How much longer can we quarantine without problems? - Page 2
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  1. #26
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    There was a pretty good run-down in today's Wall Street Journal about why covid19 is different from the flu:

    "As one state after another issued economy-wrecking stay-at-home orders to counter the spread of the new coronavirus, skeptics asked a confounding question: Millions of Americans get the flu each year, and tens of thousands die from it. Why doesnít the flu cause a shutdown?

    According to the Centers for Disease Control and Prevention, up to 55 million Americans got the flu this season, and as many as 63,000 died.

    In comparison, more than 450,000 have been diagnosed with Covid-19, according to Johns Hopkins University, and more than 16,000 have died.

    But the numbers donít tell the whole story.

    For starters, the flu tallies are estimates of total flu burden, while the Covid-19 figures are confirmed cases only. Eventually, the CDC will estimate the total Covid-19 burden, but for now, the numbers are not an apples-to-apples comparison.

    'We always know confirmed cases are an underestimate,' said Lynnette Brammer, who leads the CDCís domestic influenza-surveillance team.

    In addition, Covid-19 differs from the flu in how quickly it spreads, the length and severity of the illness, and the unusual demands a contagion with no cure places on medical staff and facilities.

    Instead of gentle waves of cases cascading across the country over a span of six months, like the flu, a tidal wave of Covid-19 cases has swept over a handful of cities in half the time. The concentration of quickly amassing serious infections overwhelmed the affected areas, and the fear is that without social distancingófor now the only effective interventionóother places will have a similar experience.

    A snapshot of the 2009 H1N1 influenza pandemic shows the difference in the speed of transmission between a raging flu and the new coronavirus. Comparing only laboratory-confirmed cases, in the first 102 days of the H1N1 flu pandemic, the CDC reported 43,677 illnesses and 302 deaths. In 22 fewer days, Covid-19 infected nine times more people and killed 42 times as many.

    'The flu season is spread out,' said William Schaffner, an infectious-disease specialist at Vanderbilt University Medical Center in Nashville. 'This is being jammed up in a short time frame.'

    Covid-19 outbreaks have also been highly localized.

    'Youíve got a hot-spot pattern instead of an even pattern,' said Emily Martin, an epidemiologist at the University of Michigan School of Public Health. 'All the pressure is concentrated in small areas.'

    New York, the state that has been hardest hit, surpassed 160,000 confirmed cases on Thursday, according to Johns Hopkins, accounting for about 37% of U.S. illnesses and 44% of deaths.

    With too few beds and not enough staff to respond to the influx, the state resorted to converting hotels, a convention center and a tennis arena into temporary hospitals and called on retired doctors and nurses to return to work. This kind of onslaught doesnít happen with the flu.

    Other regions of the country are bracing for a similar deluge.

    Last week, the University of Michigan Medical Center saw its number of Covid-19 inpatients climb to 166. In the coming week, it expects to have 300 to 350 coronavirus-positive patients in the hospital. The center, which has a total of 550 adult beds, typically admits 250 to 300 flu patients over the entire season.

    'Usually, a hospital is a bunch of medical patients, surgery patients and cancer patientsóitís a mix,' said Adam Lauring, an associate professor of microbiology and immunology at the university. 'We anticipate the hospital will be taken over by Covid-19 and medical patients.'

    Not only are more Covid-19 patients coming into hospitals, they require longer care.

    The median length of stay for adults hospitalized with seasonal flu is 3.6 days, according to research published in the journal Clinical Infectious Diseases.

    In nine Seattle-area hospitals, where 12 of 24 Covid-19 patients died through March 23, the median stay was 12 days in the hospital, 9 days in ICU and 10 days on mechanical ventilators. (The median for survivors was 17 days in the hospital, 14 in ICU and 11 on a ventilator.)

    'Approximately 20% of Covid-19 patients have needed supplemental oxygen,' said Frederick G. Hayden, an infectious-disease expert at the University of Virginia. 'Of those, about one-quarter go on to require intensive-care support for critical illness. Once they are on mechanical ventilation in the ICU, itís often a protracted stay.'

    Having a hospital full of highly contagious patients leads to diminished stores of equipment intended to protect staff members who are also at risk of infection.

    The University of Michigan Medical Center now requires everyone to wear a mask. Additionally, anyone caring for patients who have or are suspected of having Covid-19 must wear a gown and eye protection.

    During flu season, the center uses 'droplet protection' only in some rooms, and there is no universal masking requirement.
    'Itís a different world,' Dr. Lauring said.

    Most people have some immunity to the flu, either from vaccines or previous exposure, and nearly all health-care workers are protected by the flu shot.

    'Itís not unusual to have compliance rates above 95%,' Vanderbiltís Dr. Schaffner said, referring to vaccinations of hospital employees. 'Thatís everybodyódoctors, nurses, dietitians, people who clean at nightóeverybody.'

    Currently, there is no vaccine or specific treatment for Covid-19, so slowing or stopping its spread has required social distancing.
    But there is one quality that might make Covid-19 less problematic than flu.

    'Itís not changing and mutating at the rate the flu can do,' said Allison Weinmann, an infectious-disease physician at Henry Ford Health System in Detroit.

    That could make it easier for pharmaceutical companies to develop an effective vaccineóand render Covid-19 no more remarkable than the seasonal flu.


    https://www.wsj.com/articles/why-doe...=hp_lead_pos11
    More Americans wanted Hillary Clinton to be President than wanted Donald Trump.

    Donald Trump has never had a wife he didn't cheat on.

    "Oh my god. This is terrible. This is the end of my presidency. Iím fód.Ē

  2. #27
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    Quote Originally Posted by No Time Toulouse View Post
    And yet, numbers like this are overall fairly insignificant. I've taken risks in my life before that were probably 100x worse than that! Between skiing and (especially) auto racing, both are endeavors where I've personally known people who died doing them.
    Not everyone looks at it through such a self centered lens.

    Insignificant? Not something I'd say about one dead person. And it's not just about deaths. Hospitals being overwhelmed with people who don't die and that has a big impact on treatment for routine problems other people may have.

    Yes, I've taken bigger risks too. I'm very healthy. I've been skiing. I was pretty sure I wasn't going to crash into an 85 year old skiing and walk away okay eventually and kill him as might be the case with throwing caution to the wind with this virus floating around.
    I don't think American hospitals have to worry much about 320 million people going skiing at the same time either.
    What a stupid and self centered analogy skiing is.

  3. #28
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    Quote Originally Posted by Srode View Post
    Lots of interesting ways to look at it:
    Kudlow says 4 to 8 weeks more. There's a school of thought that much of the West coast already has Community immunity and it started much earlier there but was attributed to a severe flue season.
    People who buy into that are idiots.

    Herd immunity kicks in around 60%. If 60% of the population of CA were infected, the death toll would be staggering.

    Additionally herd immunity does NOT stop transmission, it merely SLOWS the rate of transmission to the uninfected part of the population. IOW, if CA had herd immunity, it would NOT have seen the spikes in cases like it did.

    We know that CA and WA locked down relatively early as well.

    There are parts of the country that are at high risk of blowing up (I'm looking at you, Florida), and the next two weeks will tell that tale. No matter what happens over that time, we NEED widespread testing to open things up safely, and to avoid a second wave that forces another shut down in parts of the nation. Until that happens, opening things up carries huge risks. Health wise and economy wise.
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  4. #29
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    Quote Originally Posted by No Time Toulouse View Post
    And yet, numbers like this are overall fairly insignificant. I've taken risks in my life before that were probably 100x worse than that! Between skiing and (especially) auto racing, both are endeavors where I've personally known people who died doing them.
    It's not your risk. It's the 14 other people you will put at risk that is the issue. So, go race your car and take a sharp corner at high speed as fast as possible. You made it around? Great. Now grab 14 random people... old, young, good drivers, bad drivers, kids who have never driven in their life... and make them take that same corner at just as high a speed. How many made it? How many did you kill?

    That's what your risk does to other people with a contagion.
    Given his penchant for nicknames, and his aversion to reading, I've decided to shorten Donald J. Trump to it's essence: Dump*

    I was "social distancing" before it was cool.

  5. #30
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    Quote Originally Posted by Srode View Post
    Lots of interesting ways to look at it:
    Kudlow says 4 to 8 weeks more. There's a school of thought that much of the West coast already has Community immunity and it started much earlier there but was attributed to a severe flue season.
    You're assuming once you've had it, you won't get it again.

    https://www.jpost.com/Breaking-News/...e-again-624262

    South Korean officials on Friday reported 91 patients thought cleared of the new coronavirus had tested positive again.

    Jeong Eun-kyeong, director of the Korea Centers for Disease Control and Prevention (KCDC), told a briefing that the virus may have been "reactivated" rather than the patients being re-infected.

    South Korean health officials said it remains unclear what is behind the trend, with epidemiological investigations still under way.

    And if it does prove to be more like traditional flu, keep in mind that virus mutates and changes making some vaccines ineffective.
    Given his penchant for nicknames, and his aversion to reading, I've decided to shorten Donald J. Trump to it's essence: Dump*

    I was "social distancing" before it was cool.

  6. #31
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    Quote Originally Posted by Opus51569 View Post
    You're assuming once you've had it, you won't get it again.

    https://www.jpost.com/Breaking-News/...e-again-624262

    South Korean officials on Friday reported 91 patients thought cleared of the new coronavirus had tested positive again.

    Jeong Eun-kyeong, director of the Korea Centers for Disease Control and Prevention (KCDC), told a briefing that the virus may have been "reactivated" rather than the patients being re-infected.

    South Korean health officials said it remains unclear what is behind the trend, with epidemiological investigations still under way.

    And if it does prove to be more like traditional flu, keep in mind that virus mutates and changes making some vaccines ineffective.
    Hopefully they were false positives in the first place. Because reactivation would be really, really bad.

    BTW, general to the recent posts, COVID-19 became the #1 cause of daily deaths in the USA on 4-7.

    As for herd immunity.... keep in mind this is a ski town with lots of travel to and from... https://www.durangotelegraph.com/new...ests-positive/
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  7. #32
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    Given his penchant for nicknames, and his aversion to reading, I've decided to shorten Donald J. Trump to it's essence: Dump*

    I was "social distancing" before it was cool.

  8. #33
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    Quote Originally Posted by Opus51569 View Post
    You're assuming once you've had it, you won't get it again.
    I'm not assuming anything, just tossing out the various points of view out there and I did mention that assumption might not be correct, right?

    Bottom line, the models are proving out to not match reality so I don't have much faith in them and anyone who does isn't looking objectively at the data. We'll know as this continues what reality is, and in the mean time it's getting uglier for the people that have fallen through the economic safety net the government has cast - too little too late.
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  9. #34
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    Quote Originally Posted by Srode View Post
    Bottom line, the models are proving out to not match reality so I don't have much faith in them and anyone who does isn't looking objectively at the data.
    False. EARLY models based on NO change in behavior were wrong. Because people changed their behavior.

    As people change behavior, the model predictions change as well.

    As for looking at the data, how much training in epidemiology do you have? Because I am going to guess zero.
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  10. #35
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    Quote Originally Posted by Jay Strongbow View Post
    Not everyone looks at it through such a self centered lens.

    Insignificant? Not something I'd say about one dead person. And it's not just about deaths. Hospitals being overwhelmed with people who don't die and that has a big impact on treatment for routine problems other people may have.

    Yes, I've taken bigger risks too. I'm very healthy. I've been skiing. I was pretty sure I wasn't going to crash into an 85 year old skiing and walk away okay eventually and kill him as might be the case with throwing caution to the wind with this virus floating around.
    I don't think American hospitals have to worry much about 320 million people going skiing at the same time either.
    What a stupid and self centered analogy skiing is.
    Jay, you seem to be unclear about the concept of a 'rhetorical question' (https://en.wikipedia.org/wiki/Rhetorical_question).
    But, yeah, thanks for your classic ad hominem response...

    The point I was trying to make (which you either missed completely, or just ignored in order to formulate your screed) was that, at some point most people will realize that they would rather take a certain amount of risk rather than hide away from society in general. Just like a good portion of the population would never be found on a ski slope, you can't use that sort of justification to prohibit everybody from skiing, just because some 85 year old would be at risk. I've actually known people in their 80's who still skied, and I doubt they would like being used for such a blanket restriction.

    If we keep the entire population quarantined just because only the most vulnerable are still at risk, then you are over-reacting. Where is that line (or partial lines, I guess), and what is going too far. We can't save everybody, because death is a necessary part of life.

    BTW, I fear this thread is soon going to get political. Can we all just try to avoid going there?
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  11. #36
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    Quote Originally Posted by No Time Toulouse View Post
    Jay, you seem to be unclear about the concept of a 'rhetorical question' (https://en.wikipedia.org/wiki/Rhetorical_question).
    But, yeah, thanks for your classic ad hominem response...

    The point I was trying to make (which you either missed completely, or just ignored in order to formulate your screed) was that, at some point most people will realize that they would rather take a certain amount of risk rather than hide away from society in general. Just like a good portion of the population would never be found on a ski slope, you can't use that sort of justification to prohibit everybody from skiing, just because some 85 year old would be at risk. I've actually known people in their 80's who still skied, and I doubt they would like being used for such a blanket restriction.

    If we keep the entire population quarantined just because only the most vulnerable are still at risk, then you are over-reacting. Where is that line (or partial lines, I guess), and what is going too far. We can't save everybody, because death is a necessary part of life.

    BTW, I fear this thread is soon going to get political. Can we all just try to avoid going there?
    You skiing only risks your own life. You failing to self-isolate and prevent the spread of a potentially deadly virus that afflicts those young and old--particularly those with pre-existing problems (like say asthma)--risks causing the entire medical care artifice in the entire USA collapsing due to influx.

    What about this is so hard to understand? Is it that hard to think about anyone beyond yourself?
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  12. #37
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    Quote Originally Posted by No Time Toulouse View Post
    The point I was trying to make (which you either missed completely, or just ignored in order to formulate your screed) was that, at some point most people will realize that they would rather take a certain amount of risk rather than hide away from society in general. Just like a good portion of the population would never be found on a ski slope, you can't use that sort of justification to prohibit everybody from skiing, just because some 85 year old would be at risk.
    Your point was clear. One is only your risk. The other risks everyone.

    There's a bazillion to zero chance that your skiing will affect me in any way. No matter how dangerous of a skier you are. Light yourself on fire and crash into a tree. I'm safe.

    If you give COVID-19 to 10 people. And they give it to 10 people... and they give it to 10 people... it'll affect me and anyone I know and love in a matter of weeks.
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    Quote Originally Posted by QuiQuaeQuod View Post
    False. EARLY models based on NO change in behavior were wrong. Because people changed their behavior.

    As people change behavior, the model predictions change as well.
    The original models were based on China and Italy. The models are only as good as the data they were based on and very little was known at the time they were run. The Data from China was complete BS and Italy is a terrible comparison. With behavior change assumptions model a month ago showed 250,000 dying in the US. Those are the models I was referring to that were wrong.

    I have as much training as you do on epidemiology I'm sure.
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  14. #39
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    Quote Originally Posted by Srode View Post
    The original models were based on China and Italy.

    ...


    I have as much training as you do on epidemiology I'm sure.
    Multiple classes at the graduate level in epidemiology and a 2 year post-doc studying hiv/AIDS? Did you also talk about SARS in a book of yours that was published?

    What a coincidence!

    Oh, and Italy is not a bad comparison curve to use. https://www.motherjones.com/kevin-dr...pril-8-update/ Scroll to the multi nation graphs.

    But that does not mean that Italy was used as a MODEL. The MODELS of epidemiology are pretty well set up. The uncertainty of predictions is mostly due to the R0 used in the models. There is more uncertainty in the R0 early in an outbreak. The R0 used is calculated (in various ways, discussion of which goes beyond the scope of this thread) by using data from early cases. The more nations effected, the more data to use, and the less any specific issues with Italian and Chinese data will matter in the estimates of prevalence and mortality.

    But I am sure you know all that, since you have as much training as I do.
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  15. #40
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    Quote Originally Posted by No Time Toulouse View Post
    BTW, I fear this thread is soon going to get political. Can we all just try to avoid going there?
    Don't worry. Jay correctly pointing out that your ideas are self-centered isn't political.
    Given his penchant for nicknames, and his aversion to reading, I've decided to shorten Donald J. Trump to it's essence: Dump*

    I was "social distancing" before it was cool.

  16. #41
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    We're going to have the real numbers here pretty quick, so models are .... models. It really won't matter which one is exactly correct.
    Are we getting anywhere close to determining if you can be reinfected, or once infected you can still pass the Cov19 or it's mutants?
    How long before a vacine? ... and what's the chances it's going to work on the mutants?
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    Quote Originally Posted by duriel View Post
    How long before a vacine? ... and what's the chances it's going to work on the mutants?
    There are lots being developed. Lots of them, and testing is going faster than I expected. Still, to prove it safe and effective, a year at the fastest is my best guess. I expect 1.5 years will see one ready. 90% sure.

    That's why we have to put out the fire as best we can, because there likely will be flare ups before widespread vaccines are available. We want as few and as small of those as possible.
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    Quote Originally Posted by QuiQuaeQuod View Post
    There are lots being developed. Lots of them, and testing is going faster than I expected. Still, to prove it safe and effective, a year at the fastest is my best guess. I expect 1.5 years will see one ready. 90% sure.

    That's why we have to put out the fire as best we can, because there likely will be flare ups before widespread vaccines are available. We want as few and as small of those as possible.
    Medical epidemiology question for you...Placebo testing really needs done and controlled for any hypothetical treatment of anything...but given rampant immediate need, is it ethical to give a placebo in a trial during a pandemic like this, knowing that people who are asymptomatic may be reckless thinking they're vaccinated?


    Damned if you don't (out goes standard medical testing procedure). Damned if you do (pandemic spreads)?
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    Quote Originally Posted by QuiQuaeQuod View Post
    Multiple classes at the graduate level in epidemiology and a 2 year post-doc studying hiv/AIDS? Did you also talk about SARS in a book of yours that was published?
    Meh, I can read the studies.
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    Quote Originally Posted by Marc View Post
    Medical epidemiology question for you...Placebo testing really needs done and controlled for any hypothetical treatment of anything...but given rampant immediate need, is it ethical to give a placebo in a trial during a pandemic like this, knowing that people who are asymptomatic may be reckless thinking they're vaccinated?


    Damned if you don't (out goes standard medical testing procedure). Damned if you do (pandemic spreads)?
    That's more of an ethical question, but since what I study includes epi (iana epidemiologist), I can speak to it.

    First, you don't need a placebo for testing whether or not a vaccine produces antibodies, that's just a blood test. Major side effects will show up too, a placebo is needed mostly for minor side effect control. (aches and pains, headaches more frequent than normal, that kind of thing).

    Second, the FIRST place they will likely test "in the wild" will be in medical workers who are working with COVID-19 patients in specific facilities. In that case you ethically WANT to use a double blind vaccine/placebo method. Why?

    Because you don't want them to change their behavior, you want them to continue best practices, and if they don't know which they got, they have incentive to do so. They are, in fact, trained to do so.

    That's the fastest and most ethical way to do testing in the wild. People with high risk of infection per day, and a group where the placebo group should be no WORSE off than if they were not in the trial.
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    Quote Originally Posted by Srode View Post
    Meh, I can read the studies.

    A lot of people can read Shakespeare, how much they take from it varies.
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    Quote Originally Posted by QuiQuaeQuod View Post
    A lot of people can read Shakespeare, how much they take from it varies.
    Excellent point! And the point of my comments in the post you took exception with a portion of was that regardless of what real risk is and the real spread, (which is most certainly different than numbers which are published daily and is unknown/unknowable), there comes a point when there are so many views and so much suffering with the current approach that the general public's interest and willingness to follow the quarantine will fade. We are getting pretty close to that in some areas now due to the financial stress on some, that's my opinion. I believe that's the question/essence of the original post correct? So back on topic, what is your perspective on the original post question?
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    Quote Originally Posted by bvber View Post
    What goes on in Sweden should be looked into as well. So far, they (without lock down) aren't doing any worse than nations with the lock down.
    They are doing significantly worse

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    Quote Originally Posted by Srode View Post
    So back on topic, what is your perspective on the original post question?
    You mean this bit?

    Quote Originally Posted by No Time Toulouse View Post
    I'm wondering just how long this is going to go on, and what is the criteria for full or partial lifting of restrictions?

    The criteria for both tightening and loosening travel restrictions are pretty basic stuff. Google should give you an answer. Or you could dip into the academic literature, given your ability to read, if you want more fine grained info. I'll stick to a basic level here. You know, for others.

    In general terms, anyone with antibodies can go out safely any time.

    Given a disease with an incubation period of X, that is infectious for Y days after it incubates, and has zero reinfections in the same person.... if everyone isolates for 2X+2Y days we can ALL go back right away. (Two cycles in lock down allows for reinfection IN a house but not OUT of the house.)

    Everyone won't. So once new case rates are "low enough" then people who have shown antibodies OR who are negative can get out. The negative people will be taking a risk, the level of which is determined by the "low enough" level that is chosen. But everyone needs to distance and wash hands and stay home when feeling any symptoms. And for any new positive there needs to be contact tracing.

    The earlier you go, the more risk to the negative people. The longer the lockdown, the safer negative people will be.

    There will be a growing case load if we do that, but the hope would be to keep any growth at a low level until the vaccine.

    The speed of getting to "low enough" depends on how well people curtail transmission.

    Widespread testing speeds the whole process up. It doesn't have to be all at once, but a big push followed by medical testing at points of contact would do wonders for opening (and closing future hot spots when the emerge and are still small).

    That pretty much covers it, at the simplest level.
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    I feel like most of the folks on this board are pretty well heeled and affluent, therefore they are able to weather this confinement with relative ease. It feels like this demographic is slightly out of touch with the number of people who must go to work every day just to keep others safe and fed while quarantined at home. For example, there was a story in the local fishwrap about a toilet paper factory who has hired 75 people and is working 24 hrs a day to keep up with the demand. Who is growing and producing your food, shipping it to your store. Who is keeping the power on and water clean?

    The restrictions they have in place are unsustainable in the long term. The paycheck-to-paycheck demographic is the hardest hit and I would not be surprised if there is a revolt in the next week or two.

    I pose the question, is there not a happy medium? Can we ask the most at risk people to stay home and the rest go back to work taking whatever precautions they and their employer deem necessary? As stated above, C19 is not going away, will we have C19 season every year just like the flu season? If so do we plan on closing down the country for 3 months every winter?

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