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One of the things I am interested in is how things change from wave to wave within each state. I am in Cincinnati, OH and Ohio seems to be having it's first really strong wave. It's obviously not all due to testing because our hospitalizations are higher than they have been. But in Hamilton County, our 7 day moving average for new hospitalizations topped out on November 3rd at the same number it did during our summer spike. The 7 day moving average for cases has been above our summer spike for over a month now and is almost 5x as high. I understand hospitalizations and deaths lag, but it seems like we should have seen some movement by now unless: 1) testing was atrocious even in July or 2) there is something "different" in how waves hit a population.

I don't mean "different" in a conspiratorial sort of way, more that it seems like the pattern we see is high density cities being hit first, then the suburbs, then the more rural areas. As the waves come back in the areas that have been hit, even with increasing case numbers, the population susceptible to serious complications seems to decrease.

The other frustrating thing is that comparing cases across waves seems extremely futile given the rapid increase in testing.

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I live in Albuquerque and agree with CSF's description and analysis. The NM Health Dept's R0 and ICU numbers peaked in late Oct, early Nov and are currently almost at or near their gating criteria. CDC excess death has been below their high line for a while too (as of 10/31); the non-C19 numbers seemingly have exceeded C19 since June. (I post that data: https://paunchy.substack.com/p/363d7cd6-b9ef-4f58-9544-470f4ea9eafe)

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This is long, I'm sorry.

I'm a resident physician starting out in southern New Mexico and could go on for a long time about the situation here. We do have a very cautious culture. Masks are worn absolutely everywhere, except maybe at parks where half the people wear them and trails, where virtually no one does. Our mitigation measures are strict. When we were partially opened in the summer, our open situation looked like Michigan's current freeze. Standards to reopen were less than 5% positivity rate AND a strict measure of fewer than 8 cases than 100k. Signs on the highway read messages like 'stay home to save lives', 'healthcare workers beg you to stay home', and 'extreme risk of spread'. Interestingly, once you cross over to El Paso, the signs are more standard. "Don't drink and drive!" "AMBER ALERT", etc. House parties are built into the social fabric here, and I wonder if these intimate home events (like Thanksgiving) are the primary spread point. Our governor deserves a mention....she is Biden's HHS pick apparent, and I've wondered if these incredibly strict measures have had anything to do with her consideration for that role. She was uncharacteristically silent during the month of Oct when our R value was highest, and I've been skeptical that this was to avoid election repercussions. (Our congressional district flipped red anyways) It *appears* that the state peaked on Nov 2, and that our county peaked on Oct 28. Her new shelter in place order was not announced until Nov 13. This is tremendously frustrating. It looks to me that we will lock down on the descending side of the curve, making it easy for her to declare lockdown policy a victory. I'm just a resident, so take my opinions with a generous pinch of salt...but that's how things look from the ground here.

A bit of levity: the pre-lockdown swarm was directed at Walmart toilet paper and.....Hobby Lobby Christmas decorations.

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The reality is that you can't control Covid away, although with enough vigilance and strict enough controls on behavior (either voluntary, through social pressure, or government enforcement) you can stave it off. Success is only achieved by limiting exposure, and the extent to which you are successful is the extent to which the population remains vulnerable to another outbreak. There is not going to be a situation where the Covid wolves are not snarling at the edge of the firelight until vaccination or natural herd immunity have had their effect. Herd immunity is not a binary status- the more people in an area that are immune/resistant to Covid, the safer the most vulnerable are from it. Could the best course of action be to provide maximum support for the most vulnerable to isolate/minimize exposure/use PPE while at the same time allowing the least vulnerable the maximum liberties to freely associate in order to promote a broader resistance? Recommend 7-10 days of "safe" behavior prior to interacting with the more vulnerable groups- and then slowly work upward from the vulnerability scale- from kids, to teens, to young adults to increase the number of people in the community who will not serve as ongoing vectors for spreading. I do not advocate anyone being encouraged to take risks that they are personally uncomfortable with and I'm not arguing that an approach like this will not be without casualties, as no echelon faces zero risk from the illness, and there would inevitably be many people in higher risk categories contracting it from lower risk echelons, however I believe that with some deliberate age/risk based policy, it would be better than a 'natural' unabated spread, while reducing the second/third- order, adverse effects of social distancing, while growing some herd resistance, and rendering the community less susceptible to the next outbreak after each wave.

Anyone can justify a spectrum of responses from perpetual total lockdown to a fatalistic 'ignore it and come-what-may' based on their own value system and risk tolerance but ultimately, a strategy based entirely on avoidance perpetuates the need for relentless vigilance and requires a high level of consistency in the mindset of the culture.

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This is really good information! Thank you for digging into the data. I recently started subscribing so I am not sure if this was discussed in a previous post, but where does the data come from? Are there links to the source data?

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This sentence lacks your normal careful nuance, "It is, of course, not a long term strategy. The only long term strategy is a vaccine."

The only long term strategy is not just a vaccine. It is Herd Immunity. Vaccination is one way to get there.

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