Genuine points of uncertainty

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Genuine points of uncertainty

Post by sTeamTraen » Thu Dec 24, 2020 10:30 am

What are some points of legitimate debate about the pandemic, between actual (biological or social) scientists who don't have a political axe to grind?

I have the impression that there is a genuine discussion about schools staying open, for example. A colleague who is the last person in the world to be a denier about anything is very unhappy with his (Dutch) university's decision not to hold live classes, when they have plenty of large lecture theatres and typically small class sizes.

And while I don't pay much attention to the "lockdown is causing tens of thousands of suicides" people, I do wonder about the overall mental health equation --- obviously testing positive is also a mental health issue, but there is an issue about imposing isolation on millions of people, especially those with no access to reliable technology or who rely on neighbours rather than (possibly non-existent) relatives for their social interactions.
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Re: Genuine points of uncertainty

Post by Woodchopper » Thu Dec 24, 2020 11:05 am

There is genuine debate over the ethics of mass surveillance, with people who recognize the seriousness of the pandemic being opposed on civil liberties grounds to, for example, apps that track people's locations and contacts.

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Re: Genuine points of uncertainty

Post by shpalman » Thu Dec 24, 2020 11:09 am

Woodchopper wrote:
Thu Dec 24, 2020 11:05 am
There is genuine debate over the ethics of mass surveillance, with people who recognize the seriousness of the pandemic being opposed on civil liberties grounds to, for example, apps that track people's locations and contacts.
Contact tracing apps don't actually track people's locations for this reason, even if it might be useful to know where people were getting infected.

There's a thread about it
Last edited by shpalman on Thu Dec 24, 2020 11:10 am, edited 1 time in total.
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Re: Genuine points of uncertainty

Post by Woodchopper » Thu Dec 24, 2020 11:10 am

sTeamTraen wrote:
Thu Dec 24, 2020 10:30 am
And while I don't pay much attention to the "lockdown is causing tens of thousands of suicides" people, I do wonder about the overall mental health equation --- obviously testing positive is also a mental health issue, but there is an issue about imposing isolation on millions of people, especially those with no access to reliable technology or who rely on neighbours rather than (possibly non-existent) relatives for their social interactions.
That is also an issue about which there is much room for debate. I'll add that on the other hand, mass infection would have severe mental health consequences as well. Untimely death is very distressing for loved ones, people can't grieve properly during lockdown (attending a funeral via a streaming service really doesn't cut it), healthcare workers have reported having PTSD due to the stress of caring for so many very sick patients, and knowing loved ones or yourself are very likely to get infected at some point would be very stressful.

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Re: Genuine points of uncertainty

Post by Woodchopper » Thu Dec 24, 2020 11:10 am

shpalman wrote:
Thu Dec 24, 2020 11:09 am
Woodchopper wrote:
Thu Dec 24, 2020 11:05 am
There is genuine debate over the ethics of mass surveillance, with people who recognize the seriousness of the pandemic being opposed on civil liberties grounds to, for example, apps that track people's locations and contacts.
Contact tracing apps don't actually track people's locations for this reason, even if it might be useful to know where people were getting infected.
Yes, and there has been a debate about whether or not they should.

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Re: Genuine points of uncertainty

Post by shpalman » Thu Dec 24, 2020 11:22 am

Woodchopper wrote:
Thu Dec 24, 2020 11:10 am
sTeamTraen wrote:
Thu Dec 24, 2020 10:30 am
And while I don't pay much attention to the "lockdown is causing tens of thousands of suicides" people, I do wonder about the overall mental health equation --- obviously testing positive is also a mental health issue, but there is an issue about imposing isolation on millions of people, especially those with no access to reliable technology or who rely on neighbours rather than (possibly non-existent) relatives for their social interactions.
That is also an issue about which there is much room for debate. I'll add that on the other hand, mass infection would have severe mental health consequences as well. Untimely death is very distressing for loved ones, people can't grieve properly during lockdown (attending a funeral via a streaming service really doesn't cut it), healthcare workers have reported having PTSD due to the stress of caring for so many very sick patients, and knowing loved ones or yourself are very likely to get infected at some point would be very stressful.
A lot of the arguments against lockdown are used to justify either delaying it or imposing it in a less strict way, both of which lead to worse problems and the need for a harder and longer lockdown later.
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Re: Genuine points of uncertainty

Post by shpalman » Thu Dec 24, 2020 12:19 pm

sTeamTraen wrote:
Thu Dec 24, 2020 10:30 am
What are some points of legitimate debate about the pandemic, between actual (biological or social) scientists who don't have a political axe to grind?

I have the impression that there is a genuine discussion about schools staying open, for example. A colleague who is the last person in the world to be a denier about anything is very unhappy with his (Dutch) university's decision not to hold live classes, when they have plenty of large lecture theatres and typically small class sizes.
As discussed in the Impact on Universities thread, some things like labs need to be done "in presence" while Universities feel like their existence is threatened if they can't deliver all their lectures in the traditional way. What actually happened here this year was that the students seem to have actually appreciated online classes in February-June when we had no choice, and in September-October we had fewer and fewer students showing up instead of watching remotely (there was a choice for them, if not for us) while November-December went back to being entirely online again following a month of exponential growth not driven by schools and universities being open at all.

It was however noted that it was difficult to make a lesson optimal in a mixed mode, with the lecturer in the room but a substantial fraction of students watching remotely, and it was also difficult to give a lesson remotely if the students also had in-presence classes since they didn't always have somewhere they could go and sit with their laptops and didn't have time to leave campus.

As for schools, we run into can't-have-everything-online because parents aren't necessarily able to work from home (either because they don't do that kind of job, or they can't do it if they're also doing childcare and home schooling) versus the disruption of having to keep going into isolation because someone in the bubble was positive again. And because of your stupid cock-sh.tting micro-managing jobsworth government we have masks which are both compulsory and forbidden, and indeed schools being forced to stay open up until the point at which everything is forced to close. And then there's that whole children-don't-suffer-from-covid-therefore-they-can't-spread it thing which never fully convinced me (and now with the new variant which England has successfully bred, maybe there's a way to backtrack on that).
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Re: Genuine points of uncertainty

Post by sTeamTraen » Thu Dec 24, 2020 1:10 pm

shpalman wrote:
Thu Dec 24, 2020 11:22 am
A lot of the arguments against lockdown are used to justify either delaying it or imposing it in a less strict way, both of which lead to worse problems and the need for a harder and longer lockdown later.
A particularly pernicious form of this can be seen in the bleating (mostly from people who have sat back and watched the NHS being taken apart for the last 10 years) about how the lockdown killed more people than it saved because of all the cancelled screenings and cancer/heart disease treatment.

While in the first wave there may have been one or two hospitals that cleared the decks more than turned out to be necessary (yes, because we had a f.cking lockdown), most healthcare systems now seem to be functioning reasonably well, except when they get overwhelmed by COVID patients. And yet I've seen that last point being spun, even recently, into "COVID prevention is killing people", even though it's the exact f.cking opposite.

It turns out that huge swathes of the population are incapable of any sort of logical reasoning and will just listen to whoever glibly strings an argument together in the most convincing-sounding way, which is very often the snake-oil salesmen rather than the scientists. (See also Brexit, of course.)
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Re: Genuine points of uncertainty

Post by shpalman » Thu Dec 24, 2020 1:47 pm

If we ever got to the stage of zero covid, nobody would seriously suggest putting the whole country into a tier-4-level lockdown if one case happened to be detected in someone just arrived from overseas. But at the same time, the more seriously you take every single case the better you can trace contacts and the sooner you can get back to normal. If you try to run things at a level you consider "acceptable" you'll find a week later that things are suddenly double what you can cope with and no matter what you do you know next week is going to be worse.

Back at the beginning of the first wave I remember the argument from the UK was that there's no point suppressing it because then there'd just be a second one, and I wanted to argue that the second wave wasn't inevitable. Compared to the first wave, we'd have better testing and better treatment and better mitigation strategies and be able to react faster because we'd know what to expect. And then the government f.cked it anyway. It turned out that all those narratives about how x had managed to turn out to be unaffected while y got hit hard were merely post-hoc rationalizations (although Bergamo has had much less of a second wave) and it's all down to a place doing fine until covid arrives there and then it goes to sh.t.
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Re: Genuine points of uncertainty

Post by snoozeofreason » Thu Dec 24, 2020 2:09 pm

I've got dental work scheduled in the new year so, for purely selfish reasons, I am hoping that the almost total closure of dental surgeries during the first wave was an over-reaction.
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Re: Genuine points of uncertainty

Post by sTeamTraen » Thu Dec 24, 2020 2:20 pm

Woodchopper wrote:
Thu Dec 24, 2020 11:10 am
shpalman wrote:
Thu Dec 24, 2020 11:09 am
Woodchopper wrote:
Thu Dec 24, 2020 11:05 am
There is genuine debate over the ethics of mass surveillance, with people who recognize the seriousness of the pandemic being opposed on civil liberties grounds to, for example, apps that track people's locations and contacts.
Contact tracing apps don't actually track people's locations for this reason, even if it might be useful to know where people were getting infected.
Yes, and there has been a debate about whether or not they should.
For contact tracing apps to have any use you would also have to make it mandatory for people to install them, and hence, potentially, require a legitimate excuse not to have a working smartphone on you at all times. Which is already going to be tough for the 20% of the UK population who don't own one.

I think the whole contact tracing thing was doomed from the start in the real world, but I would like to see research into how it might be made to work for the next pandemic. This will have technical, sociological, legal, and ethical implications.
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Re: Genuine points of uncertainty

Post by shpalman » Thu Dec 24, 2020 2:31 pm

You must have seen those threads about arriving in South Korea (I think it was) and everybody being given a cheap smartphone and/or SIM as needed to make sure everybody was traceable at all times?
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Re: Genuine points of uncertainty

Post by bob sterman » Thu Dec 24, 2020 2:41 pm

What are some points of legitimate debate about the pandemic, between actual (biological or social) scientists who don't have a political axe to grind?
I would say the relative importance of aerosol and fomite transmission is still up for debate.

I don't think there's much debate about respiratory droplets being an important mode of transmission - but I think the jury is still out on the importance of aerosols and fomites (i.e. the extent to which they are accounting for real world pandemic spread).

The extremely low levels of laboratory confirmed influenza cases in the UK - with rising COVID-19 cases - would seem to suggest that there are significant differences in the dominant modes of transmission for these two diseases.

On a positive note - the low levels of influenza would seem to suggest we could suppress a new influenza pandemic quite effectively with the measures we're using right now.

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Re: Genuine points of uncertainty

Post by shpalman » Thu Dec 24, 2020 2:53 pm

bob sterman wrote:
Thu Dec 24, 2020 2:41 pm
What are some points of legitimate debate about the pandemic, between actual (biological or social) scientists who don't have a political axe to grind?
I would say the relative importance of aerosol and fomite transmission is still up for debate.

I don't think there's much debate about respiratory droplets being an important mode of transmission - but I think the jury is still out on the importance of aerosols and fomites (i.e. the extent to which they are accounting for real world pandemic spread).

The extremely low levels of laboratory confirmed influenza cases in the UK - with rising COVID-19 cases - would seem to suggest that there are significant differences in the dominant modes of transmission for these two diseases.

On a positive note - the low levels of influenza would seem to suggest we could suppress a new influenza pandemic quite effectively with the measures we're using right now.
That just suggests that it's a lot easier to suppress transmission of influenza than it is to suppress transmission of covid-19, not that the modes of transmission are fundamentally different (or else you'd also have examples of situations in which covid-19 were suppressed but influenza was not).
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Re: Genuine points of uncertainty

Post by bob sterman » Thu Dec 24, 2020 3:33 pm

shpalman wrote:
Thu Dec 24, 2020 2:53 pm
That just suggests that it's a lot easier to suppress transmission of influenza than it is to suppress transmission of covid-19, not that the modes of transmission are fundamentally different (or else you'd also have examples of situations in which covid-19 were suppressed but influenza was not).
Yes - that could well be the case.

However, I don't think we can exclude the possibility that the relative importance of aerosols vs droplets differs. If aerosols are more importance for COVID-19, and droplets more importance for influenza, it's hard to imagine how we could create a situation where you'd get COVID-19 suppression without concomitant influenza suppression. Loose fitting masks can block droplets while letting aerosols out - but how could you achieve the opposite?

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Re: Genuine points of uncertainty

Post by shpalman » Thu Dec 24, 2020 3:40 pm

bob sterman wrote:
Thu Dec 24, 2020 3:33 pm
shpalman wrote:
Thu Dec 24, 2020 2:53 pm
That just suggests that it's a lot easier to suppress transmission of influenza than it is to suppress transmission of covid-19, not that the modes of transmission are fundamentally different (or else you'd also have examples of situations in which covid-19 were suppressed but influenza was not).
Yes - that could well be the case.

However, I don't think we can exclude the possibility that the relative importance of aerosols vs droplets differs. If aerosols are more importance for COVID-19, and droplets more importance for influenza, it's hard to imagine how we could create a situation where you'd get COVID-19 suppression without concomitant influenza suppression. Loose fitting masks can block droplets while letting aerosols out - but how could you achieve the opposite?
Well, you wouldn't. Do you have any links to research on modes of transmission or even the formal difference between "aerosols" (small droplets which float?) and "droplets" (bigger droplets which travel ballistically?) and how humans create them by sneezing/coughing?
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Re: Genuine points of uncertainty

Post by sTeamTraen » Thu Dec 24, 2020 4:22 pm

shpalman wrote:
Thu Dec 24, 2020 2:31 pm
You must have seen those threads about arriving in South Korea (I think it was) and everybody being given a cheap smartphone and/or SIM as needed to make sure everybody was traceable at all times?
Yes, but AIUI that was mostly about being able to phone them up (or, for all I know, track their movements from the tower signals or GPS reporting), not to track their contacts via Bluetooth-based interactions. And if you had gone round UK residents with phones you'd have had the tabloids going nuts about benefit scroungers having more to spend on booze and fags now they don't pay for their phones like hard-working people.

Of course, the various technical aspects all tend to get conflated into "The government is spying on you" anyway...
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Re: Genuine points of uncertainty

Post by shpalman » Thu Dec 24, 2020 4:38 pm

sTeamTraen wrote:
Thu Dec 24, 2020 4:22 pm
shpalman wrote:
Thu Dec 24, 2020 2:31 pm
You must have seen those threads about arriving in South Korea (I think it was) and everybody being given a cheap smartphone and/or SIM as needed to make sure everybody was traceable at all times?
Yes, but AIUI that was mostly about being able to phone them up (or, for all I know, track their movements from the tower signals or GPS reporting), not to track their contacts via Bluetooth-based interactions.
I think it was to track their movements, with regular calls to make sure that they hadn't just left their phones at home and gone out. Which is considerably more intrusive than the apps based on the bluetooth-based contact tracking API.
sTeamTraen wrote:
Thu Dec 24, 2020 4:22 pm
... And if you had gone round UK residents with phones you'd have had the tabloids going nuts about benefit scroungers having more to spend on booze and fags now they don't pay for their phones like hard-working people.
We need social programmes to get internet access to everyone, as more and more things move online including e.g. job application processes.

As for the tabloids, well I've seen people on here complaining about minimum alcohol pricing or Pigouvian taxes. More likely you'll get a backlash from the people you're trying to help when you give them a two-year-old landfill Android which isn't any good for anything. With a side order of corruption when it turns out that the contract to supply them went to an MP's spouse or someone they met in the pub.
sTeamTraen wrote:
Thu Dec 24, 2020 4:22 pm
Of course, the various technical aspects all tend to get conflated into "The government is spying on you" anyway...
Well there was some of that on here too, from people who didn't understand how the app worked or didn't understand what contact tracing was actually for.

It's fair enough, though, that a person wouldn't want to tell the authorities that they'd had contact with a friend because they consequences for the friend are an order to self-isolate and there are only penalties and no benefits.
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Re: Genuine points of uncertainty

Post by Squeak » Fri Dec 25, 2020 11:59 pm

shpalman wrote:
Thu Dec 24, 2020 1:47 pm
If we ever got to the stage of zero covid, nobody would seriously suggest putting the whole country into a tier-4-level lockdown if one case happened to be detected in someone just arrived from overseas. But at the same time, the more seriously you take every single case the better you can trace contacts and the sooner you can get back to normal. If you try to run things at a level you consider "acceptable" you'll find a week later that things are suddenly double what you can cope with and no matter what you do you know next week is going to be worse.

Back at the beginning of the first wave I remember the argument from the UK was that there's no point suppressing it because then there'd just be a second one, and I wanted to argue that the second wave wasn't inevitable. Compared to the first wave, we'd have better testing and better treatment and better mitigation strategies and be able to react faster because we'd know what to expect. And then the government f.cked it anyway. It turned out that all those narratives about how x had managed to turn out to be unaffected while y got hit hard were merely post-hoc rationalizations (although Bergamo has had much less of a second wave) and it's all down to a place doing fine until covid arrives there and then it goes to sh.t.
Australia is pretty close to the straw man in your first sentence. We don't lock down a state or city for a single arrival with the disease (mostly because that person will probably be in hotel quarantine for two weeks, supervised by police, army, or security guards). But we do lock down when there's any community transmission. In South Australia, they imposed a statewide lockdown so strict that you couldn't even walk the dog because lying patients meant they couldn't trace an obvious transmission path. You won't find many Australians angry about it (though you will find plenty of people angry about the lying). We've seen what happens when governments don't do what looks like an overreaction to tiny numbers of new cases.

Things only turn to sh.t after covid's arrival if the government lets them. Stamp out the sparks and things are pretty ok.

(And here's your regular reminder that Australia, South Korea, and China have all taken situations with thousands of community transmissions and turned them into zero transmissions. We aren't just lucky, we let the public health professionals make massively disruptive decisions, which turn out to be much less disruptive than the alternative.)

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Re: Genuine points of uncertainty

Post by jimbob » Sat Dec 26, 2020 12:21 am

Squeak wrote:
Fri Dec 25, 2020 11:59 pm
shpalman wrote:
Thu Dec 24, 2020 1:47 pm
If we ever got to the stage of zero covid, nobody would seriously suggest putting the whole country into a tier-4-level lockdown if one case happened to be detected in someone just arrived from overseas. But at the same time, the more seriously you take every single case the better you can trace contacts and the sooner you can get back to normal. If you try to run things at a level you consider "acceptable" you'll find a week later that things are suddenly double what you can cope with and no matter what you do you know next week is going to be worse.

Back at the beginning of the first wave I remember the argument from the UK was that there's no point suppressing it because then there'd just be a second one, and I wanted to argue that the second wave wasn't inevitable. Compared to the first wave, we'd have better testing and better treatment and better mitigation strategies and be able to react faster because we'd know what to expect. And then the government f.cked it anyway. It turned out that all those narratives about how x had managed to turn out to be unaffected while y got hit hard were merely post-hoc rationalizations (although Bergamo has had much less of a second wave) and it's all down to a place doing fine until covid arrives there and then it goes to sh.t.
Australia is pretty close to the straw man in your first sentence. We don't lock down a state or city for a single arrival with the disease (mostly because that person will probably be in hotel quarantine for two weeks, supervised by police, army, or security guards). But we do lock down when there's any community transmission. In South Australia, they imposed a statewide lockdown so strict that you couldn't even walk the dog because lying patients meant they couldn't trace an obvious transmission path. You won't find many Australians angry about it (though you will find plenty of people angry about the lying). We've seen what happens when governments don't do what looks like an overreaction to tiny numbers of new cases.

Things only turn to sh.t after covid's arrival if the government lets them. Stamp out the sparks and things are pretty ok.

(And here's your regular reminder that Australia, South Korea, and China have all taken situations with thousands of community transmissions and turned them into zero transmissions. We aren't just lucky, we let the public health professionals make massively disruptive decisions, which turn out to be much less disruptive than the alternative.)
Yup, the only way to get or keep control is to increase restrictions as soon as cases rise.

You don't have time to wait for confirmation that that's happening.
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Re: Genuine points of uncertainty

Post by Squeak » Sat Dec 26, 2020 2:24 am

jimbob wrote:
Sat Dec 26, 2020 12:21 am

Yup, the only way to get or keep control is to increase restrictions as soon as cases rise.

You don't have time to wait for confirmation that that's happening.
So much this. I think it's easy for Americans and Europeans to tell themselves stories about Australia's remoteness and Asia's culture that let themselves off the hook for genuinely sh.t pandemic responses.

But the public health people know how to stop airborne disease and have known for a long time. The challenge is in getting an entire society to do it.

We've used police, the army, and private security guards to enforce quarantine in hotels and in private homes through spot visits. And we've made sure people don't starve when they stay home. This stuff isn't unknown or uncertain, it just takes a political willingness to set rules, enforce them, and help people be ok while they obey.

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Re: Genuine points of uncertainty

Post by Chris Preston » Sat Dec 26, 2020 3:12 am

There is no real doubt that lockdowns work. It is the political will to do it and get cases to zero, which allows opening the economy back up with some limited restrictions. The final economic impact of the lock down and eradicate v allowing large numbers of infections to persist* in the community, but early indications are the first strategy is better.

One of the interesting things about the Australian response is that it was the State governments and their public health officers who instituted the eradication of community transmission strategy, rather than the federal government. The governments are now trying the option of limited geographic lockdowns with lesser restrictions in the surrounding zones as in the current Northern Beaches outbreak.

*The option of having small numbers of infections moving through the community does not seem to work. It fairly quickly turns into a full wave of infections that has to be suppressed.
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Re: Genuine points of uncertainty

Post by jimbob » Sat Dec 26, 2020 7:11 am

Chris Preston wrote:
Sat Dec 26, 2020 3:12 am
There is no real doubt that lockdowns work. It is the political will to do it and get cases to zero, which allows opening the economy back up with some limited restrictions. The final economic impact of the lock down and eradicate v allowing large numbers of infections to persist* in the community, but early indications are the first strategy is better.

One of the interesting things about the Australian response is that it was the State governments and their public health officers who instituted the eradication of community transmission strategy, rather than the federal government. The governments are now trying the option of limited geographic lockdowns with lesser restrictions in the surrounding zones as in the current Northern Beaches outbreak.

*The option of having small numbers of infections moving through the community does not seem to work. It fairly quickly turns into a full wave of infections that has to be suppressed.
I was talking to Dad and some of his college friends, who all started in MAFF a few years before Opti, and whose first year included the 1967 Foot and Mouth outbreak. That lesson was known from then and included in the subsequent report
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Re: Genuine points of uncertainty

Post by jimbob » Sat Dec 26, 2020 7:15 am

Chris Preston wrote:
Sat Dec 26, 2020 3:12 am

*The option of having small numbers of infections moving through the community does not seem to work. It fairly quickly turns into a full wave of infections that has to be suppressed.
That's about as sensible an approach as Australia in the wildfire season deciding not to worry about small fires in the bush.
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Re: Genuine points of uncertainty

Post by bob sterman » Sat Dec 26, 2020 8:03 am

shpalman wrote:
Thu Dec 24, 2020 3:40 pm
bob sterman wrote:
Thu Dec 24, 2020 3:33 pm
shpalman wrote:
Thu Dec 24, 2020 2:53 pm
That just suggests that it's a lot easier to suppress transmission of influenza than it is to suppress transmission of covid-19, not that the modes of transmission are fundamentally different (or else you'd also have examples of situations in which covid-19 were suppressed but influenza was not).
Yes - that could well be the case.

However, I don't think we can exclude the possibility that the relative importance of aerosols vs droplets differs. If aerosols are more importance for COVID-19, and droplets more importance for influenza, it's hard to imagine how we could create a situation where you'd get COVID-19 suppression without concomitant influenza suppression. Loose fitting masks can block droplets while letting aerosols out - but how could you achieve the opposite?
Well, you wouldn't. Do you have any links to research on modes of transmission or even the formal difference between "aerosols" (small droplets which float?) and "droplets" (bigger droplets which travel ballistically?) and how humans create them by sneezing/coughing?
I think there is even quite a bit disagreement over the definition of "aerosol" and "droplet" and as this is the "Genuine points of uncertainty" thread - I just wanted to point out that there is uncertainty - over the relative importance of these modes of transmission.

This obviously has important practical implications - e.g. for universities expecting staff to teach in rooms with students not wearing masks as they are spaced out at >2m.

Here's a BMJ editorial on the issue...

Airborne transmission of covid-19

https://www.bmj.com/content/370/bmj.m3206

And one review published on this...

Transmission of COVID-19 virus by droplets and aerosols: A critical review on the unresolved dichotomy
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7293495/

(My point about not being able to suppress aerosols without also suppressing droplets was to show why you probably wouldn't have naturally occurring examples of situations in which covid-19 was suppressed but influenza was not).

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