Did Sweden end up taking the best approach?

304,309 Views | 1675 Replies | Last: 1 yr ago by Enzomatic
CDub06
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Here's a good article from the NY Times that kind of summarizes and compares their situation.

There aren't really any answers yet. But the data is interesting.


https://www.nytimes.com/interactive/2020/05/15/world/europe/sweden-coronavirus-deaths.html
DadHammer
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My problem is with the writers that assume more people will die without the lockdowns. In ny something like 66% of new patients were in lockdown.

If your hospitals have room and most deaths are a certain part of your population and the virus is here to stay then it shouldn't make any difference over time. They need to stop just assuming that when it's just not proven to be true. Sweden's neighbors are also not counting deaths the same either. That has been discussed many times already too. That was also left out.
fig96
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I feel like we need some context of other family members for the "66% in lockdown statistic" that we don't have. For one it doesn't account for typical errands that an individual might be doing and how safe they might be while doing them or whether they're disinfecting and washing their hands regularly.

It's also misleading because it ignores the fact that their case numbers have dropped off dramatically while people have been quarantining, so acting like social distancing didn't have any effect is pretty disingenuous.
dragmagpuff
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fig96 said:

I feel like we need some context of other family members for the "66% in lockdown statistic" that we don't have. For one it doesn't account for typical errands that an individual might be doing and how safe they might be while doing them or whether they're disinfecting and washing their hands regularly.

It's also misleading because it ignores the fact that their case numbers have dropped off dramatically while people have been quarantining, so acting like social distancing didn't have any effect is pretty disingenuous.
I don't think DadHammer is arguing against a lockdown flattening the curve, but is saying that the area under the curve, and thus eventual deaths is the same as long as hospital resources aren't overwhelmed and the death rate doesn't improve significantly over time with new treatments that take time to develop.

Zobel
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Yeah, but that isn't correct. The lower the effective transmission rate, the fewer people get it. Area under the curve isn't constant.
Infection_Ag11
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dragmagpuff said:

fig96 said:

I feel like we need some context of other family members for the "66% in lockdown statistic" that we don't have. For one it doesn't account for typical errands that an individual might be doing and how safe they might be while doing them or whether they're disinfecting and washing their hands regularly.

It's also misleading because it ignores the fact that their case numbers have dropped off dramatically while people have been quarantining, so acting like social distancing didn't have any effect is pretty disingenuous.
I don't think DadHammer is arguing against a lockdown flattening the curve, but is saying that the area under the curve, and thus eventual deaths is the same as long as hospital resources aren't overwhelmed and the death rate doesn't improve significantly over time with new treatments that take time to develop.




That is what he's arguing, it's just wrong. In this case the transmission rate, and thus the area under the curve, changes with social behavior.
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cone
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I thought herd immunity was always based on R0, not Rt
dragmagpuff
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Infection_Ag11 said:

dragmagpuff said:

fig96 said:

I feel like we need some context of other family members for the "66% in lockdown statistic" that we don't have. For one it doesn't account for typical errands that an individual might be doing and how safe they might be while doing them or whether they're disinfecting and washing their hands regularly.

It's also misleading because it ignores the fact that their case numbers have dropped off dramatically while people have been quarantining, so acting like social distancing didn't have any effect is pretty disingenuous.
I don't think DadHammer is arguing against a lockdown flattening the curve, but is saying that the area under the curve, and thus eventual deaths is the same as long as hospital resources aren't overwhelmed and the death rate doesn't improve significantly over time with new treatments that take time to develop.




That is what he's arguing, it's just wrong. In this case the transmission rate, and thus the area under the curve, changes with social behavior.
I completely understand that the herd immunity threshold increases the more contagious a virus is.

But maybe you can help me understand something.

There are obviously multiple components that affect the transmission rate.

We have seen the effects of human activity changes to bring the R<1. In a virgin population, the R can range from 0 (perfect lockdowns) to the "natural" unmitigated R0 at the baseline activity/interaction rate for a given population.

As cases develop, herd immunity effects start to impact the maximum natural transmission rate. (i.e start with 0 immune then 1 in 1000, then 1 in 100, then 1 in 10, then half).

What happens if you reach the herd immunity threshold via an artificially suppressed transmission rate, then go back to normal? If the virus is not completely eradicated, then does the herd immunity threshold "update" to the natural value?
cone
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yes
Pumpkinhead
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Infection_Ag11 said:

dragmagpuff said:

fig96 said:

I feel like we need some context of other family members for the "66% in lockdown statistic" that we don't have. For one it doesn't account for typical errands that an individual might be doing and how safe they might be while doing them or whether they're disinfecting and washing their hands regularly.

It's also misleading because it ignores the fact that their case numbers have dropped off dramatically while people have been quarantining, so acting like social distancing didn't have any effect is pretty disingenuous.
I don't think DadHammer is arguing against a lockdown flattening the curve, but is saying that the area under the curve, and thus eventual deaths is the same as long as hospital resources aren't overwhelmed and the death rate doesn't improve significantly over time with new treatments that take time to develop.




That is what he's arguing, it's just wrong. In this case the transmission rate, and thus the area under the curve, changes with social behavior.


Yeah, 'flattening the curve' also reduces the total area under the curve and thus reduces the total deaths specifically from the disease. The same number of people won't eventually die, it will be less. Go to any document or site walking through an infection curve And the dynamics of flattening and you will easily see that.

Now, you can argue how much trade off is worth the economic costs of 'flattening curve', but anybody saying that the same number of people will eventually die from COVID Regardless, got some bad information from some source.
DadHammer
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In a small time frame say 8-12 months or so and the hospitals have room, I absolutely believe about the same number of deaths will occur over time. Especially looking at who the disease kills the most as it is a very targeted type of person for the most part. The disease will not be eradicated before it spreads to most people over time. But if by some miracle a cure is found before that time frame then yes less people will die over time. It's just not feasible to have a lock down that lasts long enough to eradicate this virus. Plus we are never really locked down as everyone goes shopping, gets food delivered, goes to Home Depot, etc....
cone
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but if it's endemic, how do you avoid Rt going back to R0 unless you keep the measures that keep it as Rt in place into perpetuity?
HotardAg07
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DadHammer said:

In a small time frame say 8-12 months or so and the hospitals have room, I absolutely believe about the same number of deaths will occur over time. Especially looking at who the disease kills the most as it is a very targeted type of person for the most part. The disease will not be eradicated before it spreads to most people over time. But if by some miracle a cure is found before that time frame then yes less people will die over time. It's just not feasible to have a lock down that lasts long enough to eradicate this virus. Plus we are never really locked down as everyone goes shopping, gets food delivered, goes to Home Depot, etc....
You just believe that because you want to believe it because it fits your world view. You have no scientific basis for that theory or belief. From what we understand about infectious diseases, you are wrong.
Dad
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DadHammer said:

In a small time frame say 8-12 months or so and the hospitals have room, I absolutely believe about the same number of deaths will occur over time. Especially looking at who the disease kills the most as it is a very targeted type of person for the most part. The disease will not be eradicated before it spreads to most people over time. But if by some miracle a cure is found before that time frame then yes less people will die over time. It's just not feasible to have a lock down that lasts long enough to eradicate this virus. Plus we are never really locked down as everyone goes shopping, gets food delivered, goes to Home Depot, etc....

I agree. The only way the lockdown saves lives in the long term is if some game changing vaccine or treatment comes out before everyone that will get exposed gets exposed. As long as the lockdown is eventually lifted then the new normal will happen and most people will eventually get exposed, just at a later date.

Even if we all got locked in our homes for a month and shot everyone with the virus so they wouldn't spread it and there were zero active cases after a month, the virus will be back from a foreigner in matter of weeks.
cone
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well, exactly why is he wrong?

how does flattening the curve reduce the required percentage for herd immunity if the disease is globally endemic?

unless you're going to keep the flattened curve measures in place into perpetuity

what am I missing?
HotardAg07
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That's not how infectious disease works. If you depress the rate of transmission and flatten the curve you lower the bar for herd immunity and less people get infected and die. If you won't believe the infectious disease doctor on this board when he tells you that, I don't know what else you need to see that will convince you. There are lots of articles and posts out there from epidemiologists who explain how this works.

My assumption here is that it's easier for people to rationalize their closely held belief that we need to open everything up if they can also believe that closing or not closing makes no difference to the outcome there's no trade off. However, there is a trade off and more people will get infected and more people will die the more that the disease is allowed to spread. I think it is perfectly fine to have a debate on the trade offs and how we should weight things. I don't think we should make up science to tell ourselves it doesn't matter what we do.

Let's put it this way, bump this thread in 2 years. If South Korea has more deaths or the same amount of deaths per capita than Sweden or the US I will PayPal you $100. If your theory is right that all of the suppression techniques are meaningless over the long haul, then I assume you conclude that South Korea must eventually have enough people get infected and die to equalize with Sweden or the US.
cone
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but isn't herd immunity calculated based on R0 not Rt?

and you don't need to be so combative with the appeal to authority. I'm just asking a question.

if you've got some links to share to educate me as to how R0 reduction methods reduces herd immunity requirements then please share.

I can absolutely understand how if the human status quo moving forward was one of distance, masking, extensive contact tracing and testing, then the Rt would be the new R0 for all intents and purposes. but if it's endemic, globally, and you eventually return to some version of pre-virus, then the R0 returns with its herd immunity requirements

of course a vaccine artificially brings you above the herd immunity threshold regardless. but the virus remains the virus so long as it's in the world.
Dad
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HotardAg07 said:

That's not how infectious disease works. If you depress the rate of transmission and flatten the curve you lower the bar for herd immunity and less people get infected and die. If you won't believe the infectious disease doctor on this board when he tells you that, I don't know what else you need to see that will convince you. There are lots of articles and posts out there from epidemiologists who explain how this works.

Please go teach the epidemiologist in Sweden about this because he is the one saying you are trading infections now for infections later with TEMPORARY lockdowns. I think we all know that a long term two year lockdown like Fauci is talking about would drastically reduce Covid only deaths but it would probably kill ten times that from poverty and runaway inflation.
Pumpkinhead
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cone said:

but isn't herd immunity calculated based on R0 not Rt?

and you don't need to be so combative with the appeal to authority. I'm just asking a question.

if you've got some links to share to educate me as to how R0 reduction methods reduces herd immunity requirements then please share.

I can absolutely understand how if the human status quo moving forward was one of distance, masking, extensive contact tracing and testing, then the Rt would be the new R0 for all intents and purposes. but if it's endemic, globally, and you eventually return to some version of pre-virus, then the R0 returns with its herd immunity requirements

of course a vaccine artificially brings you above the herd immunity threshold regardless. but the virus remains the virus so long as it's in the world.


Here are the animations from one of the popular articles out there that show in a pretty simple and easy to understand way how social distancing mitigation measures not only flatten the curve but also ultimately result in less total people infected at the end of the day.

https://www.washingtonpost.com/graphics/2020/world/corona-simulator/

It has animated simulations of the outcomes of 'do nothing', full quarantine lockdown for awhile but then do nothing, moderate social distancing, and extensive social distancing approaches.

you can see in the animated simulations of the two social distancing-based approaches how the outbreak eventually dies down having affected less total people than the 'do nothing' or 'full lockdown then do nothing' approaches. It shows in a simple way that Everybody is not pre-ordained to eventually get infected with COVID regardless, but rather that the quarantine/social distancing approach used does have an impact on the end result total cases.

Not arguing against re-opening because economy is super important too, but anybody who feels that 'everybody is going to get this anyways so might as well do nothing and have done nothing' Is probably off base.
BiochemAg97
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k2aggie07 said:

Yeah, but that isn't correct. The lower the effective transmission rate, the fewer people get it. Area under the curve isn't constant.
Except it is going to be endemic... not go away. Far too wide spread for quarantine to control the spread at this point. Ultimately, most people will be exposed eventually, maybe in a series of curves as an area isolates active infections and then someone brings a new wave.

Think chicken pox pre vaccine. Basically every child eventually got it, but it might not be right away but some infectious wave later. Ok some children didn't get it, but ended up getting it later as an adult.
cone
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I'll check it out

but I'll ask again, doesn't R0 stay R0

and if so, doesn't the herd immunity remain tied to the value

that's why a 20% seroprevalence in NYC and Rt in the 1.3 range now doesn't mean NYC is reaching herd immunity. it would have to still get to +60% if/when they eventually begin to relax the measures that reduced it to the current Rt.

of course, you can drive Rt to below one and let it burn itself out over time, but this is global. you're going to be importing cases eventually since not everywhere is reducing the spread to eradicate the disease.
swintie
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Cone, you are absolutely right. You are also being much nicer about it than I would ever be. I think you know darned well that you are right, but are playing the part of "Columbo" in pretending you are confused in order to get others to come to the right conclusion on their own. I don't have that kind of patience :-)

Yes, we can modulate R(t) through behavioral changes. Yes, that lowers the bar for herd immunity as long as those behavioral changes are in place. As soon as behavior goes back to "normal", R(t) goes back to the original R_0 (and the original % required for herd immunity). Almost ALL of these models that are reported show what happens assuming the controls are in place for as long as necessary. We know that isn't going to happen (shutting down the economy for two years waiting for a vaccine),
Pumpkinhead
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swintie said:

Cone, you are absolutely right. You are also being much nicer about it than I would ever be. I think you know darned well that you are right, but are playing the part of "Columbo" in pretending you are confused in order to get others to come to the right conclusion on their own. I don't have that kind of patience :-)

Yes, we can modulate R(t) through behavioral changes. Yes, that lowers the bar for herd immunity as long as those behavioral changes are in place. As soon as behavior goes back to "normal", R(t) goes back to the original R_0 (and the original % required for herd immunity). Almost ALL of these models that are reported show what happens assuming the controls are in place for as long as necessary. We know that isn't going to happen (shutting down the economy for two years waiting for a vaccine),



They won't 'shut down' the economy for two years but there will be a 'new normal' with at least some moderate social distancing controls in place For a long time. You will almost certainly see impact in large events, air travel and traveling between borders, Etc. Masks may be prevalent or required for certain activities or employees in certain places, you'll see stuff like temperature screening and trying to space people farther apart. Hand sanitizer dispensers will be everywhere and encouraged. Work-from-home when possible will be more prevalent. You will see differences in border controls. just like Sept. 11 changed our air travel experience even still today, things are not going to go back to how they were in Feb. 2020 for a long time. if folks are hoping the college football season 2020 looks and feels just like 2019 with same number of fans in the stadium, unfortunately very unlikely.

What is going to happen is most likely they will relax shelter-in-place orders, businesses will gradually reopen back up, but there going to be at least some moderate Social distancing related measures lingering in many aspects of our society for a long time to come.

I am pretty sure that is going to be the reality and the one that I think posters Should mentally prepare themselves for. A marathon, not a sprint.
Pumpkinhead
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cone said:

I'll check it out

but I'll ask again, doesn't R0 stay R0

and if so, doesn't the herd immunity remain tied to the value

that's why a 20% seroprevalence in NYC and Rt in the 1.3 range now doesn't mean NYC is reaching herd immunity. it would have to still get to +60% if/when they eventually begin to relax the measures that reduced it to the current Rt.

of course, you can drive Rt to below one and let it burn itself out over time, but this is global. you're going to be importing cases eventually since not everywhere is reducing the spread to eradicate the disease.


Definitely check out that article, because the U.S. is currently implementing varying degrees of the moderate to extensive social distancing approaches (Depending where you live), and then read my last post. Rules and changes related to this will probably be lingering in many aspects of our society for a long time.
cone
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what took the biggest bite out of R0?

personally I think this is a very super spreader friendly bug, so large gatherings was huge. and corporate work from home. and restaurants going take out only.

who knows? maybe universal masking (which wasn't the first step, but is by all accounts an effective step) can offset the anti-social methods. but if the thought is that you can't go to church or a NBA game ever again without a mask for a bug that effectively kills a small relatively predictable part of the population, generally at ages ABOVE the life expectancy, well I don't think that's politically sustainable.

two years of masking/distancing of a new normal while THEY FIND A WAY TO OPEN SCHOOLS AND DAYCARES, yes that's plausible. perpetual suppression of R0 for a disease that has a 0.7-1.0 IFR and the median age of death so far in the 80s, yeah I don't know about that.
cone
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personally I'm curious what IFR would be politically acceptable for a novel disease in 2020

we know H1N1's was acceptable 10 years ago, but it never scared the **** out of people like this has, so you're working against that mental headwind.

if a therapeutic brought COVID IFR down to say 0.3% (antibody booster shot), what would be allowed to relax?
Carnwellag2
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swintie said:

Cone, you are absolutely right. You are also being much nicer about it than I would ever be. I think you know darned well that you are right, but are playing the part of "Columbo" in pretending you are confused in order to get others to come to the right conclusion on their own. I don't have that kind of patience :-)

Yes, we can modulate R(t) through behavioral changes. Yes, that lowers the bar for herd immunity as long as those behavioral changes are in place. As soon as behavior goes back to "normal", R(t) goes back to the original R_0 (and the original % required for herd immunity). Almost ALL of these models that are reported show what happens assuming the controls are in place for as long as necessary. We know that isn't going to happen (shutting down the economy for two years waiting for a vaccine),

You said it best.. cone is being very patient with these guys. The area under the curve doesn't change if society goes back to ore-covid. The data, the models, the science all show this.

Why is it hard for the lock down forever crowd to accept it?
BiochemAg97
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Something else to consider. Herd immunity doesn't mean the virus goes away and no one every gets sick. It means an outbreak results in a smaller group of people who get infected in subsequent waves. For an endemic disease, odd are you will eventually get it unless there is a vaccine.


Oh, and all those fancy simulations in the link above: notice the simulation ends before the social distancing curves return to 0. The area under this simulated curve is less because they cut off part of the curve.

That isn't to say that flattening the curve and delaying the infection has no value. If you flatten the curve until you get to a vaccine, then the vaccine reduces the area under the curve, because vaccinating everyone basically ends the simulation.
cone
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Pumpkinhead
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cone said:

what took the biggest bite out of R0?

personally I think this is a very super spreader friendly bug, so large gatherings was huge. and corporate work from home. and restaurants going take out only.

who knows? maybe universal masking (which wasn't the first step, but is by all accounts an effective step) can offset the anti-social methods. but if the thought is that you can't go to church or a NBA game ever again without a mask for a bug that effectively kills a small relatively predictable part of the population, generally at ages ABOVE the life expectancy, well I don't think that's politically sustainable.

two years of masking/distancing of a new normal while THEY FIND A WAY TO OPEN SCHOOLS AND DAYCARES, yes that's plausible. perpetual suppression of R0 for a disease that has a 0.7-1.0 IFR and the median age of death so far in the 80s, yeah I don't know about that.


Where things ultimately land on the social distancing Regulations and controls spectrum for the long term (perhaps even years) will no doubt be Politically driven but also driven by business market forces. Companies and organizations will do things to promote 'safer' to their customers and employees, and to protect themselves from legal liability.

Folks advocating a strict 'lockdown' for a long term are being ridiculous. The world has to have functioning economies.

But folks on the other extreme who are hanging onto life going back to the way it was in Feb. 2020 are also going to have to go through some 7 stages of grief. Because there is going to be a 'new normal' that stays in place for quite some time.

A year from now, in your daily routine, whether if it having to stand on a little dot in some line to stay 6 feet apart, have to wear a mask somewhere, there is protective thing between you and a cashier so can't breath in their face, capacity limits, whatever...there will probably be something in your 'new normal' that reminds you of COVID.
dragmagpuff
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HotardAg07 said:

That's not how infectious disease works. If you depress the rate of transmission and flatten the curve you lower the bar for herd immunity and less people get infected and die. If you won't believe the infectious disease doctor on this board when he tells you that, I don't know what else you need to see that will convince you. There are lots of articles and posts out there from epidemiologists who explain how this works.

My assumption here is that it's easier for people to rationalize their closely held belief that we need to open everything up if they can also believe that closing or not closing makes no difference to the outcome there's no trade off. However, there is a trade off and more people will get infected and more people will die the more that the disease is allowed to spread. I think it is perfectly fine to have a debate on the trade offs and how we should weight things. I don't think we should make up science to tell ourselves it doesn't matter what we do.

Let's put it this way, bump this thread in 2 years. If South Korea has more deaths or the same amount of deaths per capita than Sweden or the US I will PayPal you $100. If your theory is right that all of the suppression techniques are meaningless over the long haul, then I assume you conclude that South Korea must eventually have enough people get infected and die to equalize with Sweden or the US.
South Korea has not come close to suppressing their virus transmission through herd immunity. They did not just flatten the curve, they bent it downward. (I think that this is a good thing).

11,000 cases out of a population of 51 million means that the virus has a 0.025% chance of running into a immune person.

I don't think that if you suppress the Rt below 1 early, you get anywhere close to herd immunity effects slowing the spread (but also nowhere near the infection/death toll).

The question is what happens if you pass the herd immunity threshold for a suppressed transmission rate, but then remove restrictions before complete worldwide eradication. Does the herd immunity threshold increase to the natural number? It it a partial bump? You would probably need to run simulations to model the dynamic system because the initial condition of the changed transmission rate has a fraction of the population with immunity. I doubt the (R0-1)/R0 equation is the answer.

I think the question is important for the possible scenario that a vaccine isn't available and early eradication is not possible due to the contagious nature with asymptomatic spread.



cone
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is South Korea going to be a closed system into perpetuity?

as far as the virus is concerned, they are still virgin timber
culdeus
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cone said:

is South Korea going to be a closed system into perpetuity?

as far as the virus is concerned, they are still virgin timber


So is Vietnam. And to an extent India.
KidDoc
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culdeus said:

cone said:

is South Korea going to be a closed system into perpetuity?

as far as the virus is concerned, they are still virgin timber


So is Vietnam. And to an extent India.
This is why A&M is studying BCG vaccine as a preventative for COVID. India should have been over run with deaths but it was not. Is universal BCG the answer?
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cone
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that would be wonderful
 
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