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In two months, 6,000 Massachusetts residents have died from a single cause

Yes, our coronavirus numbers are trending in the right direction - ICU use is down, so are daily cases. But today we reached yet another milestone: More than 6,000 Massachusetts residents have died from Covid-19 in the two months since we recorded our first death. For all the curve flattening and staying at home, that's 6,000 people (6,066 to be sort of exact, given how nothing related to this virus seems exact, least of all statistics). Only New York and New Jersey have had more deaths. There are investigations into what happened at the Holyoke Soldiers Home. Will we see a similar investigation into all the other deaths and misery in our small state?

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Seems to explain a lot of it. MA is 3d in population density. NJ is 1 and NY is 7.

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And that's where most of the NY deaths have been.

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...and some of the worst in NJ has been in the towns & cities along NYC commuter corridors.

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But also more likely that density often relates to international travel, affluence, etc. These are where the virus is first going to land due to business and travel connections.

As an example middlesex county (pretty dense) started out really high in terms of rate per capita at the start of the epidemic. Plymouth and Essex County (much less dense) have now surpassed them.

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Exactly. People are already looking at these stats and asking things like, "California is just as populous as New York but wasn't hard-hit, what was better about their response?" but that's not necessarily the right question. The premise that "populous = hard-hit" may be invalid. Part of how hard-hit a state was is certainly going to be population, total and density, but other factors like how many actual infectious cases landed at their airports, are going to be just as important if not moreso. NY, MA, and NJ may simply have had a lot more infected travelers start the spread. CA may have just been lucky.

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Within the largest outbreaks, the distribution follows the opposite (the less dense, the more deaths). See today's NY Covid numbers by zipcode for an example; or this tweet for a visualization:

IMAGE(https://i.imgur.com/IZGnXn5.png)

On top of that, some of the most dense cities in the US (and the world) didn't see numbers anywhere near NYC or boston even though their densities are similar.

Chalking this up to density is WAY too simple (and dangerously misleading).

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The residential density of a zip code doesn't matter if people in the lower-density zip codes are still going to work in the business district.

And the densest residential neighborhoods tend to be the super-expensive areas, where people have jobs that allow working from home. Or they vacate to their vacation houses.

It would also be interesting to see a plot of COVID cases, rather than COVID deaths.

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You don't want to do that unless you really, really have no other choice.

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What's the total number of old folks in tightly packed urban areas vs others?

I don't think theorizing the intuition that population density helps a spreading virus is "dangerously misleading".

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You’re asking a great question. It seems much of people’s attention has been focused on bemoaning how other areas of the country are opening up way too soon, because, um, they’re just so ignorant or whatever, while we’re so smart here. But the reality is that MA, NY and NJ got just about the worst of it, so maybe the local conventional thinking is missing the real picture.

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Hard to know with the shortfalls in testing and tracing. What were the real vectors into the US?

I do think MA was quicker to a initially slightly stronger response (emergency orders). There had been news, discussion and increasing awareness through the first two weeks of March, really ramping up at levels close to most people during the second half of the week ending March 14th. Significant restrictions went into place the beginning of the following week.

NY and NJ were a week behind that response (though I don't have a firm sense of how differently the developing situation was perceived there than here). Fortunately, the major Saint Patrick;s Day parades were cancelled (can you imagine how bad it would be if they had gone on as scheduled?), but the significant restrictions didn't come until a week later than MA (went into effect the night of Sunday March 22). How different would it have been if restrictions went into effect on the 15th?

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If those states made their decisions based on the available data and science, then that's fine.

If they made decisions based on something made up, then yes, that would be ignorant.

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Nearly 1/2 of all MA COVID-19 deaths have occurred at elder care facilities. Understaffed, staff under-paid and under-trained.

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More particularly, filled with some of the most at-risk (older, pre-existing conditions) and physical setup of these places is often such that there is little can be done in flu season and such times but batten down the hatches, eliminate outside visitors, restrict interior mixing.

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History lesson: Cities and castles never withstand a siege. Ever. They always fall. Always. The only hope is to lift the siege. Think of nursing homes in the same way.
1. Withstand the siege. Isolate the C+, isolate the C-. Separate buildings if needed. Hire people that you don't have to worry about spreading or catching it themselves, like antibody positives. They'll be like Tom Hanks, not worried about themselves. Watch the contact transfer. Like a hawk. Like two hawks.
2. Quarantine the place to minimize accidental contamination. Set up UV light input areas for anything inbound, food, gear, etc. H2O2 sanitizing. Bleach. Whatever it takes. Frozen food. Does COV survive freezing? I dunno. Strong sunlight. Leave shipments on the loading dock in the sun to decon it. Hot, warm, cold zones. Go by the book. There is a book. It can be done.
3. Lift the siege. Develop the vaccines and treatments that will help the patients.

IMAGE(https://i.imgur.com/WpKndKb.jpg)

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Don't quit your day job.

The real issue with nursing homes is that they apparently selected for people who were asymptomatic yet able to spread COVID. The nursing facilities in Medford that were hit worst had nearly 50 superspreaders providing intimate personal care.

PPE might have helped, but no amount of bleach or UV in the world will fix that.

FYI: cornaviruses absolutely survive freezing. That's how I used to preserve them in sputum samples.

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There was a good Boston Globe oped on this. Too many nursing home workers need 2 jobs to survive. If there's an outbreak in one facility where they work, they bring it to the other because they don't have adequate PPE and don't wash/change clothes between jobs.

I can also tell you from my experience in rehab from an injury last year that even the "good" facilities don't have great hygiene. I was there 2 weeks and no one ever cleaned my bedside table, where aides sometimes placed soiled items. I don't know if they were inadequately trained or inadequately supervised or too overworked to care, but the limit to their hygiene steps seemed to be wearing gloves. If there was one sick patient, I could see it easily being spread between rooms.

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They said someone with antibodies, not asymptomatic. Very different. I think that strategy that was laid out was far better than anything the state of MA has done, which has been scientifically insulting at best. Deeming liquor stores essential so we can crowd small stores and destroy our immune systems at the same time. Yes..very smart. I mean, dont get me wrong..thank god they are open, but its truly comical to believe we are trying to be intelligent about this. To make it even funnier, I swear every liquor store Ive been to has a cashier with a mask around his neck. Home depot, target, costco all reporting big increase in sales. Crowding more people into less stores makes the situation worse. We need more surgical mitigation that focuses on at risk people. Its only the unhealthiest 2% that really need mitigation. We should focus on that. There may be outlyers here and there, but that is nothing compared to the deaths this lockdown will cause.

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Leningrad was besieged by the Germans from September 8, 1941 until January 27, 1944, but never fell.

However, a pandemic is not a siege.

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Densely populated areas like Chelsea have been the hardest hit. Most of them have blue-collar jobs which prevent a work at home scenario.

So what industry is a high percentage of their residents in: Healthcare.

Like the staff at Nursing Homes.

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More like 60%. A lot of PPE is being supplied to the nursing homes. As far as staff, the ones that I have met are well trained and professional. They know their shit, they're not stupid. I cannot speak to their pay scale.

IMAGE(https://i.imgur.com/dOAdJb5.jpg)

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There were articles a few weeks ago discussing how at the start of the outbreak, many nursing homes didn't have enough of the PPE on hand and the staff were inconstant about wearing it. This isn't blaming them, just noting that once a facility has a few cases, it's very hard to contain without extensive testing and isolation -- things which were lacking.

The point behind all this is that the Federal Government screwed up big time. They should have been prepared with messaging, nationwide PPE, equipment, etc. That should have been ready by mid-February. Instead, they downplayed everything until it was too late.

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It's a different world at night.

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I only wish our political leaders showed the same amount of compassion they had for the safety of convicts in prisons as the innocents dying in record numbers in our nursing homes.

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Meanwhile, every Massachusetts resident has lost 2 months (or over 0.2% of their lifespan) to a single cause.

At some point, the cost-benefit of the lockdown becomes worse than the disease. The tipping point varies by health and age, since the disease is worst for people with bad health or an average age of 82, while the lockdown is worst for people between 14 and 65.

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Many people have lost their jobs sure, but not anything like a majority of people. Personally, I've been inconvenienced for two months of my life but I haven't lost shit. My kids have had two months of meh education but again no loss.

Love that right wingers are now all about choosing to let people die after all the 'death panel' nonsense about the ACA let alone Terry Schiavo.

What have you lost that wasn't offset by saving the lives of old folks through your personal inconvenience?

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I lost my job...

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I don't at all intend to dismiss that lots of people have been badly hurt by this.

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Many people have lost their jobs sure, but not anything like a majority of people. ...
What have you lost that wasn't offset by saving the lives of old folks?

This is emblematic of the hypocrisy. Turning a blind eye to one group (20% of people lost their jobs, but hey it's not a majority) and focusing on another (ohmigosh so many old people. could be 0.1% of the population). Those two groups of school/working age people, and people over 75 are pretty distinct.

The tradeoff of lockdown vs disease is divisive. That so many people are unwilling to acknowledge and analyze it is lousy.

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If you want to restate your original post that I was responding to, fine but don't get mad because you didn't write what you meant.

What I have little patience for is the argument that seems to just accept that we can't do any better therefore must just give up on an optimum outcome. South Korea and Germany among others show that it is possible to reduce avoidable deaths without requiring endless sacrifice.

Here is our only option to just accept that we will all die in larger numbers so the 1% doesn't have any impact at all? So Joe Plumber doesn't have to feel uncomfortable wearing a mask? Because what will happen the second we start to just open shit up without specific, trackable plans is a lot of people will just say 'fuck it' and in that case all the sacrifice of the last two months is completely negated AND the economy will be fucked when the second wave hits in September.

What have you personally lost? A job? A vacation trip? Your kid's graduation? Honestly asking since you insist that we all lost two months. If you just mean you were inconvenienced because you couldn't go to a BBQ or to Fenway, your definition of loss and concept of the greater good is pretty shitty.

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Since you and other posters prefer to frame this dilemma as a partisan issue ("right wingers", "GOP", "conservatives") instead of as a comparitive statics problem, I want to throw out there that yes, I agree there will likely be another spike and lockdown in the fall, if for no other reason than additional panic and economic distress will benefit one political party more than the other in the November election.

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You can't actually name anything you've personally lost over the last two months?

It's not truly a partisan issue as Baker is doing a decent job and is GOP and Cuomo/Deblasio for example, did less well and are Dems. There are huge differences in the way Trumpists like Disantis and governors like Inslee are handling this, but it's not truly partisan. Even a right wing entity like Facebook is having employees work from home until 2021- another Democrat plot?

Can you clarify though, are you stating that if there's a spike in infections in the fall, globally, that is going to be results of liberal meddling vs. actually how viruses work? That's wild QAnon bullshit.

Finally, let's do talk comparative statics. You want to talk momentum, inertia or what?

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You think people are worried about a barbeque? Seriously? Are you seriously that disconnected? People are losing 20 year old businesses! People are losing their entire livelihoods!!! In droves! How could you possibly be that oblivious?? We are talking about unprecedented and MASSIVE numbers of small businesses closing. This is unlike anything we will ever see. One out of four restaurants are predicted to close. You honestly think restaurants can be profitable 25% capacity??? Do you have any incling whatsoever on what it takes to run a business? Do you realize that small business completely drives our economy? Do you realize it is also what gives character and soul to cities? Unfortunately it is probably too late for a large number..as we cross June 1, that number will skyrocket. I cant believe how short sighted you are.

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You seem to think this is all about YOU.

Just because you are experiencing minor inconveniences, you don't speak for others.

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I am not saying people aren't impacted. I'm saying that the fact that people are deeply being impacted isn't enough reason to change course without specific plans to prevent further problems.

See?

Saying 'eh, this is too hard to continue with, let's stop' which isn't policy just lazy fatalism.

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while the lockdown is worst for people between 14 and 65

Nope.

Poverty is where the suffering is right now. Either they have to go to work and risk exposure, or work and school are shut down and they're at risk from food insecurity, possible loss of home, and from getting the virus.

Age is irrelevant.

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There's no point in trying to do a cost-benefit analysis right now. It sounds like this virus can have long-term or permanent deleterious effects. Scientists are 6 months into studying something that's going to take years to fully understand. Is 0.2% of your life worth permanent lung damage? That's the kind of cost-benefit analysis you're talking about.

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It doesn't have to just be a choice between lockdown where people suffer and an "opening" where people straggle back to try to rescue a crippled economy in stages risking a new wave of deaths. It's only because the republican-led government can only think of using the levers of power to reward their billionaire donors and the democratic party's corporate hacks are incapable or unwilling to loudly advocate real alternatives.

If the federal government guaranteed people's livelihoods during lockdown as they have in places like Denmark and Germany, we wouldn't be forced into these Hobbesian choices of opening up or starving.

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Forty years of policies and politics favoring "free markets", driven by the notion that "government is the problem", have weakened the federal government to the point where it can no longer respond effectively to a crisis such as this one.

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No one lost two months. You can still enjoy life. I know that’s hard for miserable conservatives but come on. Having to watch more TV and not get a professional haircut is not a big sacrifice.

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watching tv?
That is not life.

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You're so busy proclaiming yourself ready to Enjoy Liberty you forget that nobody was actually locked into their house, forced to just watch TV 24 hours a day. People who care about public health and not letting other people die may be too strict for your tastes, but please, they are not monsters.

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Get a grip Adam.
I'm not sure how you got all that from my post?

Don't know where you think I don't care about people dying, or care about taking precautions. I do take precautions!

Just stating "watching TV" is not living, doesn't mean any of the things you cry about.

I've been getting all my gardening done, instead of waiting for weekends. Getting in reading time and other in home projects.

Enjoy Liberty? What the hell are you talking about?

My God, man get a freaking grip. You're losing it.

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If people want to do cost-benefit analysis on lives lost, they should at least consider all factors. I read a lot of comparison asking why __ million people should be unemployed for the sake of 100,000 deaths. Cost-benefit analysis is a pretty cold type of mathematics, but if you do it well it at least can reflect what you, or what our society, thinks and values.

1. The comparison shouldn't be with 100,000 deaths that occurred, but the number prevented, which is an unknown number. I've looked at some hot spots to speculate about what the total deaths could have been in a worst-case scenario, and don't feel like I can share a guess, beyond saying that the stay-at-home orders prevented what could have been a much higher number of deaths.

2. Rather than compare number dead vs. number unemployed, we should compare weeks of unemployment vs. lost weeks of life. The average 80-year-old woman has a life expectancy of approximately 10 years, to age 90. So a death of an 80-year-old woman is a loss of 520 weeks of life. The age range of people who have died, or who would have died without the stay-at-home orders, is a wide distribution, with an average in the 80's., so estimate 500 weeks of lost life for each death.... a cold-sounding calculation, until you think of it in terms of the quality of life lost, to the person, family and wider community. (I think a lot of the protestors underestimate the health, productivity & value of middle-aged and older people by the way.)

3. You could also add in 4-6 weeks of lost productivity for people who are significantly ill and recover.... or who would have been ill without the stay-at-home measures.

4. Compare the weeks lost to illness and death to __ weeks of unemployment for the __ million unemployed to find total weeks of unemployment.

5. The ratio of weeks lost to unemployment vs. weeks lost to illness and death would be a much closer ratio. I've come up with a variety of estimates under different assumptions, such as maybe 10 weeks of unemployment to 1 week of life lost.

6. The next step involves a value judgement. Which is sadder to you: 10 weeks of unemployment vs 1 week of lost life? Would you be sadder if you learned that 10 of your friends or family members are unemployed this week or if you learned that 1 of your friends or family members is dead?

This step is where values come in... public health measures usually don't seek to prevent all deaths, but to take reasonable measures to prevent preventable deaths.... such as worker safety laws, speed limits, seat belts, food safety laws, vaccinations, and other public health measures. We don't want to live in a bubble, but the more we value life, the more we favor reasonable safety measures.

Would love to see other people's take on a cost-benefit analysis.

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Sweden didn't lock down, but there are indications that they didn't spare themselves anything by not locking down.

In fact, the mounting death toll is now costing them, too.
https://www.businessinsider.com/sweden-economy-likely-wont-benefit-from-...

The counterfactual cannot possibly be "no economic impact". Given how fast and hard MA was hit even with social distancing, people would have altered their behavior in ways that impacted the economy once the hospitals overflowed and bodies piled up.

Anyone who says otherwise is either arguing in bad faith, does not understand how highly virulent pathogens work, or likely both.

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Is it true that deaths by pneumonia, influenza and "natural causes" have been virtually eliminated in MA this year, at least on death certificates? How has the overall death rate differed from years past? It was fascinating yesterday to read that the Colorado Covid death count has been revised downward by 25%, after a watchdog group became suspicious and sued. Watch for more "downward revisions" as the dust settles. Recall that the average age of Covid death here is 82, well beyond life-expectancy. Further, those under 60 in good health have almost zero risk of death. As for the accuracy of the death counts, the Worcester City Manager was asked yesterday why the sudden, unexpected one day increase in deaths? He responded, "“Some of these cases that we’re reporting today are cases that could be a week or two old that are just getting cleaned up and refreshed in the system.” It's like pulling a rabbit out of a hat, deaths from two weeks ago suddenly appearing as Covid. Unbelieveable.

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And you won't know for a while

One of the issues is that nursing homes in MA don't always operate the same way. How many DNR's were there? How many cases were declined by the ME? How many cases were tested for influenza and Covid?

In general if someone in a nursing home tests positive for Covid and they die of pneumonia, the cause of death will be Covid, and that is simply written on the death certificate by the funeral home or nursing home itself since the ME isn't going to take most nursing home deaths cases. Who is correlating all of those death statistics this year and are they consistent?

But what is interesting is finding out how deaths in 2019 or before were classified. If someone died of pneumonia in 2018 but had influenza what did it say on those death certificates? I think that is where some of the range comes in (40k to 80K deaths) instead of an exact number.

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Social distancing and masks likely reduce transmission of flu and other communicable diseases as well as Covid-19.

Less travel should mean fewer deaths from motor vehicle crashes and other outdoor accidents.

People staying indoors should mean fewer deaths from gunshots, stabbings, and the like.

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Should, yes. Social distancing and masks help with contagious diseases, though doctors and public health are already concerned about children missing scheduled vaccinations because they aren't getting to the pediatrician's office. The list of priority in-person medical visits that can now resume includes vaccination, for that reason.

Traffic deaths aren't down, because the people who are still on the road are driving faster and less carefully: DOT was asking people to *please* slow down and drive carefully, because the actual number of crashes went up slightly as the number of miles driven fell by 50%. (Some of that is people consciously ignoring anything resembling a speed limit; some may be from distracted driving, because so many people are distracted right now, even without looking at a screen or talking on the phone.)

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I don't entirely agree with the other two sentences.

If people are angry, desperate or depressed enough, especially since many people have been consuming more alcohol in order to deal with the stressful affects of the stay-at-home advisory and social isolation, crashes are likely to increase, rather than decrease, and the crime rate, too, could very well increase, because plenty of crimes, including assault, rape and homicide occur as a result of excessive alcohol imbibing.

Excessive amounts of alcohol drown out the "don't do it" signal in the brain, or the lymbic system (or the reptile brain, as it's called), thereby lessening self-control. All too often, when intoxicated people will do stuff that they'd ordinarily refrain from doing when sober.

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On the other hand, there's also an obvious conspiracy to minimize the impact of Covid-19 so the "re-opening" can occur. There's plenty of evidence in New York that there's a lot of excess mortality due to Covid-19 that is not being picked up official statistics. And it would seem that the states most invested in "re-opening" are the least transparent about their death statistics.

And, sure, we know that the deaths are weighted to folks older than 70 or so. But you can't say they were "well beyond life-expectancy". That's not a thing. Life expectancy is an average across a population not individuals. When people die from something new that lowers life expectancy for everyone. If people die at 82 instead of 85 life expectancy goes down even if life expectancy is 75. The historical reason we have longer life expectancy is public health measures that limit disease. Why do we spend so much energy on cancer treatments? Because that extends life expectancy which is kind of the humane thing to do. Minimizing death because old people die is a corporate mindset that sees people as mere tools.

Cherry pick all the stories you want, but you're going to have to convince people like me that it's safe to go back to a restaurant or gym before the precious billionaire enhancing economy is back on track. Sure I'd love to go back, but people doing the "more death, yada, yada, get back to work now" trope just shows the fetishization of the economy over everything else. It's not convincing me to go out more. Why are the folks who bleat about the sanctity of life now just tossing off the death of 100,000 Americans in a couple of months so we can get back to work? The economy won't recover until we are sincere in protecting the health of their workers and consumers. Telling us to be brave warriors is just business PR. Even Fox News gets it and has their people working from home.

I do get the need for balance and for people to go back to work. This is a very hard problem and "re-opening" doesn't solve it. We're going to need to step out of our comfort zones and get really creative. Denial won't solve this.

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On March 22, "O-FISH-L" was yelping loudly that only 2 people had died of COVID-19 and that everyone was overreacting. https://www.universalhub.com/2020/childrens-hospital-shows-other-hospita...

Now 2 months later 6,000 people have died in MA and over 90,000 nationwide and this disinformation troll is ineptly trying to question the # of documented deaths, not a single source in site.

Normal people incorporate evolving facts on the ground into their opinions and consider they might be wrong. Idiots, sycophants, bots, and trolls just keep spouting the party line of their masters no matter what the facts say.

Which one are you, O-FISH-L...I mean of the second category, of course?

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Give it a rest. Jumping on Fish and others with different opinions is like jerking off for some uhubers.

Ignore all the shootings and crime happening just this week, just go get your rocks off piling on Fish.

It's all so predictable.

This site needs a new shtick.

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but you ain't doing it right, friendo.

O-FISH-L is not expressing a "different opinion." He is intentionally downplaying a mass death event to defend his sociopathic political view - Which you just did too!

There were 128 deaths in MA (0 in South Korea!) from COVID-19 reported on the single day of May 20th, a number heavily increased by people like O-FISH-L and the federal government trying to ignore the deadliness of the virus. Do you really think the # of "shootings" in Boston compare to that carnage?

Congrats on being another member of the death cult!

Numbers here: https://www.worldometers.info/coronavirus/country/south-korea/
https://www.reddit.com/r/boston/comments/gnj83e/ma_covid19_data_52020/

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...you don't get to have your own facts, and neither does Fish.

This site needs a new shtick.

Maybe you need a new site.

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Influenza A and B both had their spikes/peaks in cases earlier in the season. I really can't speak for what death certificates have said, since I don't seek those out but people definitely died from influenza earlier in the flu season, before we even knew COVID was here (or even before COVID-19 was named)

https://www.cdc.gov/flu/weekly/weeklyarchives2019-2020/images/WHOPHL19_s...

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You are one of them.

Here's a primer:

1. There are codes for causes of death. They are called International Cause of Death, or ICD Codes. There was no code for COVID-19 until mid-march.

2. Most death certificates have multiple places to list multiple causes of death - main causes and contributing causes. Some even allow listing of notable morbidities that may or may not have contributed.

3. Somebody with an underlying condition might have COVID as their main cause of death and, say, diabetes or cardiovascular disease as contributing causes of death. If they had asthma, that might also be noted.

4. Somebody with an underlying condition might have COVID as a contributing cause - in other words, they might have cardiovascular disease or cardiac arrest listed first, then COVID having brought that on as a contributor. This might be the situation if someone had COVID, was stressed by it but not hospitalized, then had a heart attack.

5. In any pandemic, there is so much stress on the health care system that there are more likely to be UNDERCOUNTS due to lack of testing and people dying at home than OVERCOUNTS. The way we will know this? A careful age stratified analysis of overall non-accidental, non-intentional mortality versus multiple prior year averages. If you subtract out the "usual" level of heart disease, cancer, etc. you get a much clearer picture of the excess and that excess will likely be entirely attributable to novel factors.

6. CDC data lag state data substantially. Some large hospitals report directly, but smaller facilities may not and coroners may or may not. In some cases, like Montana, the state has not reported any deaths because they haven't reached the reporting threshhold. Those are not errors - those are lags. State surveillance systems usually have the more up to date picture.

So, if you see phrases like "downward revisions" or "overcounts" and other blah blah blah like fishy says above? THAT IS RIGHT WING TALKING POINTS BLATHER ATTEMPTING TO MINIMIZE THE DAMAGE THAT TRUMP IS DOING TO OUR COUNTRY. It is spewed by sociopathic idiots to target laypeople willing to believe there is a conspiracy because they don't understand 1-6 above.

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82 isn’t well beyond average death here. It’s about only 18 months difference. Perhaps you are thinking of the pathetic average lifespans in shit hole republican states like Mississippi? You would fit in better down there.

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The life expectancy of someone in their early 80's is another 10 years, to 90-something. If you look at actuarial tables, you see that life expectancy rises as you get older.... if you lived to 80 you'll probably live to 90 or beyond. I just wrote about that in a comment above -- with my version of cost-benefit analysis.

I also think the protesters undervalue the health, productivity & value of people who are older, as well as of people who may have "underlying conditions" which are not necessarily life-altering underlying conditions.

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Being seriously ill for a month or more is likely to drive you into bankruptcy, assuming you survive.

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