior medical condition, thus potentially under-reporting Covid-related deaths...

Anyone more familiar with the facts on this?

I haven't seen any indication from a reliable source that Germany is under-reporting deaths systematically as opposed to any other country.  The main reason their fatality rate is so low is that they've simply tested more people than most countries, and thus have fewer unreported cases.  The RKI (Germany's CDC, in effect) said that in fact too many asymptomatic people were being tested, to the point where running out of tests was a concern.  They've started to shift away from the practice, which likely means you'll see their fatality rate start to creep up.

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3 hours ago, NSXCIGAR said:

At least one Stanford researcher thinks it's at least worth looking into:

https://www.sacbee.com/news/coronavirus/article241855856.html

Unfortunately, Stanford scientists' extensive PCR testing (n=2,888) indicates there was no such prevalence.

Samples were analyzed from upper respiratory tract patients who had been sick between for early February to late February. 

Zero positives were found from samples before the last week in February.

 

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7 hours ago, Jeanff said:

I read somewhere Germany is only reporting deaths as Covid-related if the patient had no other factor or prior medical condition, thus potentially under-reporting Covid-related deaths...

Anyone more familiar with the facts on this?

As far as I know this is not true. They are counting all cases as Covid-related. Right now the German CDC (RKI) is advising not to perform an autopsy due to the higher risk of infection which leads to a discussion in German media and some backlash from Germany's coronor association because one cannot definitely say right now whether a patient died due to Covid-19 or frome a different underlying condition (heart-attack etc.) and was "just" infected with Covid.

There is more and more discussion growing in Germany as well, when to restart things here and yesterday a study was "kind-of published" on a press conference about one of the earliest clusters in North Rhine-Westphalia, Germany's most populous and one of the most densely populated states in Germany, which was promising because it reported a much higher herd immudity and led to hopes of being able to get back to normal sooner than hoped. Soon after the study was critized by several scientists, because the paper has not been released and several questions were un-answered.

So, there is definitely some restlessness going around in Germany as well and the people are very eager to get some good news.

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13 hours ago, Deeg said:

I haven't seen any indication from a reliable source that Germany is under-reporting deaths systematically as opposed to any other country.  The main reason their fatality rate is so low is that they've simply tested more people than most countries, and thus have fewer unreported cases.  The RKI (Germany's CDC, in effect) said that in fact too many asymptomatic people were being tested, to the point where running out of tests was a concern.  They've started to shift away from the practice, which likely means you'll see their fatality rate start to creep up.

 It's looking to be a mix of luck and gentle data massaging. It may simply be the system in which they record deaths though. Although no country wants to look like it has large scale infections, especially huge net exporters. In other times this method of recording deaths may show a less favourable statistic in those previous underlying health conditions. Most infections in Germany look to be brought in from skiers, predominantly young and healthy, who had visited Italy before their lockdowns came into place. The average age of infected were 35-45, opposed to 20 years older in Italy.

  Also German hospitals and don't test anyone who comes in to hospital seriously ill with an illness or disease that has been exacerbated by COVID 19. considering that COVID19  does the most damage to those with serious underlying health issues like obesity, heart disease, asthma, respiratory failure, this cuts a hefty chunk out of the data available. They will have their deaths caused recorded as those underlying health issues

https://www.spectator.co.uk/article/why-is-the-coronavirus-mortality-rate-so-much-lower-in-germany-

  The rise may come if those young people spread the infection to older members of their family. The increased testing and lock down of those young people might hold the key to holding back the numbers which are now starting to rise.

  Fingers crossed they managed to identify those initial infected and close it down early enough.

  It's a fascinating dig into how each nation does record deaths in this, then you start finding that even states/regions within nations do it differently too.

  Factors seems to be looking to be so wide and varied that it might be too simple to suggest that any nation did the right or wrong thing, especially when you consider how integrated the world is now.

  I think there will be plenty of years when this has settled down until and solid data can show what caused spikes or falls. I'd suspect local factors will be huge eg  in northern Italy where whole families, elderly to newborns can live in close proximity, even in the same household. The UK hasn't been including care home deaths, while France has.

  Even regional differences seem to be very central to spikes. Areas with high pollution are faring worse as their population have less healthy respiratory systems. Men in their 60's are getting hammered disproportionately and it looks to be down to they were more likely to have spent long lengths of time in heavy industry and have serious respiratory damage from it.

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Found this interesting article in the Financial Times a few days ago - it might explain that we do not have an "Exit strategy" and that it will take a mininum of 2 to 3 years before a vaccine might be available.

Imperial’s Neil Ferguson: “We don’t have a clear exit strategy”

April 7 2020

By: Jemima Kelly

There’s a stark truth stalking the debate about the effectiveness of lockdowns. While governments can theoretically check out any time they like (and indeed will be inclined to do so quickly), they might not in reality be able to leave. 

If restrictions are eased too quickly, we risk a second wave even more deadly than the first.

Yet an apparent lack of awareness about the dangers posed by a secondary wave is adding to a wave of confusion and misinformation around coronavirus that we have noticed spreading across the internet since that report from Imperial College London from March 16th. (The optimism appears, also, to be making markets rather giddy). 

But if we aren’t heading towards a clean exit, what are we heading towards? If we have really abandoned herd immunity – the strategy of allowing the virus to spread gradually through about two-thirds of the population in order to let it die out of its own accord – how are we planning on getting back to normal life?

Trying to get to grips with the UK government’s real strategy is problematic, despite the fact that a great deal of virtual ink has been spilt in trying to “explain” it. Indeed it hasn’t seemed totally clear to us whether they are deliberately not giving us the full picture, or whether the government does not actually know what the strategy is beyond this initial curve-flattening stage.

One group of people who might be able to help, we figured, would be the scientists advising government. And while we do not intend to endorse Imperial’s modelling above others’ work – and indeed we realise that doing so at this point constitutes taking a clear side in a debate that has become highly politicised – we do feel that Professor Neil Ferguson, who leads Imperial’s team, appears so far to be carrying the most influence among the government’s advisers.

So we decided to have a chat with Ferguson. What follows here is what we gleaned from our conversation with him (and, crucially, what still remains unclear, which is, we’re afraid... a fair bit). 

Did the government really U-turn on “herd immunity” after the Imperial report?

On Sunday health secretary Matt Hancock told The Andrew Marr Show that herd immunity was never part of the government’s strategy, adding (somewhat irritatedly, we should add) that the idea they had being pursuing it had “been rubbish from start to finish”, and also that any journalists suggesting otherwise were “talking nonsense”.

But that is somewhat at odds with what we have seen and heard until now.

For a start, Britain’s chief scientific adviser, Sir Patrick Vallance has spoken quite openly about the strategy. He said in a BBC interview on March 13th that “if you suppress something very, very hard, when you release those measures it bounces back and it bounces back at the wrong time”, and that the aim, therefore, was “to try to reduce the peak, broaden the peak, not suppress it completely”, so as “to build up some kind of herd immunity”.

But after causing a considerable amount of controversy and alarm when he told Sky News on the same day that about 40 million Britons would need to catch Covid-19 in order for the nation to build up that herd immunity, there appeared to be a change – in tone, at least.

The Guardian’s front page on March 14th

The very next day, talk of a government “U-turn” was splashed over the front pages, as Downing Street indicated it would be banning mass gatherings from the following weekend. Still no lockdown – that wouldn’t come till ten days later – but it appeared that the government, suddenly, had changed its mind about this herd immunity idea (or had decided that talking about it quite so openly was a bad idea, anyway). 

Then on March 16, the “bombshell” Imperial report came out: there would be as many as a quarter of a million deaths in the UK if the government pursued the milder “mitigation” measures that would accompany a herd immunity strategy. That, said the press, must have been the reason that the UK government had abandoned its original strategy. 

But was that really what happened?

Here’s what Ferguson told us regarding the rationale for that so-called “U-turn” (all emphasis, here and throughout, ours):

The government were aware of what our results were showing certainly in the previous week, and some of (the results) in the previous two weeks. There was a very active debate within government and within scientific advice bodies as to the timing of interventions and the package that would need to be put in place. 

The paper came out that day partly because there was pressure on government to be showing the modelling informing policymaking, so we worked very hard to get that paper out at that time... it looked, therefore, like that was the paper that informed policymaking, but in fact a much wider range of scientific advice and modelling advice had gone into government in the previous two weeks, all of which pointed in that direction. 

The above implies the government was aware of the potential death toll – or the one being projected by the scientists on their advisory committee, anyway – but had not considered a drastic lockdown strategy until it became clear that the likely number of deaths from any other strategy would not be seen as politically acceptable. It seems, therefore, that the paper was published at that time partly to help justify a change in the messaging. A “U-turn” doesn’t seem like quite the right term, therefore, for what happened. 

Was this just a messaging change then?

A few days ago Buzzfeed reported that a person who was familiar with the thinking of both the UK’s chief medical officer Chris Whitty and Sir Patrick believed that herd immunity remained, privately, a long-term objective. 

This chimed with a lot of what we had been thinking about the government’s strategy. While the current strategy appears to be geared towards trying to prevent overwhelming the NHS, hence the current lockdown strategy, are we really trying to keep deaths to the lowest number possible?

Some countries brought in lockdowns before suffering even a single death (Politico has a useful list here), so why did we wait so long to begin ours? Was this a case of putting the economy ahead of lives? Was it negligence?

Neil Ferguson seemed to suggest to us it was a bit of both (note the bolded bit in particular):

The government made decisions about the timing of interventions, balancing I would say the impact of the epidemic and impact, therefore, on healthcare demand and mortality, against the staggering economic and social costs of these type of interventions. 

I think in some sense, what had happened in China was a long way away, and it takes a certain type of person to take on board that this might actually happen here. And I think that evidence coming out of Italy in the prior two, three weeks to lockdown being imposed here clarified thinking a lot in terms of: this really was in line with the numbers we’ve been producing for some weeks in terms of potential mortality and that this was really likely to happen.

But perhaps there was also another reason. After all, what keeping the country up and running for two extra weeks might have done is infect a good number of people: not enough to overwhelm the NHS, but enough to make a start at building up herd immunity. This, eventually, would provide some kind of exit (and one that was advocated by the chief pandemic modeller, Sir Graham Medley in the Times over the weekend).

Ferguson said that the relatively small proportion of the country that he estimates have been infected so far – between about 3 and 5 per cent – would mean the extra two weeks before lockdown wouldn’t have got us very far with herd immunity. Even after the peak of deaths that he estimates will come in around a week or so’s time, he reckons no more than about 10 per cent of the population will have been infected.

But as we know from the rather controversial Oxford paper that suggested as much as 68 per cent of the population could have contracted the virus, the Imperial researchers are not the only ones trying to work out how many infections there have been so far, and so they could be underestimating the rate. And when we suggested to Ferguson that some in government might be pursuing some kind of watered-down version of herd immunity, or at least might be considering it a back-up option (in case a vaccine is not found in 18 months), he didn’t totally dismiss the idea. 

Instead, Ferguson noted that there was actually no definite exit strategy in place at this point, though testing and contact-tracing might help (more on that in a bit).

It doesn’t seem clear to us, though, that we can rule out the idea that at least some in government are still pursuing the idea of herd immunity in the background, even if it is just a fall-back plan.

What about this “adaptive policy” Imperial suggested?

The “adaptive policy” outlined in Ferguson’s Imperial report was the basis for the assumption that deaths in the UK could be contained at around the 20,000 level. This strategy, the paper said, would involve relaxing certain measures (namely social distancing and school closures) when ICU case incidence falls below a certain threshold, and tightening them again when that is exceeded, and continuing on like this until a vaccine is found. (Home isolation and household quarantine for symptomatic cases, meanwhile, would be kept in place throughout.)

Ferguson’s paper estimated that the way this would work out would mean that, in the UK, social distancing measures would be in place about two-thirds of the time until we have a vaccine (Ie, about 12 months if the vaccine were to come in 18 months, a timeline which is not at all certain). 

But Ferguson’s testimony to the Science and Technology Select Committee on March 25 confused many when he also suggested this strategy would only be used until other “counter-measures” became available, and also, that “we clearly cannot lock down the country for a year” despite forecasting the same numbers of deaths.

In our interview, Ferguson appeared again to distance himself from the version of adaptive policy idea that had been outlined in the report (and that’s despite the fact that because the NHS has now increased its surge capacity, the amount of time that the nation would be in suppression mode would be likely to be less than the two-thirds of the time until a vaccine is found that Imperial had initially estimated). 

Instead, Ferguson focused more on the ramping-up of testing.

There are lots of downsides to that strategy: first of all that would mean months and months of the NHS being under high stress. Second you’ll have high mortality even with shielding in place. The third one, and I’m not the one to talk about this, but the population acceptability of such a strategy of relaxing things and then telling people sorry we’re going to have to lock down again – there’s quite a lot of behavioural science underway at the moment suggesting that a lot of people would find that a hard strategy to swallow and accept.

So whilst we are looking at those things, we’re also looking at: can we substitute massively ramped up testing ... for some of the more draconian social distancing currently enforced?

And what about those death estimates?

There has also been confusion around the fact that Ferguson also noted in his parliamentary testimony, that the reproduction number – i.e. the average number of others that each infected person passes the virus onto – had increased to around 3, or just above, relative to an original forecast of 2 and 2.6, without a commensurate increase in deaths. (He confirmed to us that he now believes that number is between about 2.8 and 3.1.) 

So how can we still be talking about the same number of deaths when the variables seem to have changed? (In the Imperial report, the higher the reproduction number, the higher the estimated deaths.) We asked Ferguson about this and he said:

Yes, if you keep the effectiveness of the intervention the same, a higher reproduction number is harder to control and you get a higher number of deaths if you make the same assumptions about interventions. But the thing which is also changing is we have some indication of how effective these interventions actually are, from data collected from the London School (of Hygiene and Tropical Medicine) on how much contact rates have gone down, and also indirect data from people’s mobility patterns, how much people are travelling — there’s a whole range of survey data. And it looks like actually the interventions have been more effective than assumed in that report.

In other words, Ferguson reckons the higher reproduction number will be offset by the fact people are complying to a higher degree than the assumptions made in the report, which were as follows:

In terms of the UK death estimates, Ferguson said:

We will be putting out updated estimates, probably in the next week, both on intervention impact and on growth rate, but we hope that the two cancel out really. We hope we’re in the same sort of regime of mortality — somewhere between about 5,000 and 30,000 deaths, and probably closer to 10,000-20,000.

So what’s the thinking on an exit plan?

Although Ferguson focused on the need to ramp up of testing and to bring in widespread contact-tracing, he said it was not obvious that even this would prevent a second wave: 

Obviously what we would like to find is a strategy which allows us to go back to — it won’t be normal life but a bit closer to normal life, and suppresses transmission. That almost will certainly involve something akin to Korea, massively ramping up testing, and contact-tracing. But it’s not clear even in Korea — and I’ve seen some of the analysis done there — that they can really relax all their social distancing and yet keep transmission low.

So
there is no master plan in the background being followed here. There is a lot of research being done in real time, which is feeding into policy, to try and work out: is there in some sense an optimal strategy which keeps the NHS functioning, allows more economic and social activity to continue than is going on at the moment and gets us through the next, frankly, 18 months? I don’t know quite what that will look like or even if it’s completely feasible.

We don’t have a clear exit strategy at the moment. 

That’s right. If we’re to trust what one of the government’s top scientific advisers is telling us, there is at this point no master plan in place. Reassuring stuff, we’re sure you’ll agree. 

Just over a week ago, we tried to flatten the coronavirus confusion curve. Since then, frankly, the confusion feels like it has intensified. We perhaps just need to accept, uncomfortable as it may be, that we are living in a world in which the “experts” and leaders to whom we normally turn for guidance just don’t have all the answers that we’re looking for. Nobody fully understands this virus yet. Nobody knows where the exit door is. 

Related links:
Let’s flatten the coronavirus confusion curve - FT Alphaville
That Imperial coronavirus report, in detail - FT Alphaville

 

 

 

 

 

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i found this to be a really interesting piece - the woman is the expert from johns hopkins, so presumably no dill. a little concerning re the vaccine. interesting looking at the different countries. there is some stuff on leadership in it but from an analytical perspective. some may disagree but this is only mentioned at the beginning and then she gets into the rest of the stuff. 

https://daily.jstor.org/jennifer-nuzzo-were-definitely-not-overreacting-to-covid-19/?utm_term=Read More&utm_campaign=jstordaily_04092020&utm_content=email&utm_source=Act-On+Software&utm_medium=email

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Exit strategy will be slow, mandatory face masks in all public places, even as far as in the workplace. Restaurants will stay closed, along with bars, public events, entertainment venues for 3 months, stateside anyway because the government has decided to pay anyone out of work for that time. Hopefully here the April 30 set date will open up public places, parks. But the powers to be, having said extra power to rule, will always use said power

stay safe!!

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5 hours ago, DaBoot said:

Exit strategy will be slow, mandatory face masks in all public places, even as far as in the workplace. Restaurants will stay closed, along with bars, public events, entertainment venues for 3 months, stateside anyway because the government has decided to pay anyone out of work for that time. Hopefully here the April 30 set date will open up public places, parks. But the powers to be, having said extra power to rule, will always use said power

stay safe!!

Some speculation here:

- smaller firms (Mom and Pop stores etc) have fewer financial reserves to stick it out for long.  They also tend to have smaller premises, which makes it easier to control the number of customers on site at any one time.  This should make them good candidates for the first round of relaxing rules.

- the less face to face interaction with customers, the lower the risk.  Such firms should also be considered for re-opening.

- sports and arts: matches and performances can take place without spectators.  Given that wide parts of the TV and film industry is currently at a standstill and that the number of actual participants is rather small (meaning low-risk), it should be entirely possible to give permission for them to go ahead and broadcast or livestream these events.  

- open-air venues, especially with controlled numbers of patrons, are also a reasonably low risk and could be re-opened.

 

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6 minutes ago, gweilgi said:

Some speculation here:

- smaller firms (Mom and Pop stores etc) have fewer financial reserves to stick it out for long.  They also tend to have smaller premises, which makes it easier to control the number of customers on site at any one time.  This should make them good candidates for the first round of relaxing rules.

- the less face to face interaction with customers, the lower the risk.  Such firms should also be considered for re-opening.

- sports and arts: matches and performances can take place without spectators.  Given that wide parts of the TV and film industry is currently at a standstill and that the number of actual participants is rather small (meaning low-risk), it should be entirely possible to give permission for them to go ahead and broadcast or livestream these events.  

- open-air venues, especially with controlled numbers of patrons, are also a reasonably low risk and could be re-opened.

 

all of which makes sense. just need to get the curve flattened and thaat seems exactly what should happen. 

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21 minutes ago, NSXCIGAR said:

There remains widespread skepticism about that theory.

https://www.sfchronicle.com/health/article/Unlikely-that-California-has-herd-immunity-15193666.php

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2 hours ago, Deeg said:

I am now at the stage where I actively avoid reading most stuff on the pandemic.  There is simply too little actual information, too little verified scientific data and too much scope for experts (both genuine and self-appointed), politicians and social media pundits to speculate to their hearts' content ... not even mentioning the paddlers of outright fake news and conspiracy theorists.  We just don't know enough.  

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2 hours ago, Deeg said:

There remains widespread skepticism about that theory.

Though I live in Tennessee, I was born in LA and am therefore immune to the virus (due to the near-adjacency of LA to SF).  No mound of logic will convince me otherwise.  Nonetheless I have chosen to remain indoors and sequester... because Arnold said so ?

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42 minutes ago, gweilgi said:

I am now at the stage where I actively avoid reading most stuff on the pandemic.  There is simply too little actual information, too little verified scientific data and too much scope for experts (both genuine and self-appointed), politicians and social media pundits to speculate to their hearts' content ... not even mentioning the paddlers of outright fake news and conspiracy theorists.  We just don't know enough.  

I get that.  I myself have tried to limit my intake (twitter is the worst of it) because my anxiety level was going on *tilt* with the sheer relentlessness of it.  As you say we just don't know very much right now - that's why I think it's important to point out that when one study or group espouses a theory (or a cure) no one else seems to be agree with, it should be viewed with considerable skepticism.

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The CA herd immunity has 3 sources debunking it as fact for every source that claims it to be correct.

Who knows what the correct answer is, but far more literature out there saying theory is inaccurate.

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Without need of copying the post, may I concur with Sigmund above?  I also had my only cold with a minor fever in February. There is too little known about this crazy virus but I am old enough to be scared.  Tomorrow morning, I have a gastro procedure I had been putting off because of this virus but can't do it any longer.  On the plus side, I will be tested.

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