The software focused teams all use Linux workstations afaik, look at their job boards and blind. Their embedded systems (robotics / av) are all Linux as well.
I simply do not believe that given how bad their drivers are.
I would not be surprised if most or all of their Linux engineers ssh into Linux from a Windows machine given how stable their command line stuff is in comparison to the graphics (once you figure out the correct permutation of userland/kernel pieces to get CUDA+cudnn+TF working anyways).
Their recommended method of installing cuda includes a 64-bit version, but not a 32-bit version. Nvidia's cuda packages are marked as incompatible with debian's nvidia-driver-* packages, so installing it uninstalls the 32-bit version. As a result, I need to choose between steam (which uses the 32-bit graphics library) and an updated cuda version (since Ubuntu 20.04's repo is pinned at 10.2).
The entire world is stuck in a liquidity trap and we have negative real interest rates. No advanced economy has had north of the 2% target for a meaningful amount of time prior to the pandemic. Inflation is something to watch out for. IMO, deflation is the bigger concern.
Source: former deficit hawk convinced hyper-inflation was just around the corner for half a decade.
I'm the opposite. I've thought about deflation for half a decade. Interestingly the conclusion is always the same but with a different coat of paint. The central bank stimulus doesn't reach the real economy and by "real economy" I mean the parts of the economy that are being used to measure inflation.
Inflation happens when lots of money chases too few goods or workers. We see it in housing, stocks, perhaps also education and healthcare. The money does go somewhere but not to where it is most effective. Why is there no inflation in salaries? Because of underemployment. Companies can always fill their open positions and pick among the cheapest applicants. Why is there no inflation in other consumer goods? Production is happening primarily in developing countries with an even larger surplus of labor.
The answer is probably a little boring and obvious. Give money to people that will spend it immediately, rather than to people who will try to convert it into inflation proof assets. The coronavirus related economic stimulus packages are pretty much the only policies that even attempt to do this.
If they overdo it can easily result in hyperinflation but I think inflation is overdue.
Florida is really thinking outside the box. Schools will have no problem opening up if children have herd immunity. This is the type of creative thinking school administrators have been looking for.
Why would any country want herd immunity from infection when nearly every developed country has demonstrated the virus can be contained without such a large loss of life? It's not as if the specter of maxed out hospitals on the news for months on end is going to help the economy.
>the virus can be contained without such a large loss of life?
Generally speaking:
But then you have to keep containing it right?
There's not a magical end of containing unless the virus just goes away / a vaccine is available ... that doesn't seem to be a thing yet.
I'm not all for just letting the chips fall where they may, but success at preventing exposure to your population vs heard immunity means the folks who haven't been exposed have to keep avoiding it.
If you don't have herd immunity, then you need to be continually surveilling for it, and when it's present, switch to containment.
Containment is easier when the number of cases is small though. If you get a handful of cases, contact trace and make general advisory news releases. If you get more than 20 cases, ask people to wear masks. If it gets worse, then you have to take bigger steps.
A lot of assumptions here. Immunity may not even be long lasting. I live in a country where we've largely stopped community transmission, and now we can open back up with masks for all to keep it that way until we all get vaccinated next year.
America's strategy (or lack thereof) is simply negligence.
Please stop repeating the “there might not be long term immunity” meme. It is unfounded and contradicts decades of established immunological principles.
Memory T-Cell reactivity to SARS-1 has been shown to persist across decades. The latest study showed strong activity after 17+ years.
SARS-2 is incredibly structurally similar to SARS-1.
Even if we pretend t-cells don’t exist, immunological memory is a thing. Once circulating antibodies have completely faded after months, there still remain memory b cells which persist across decades and will ramp up antibody production all over again when exposed to SARS-CoV-2. Therefore the subsequent infection is addressed more quickly and more powerfully, leading to lower peak viral load and therefore theoretically lowered transmissibility and vastly improved individual outcomes.
So if we pretend half the immune system doesn’t exist, then you can get reinfected months later but you will spread way less and not be at any significant personal risk of bad outcome.
Herd immunity works. It’s a natural phenomenon that has been unjustifiably demonized.
If herd immunity works, then what is your explanation for the fact that alpha and beta coronaviruses such as 229E, NL63, OC43, and HKU1 (responsible for many occurrences of the common cold) are in continuous circulation?
Great question. Reaching herd immunity does not cause a virus to stop circulating. It just stops it from spreading exponentially. That’s a common misconception.
What you are referring to is eradication, which has only ever been performed twice. SARS-2 is functionally impossible to eradicate due to its zoonotic origin and incredible spread.
Even with herd immunity SARS-2 is here to stay. That’s not a problem though, even if we could so something about it. Why? Because SARS-2 kills the very old but spares the very young. Therefore once it has passed through the current population, the set of SARS-CoV-2-naive individuals becomes dominated by new entrants to the world, meaning babies/toddlers, the same group that does not die to COVID-19 in any real numbers. Therefore unlike Influenza, recurring deaths from COVID-19 will be incredibly low in subsequent years.
See, they use general human coronaviruses as a model, instead of SARS-1, which is incredibly functionally and structurally similar to SARS-2.
Why would you willfully ignore the enormous research literature showing enduring immunity developing from SARS-1? Oh, right, because either you haven't read it or you don't like that it doesn't support your conclusions.
It's like, imagine we're discussing H1N1 reinfection, and we have a highly similar H1N0 which varies very slightly, and we know that doesn't lead to reinfection. But instead you look at a number of Influenza viruses in the same family but not nearly as similar.
Don't you see how ridiculous that is?
We obviously should use SARS-1 as a model for SARS-2.
I never said anything about herd immunity, all I've said is that immunity may not be long lasting.
Basing an entire countries policies around a supposition that herd immunity is practical is, in my opinion, negligence. It's only practical for diseases that don't kill 0.5-1% of the infected population.
It's been proven that lockdowns and slow reopenings work to limit spread, followed by contact tracing clusters to prevent reemergence until community vaccination programs.
Americans are just bitter that their governments are totally inept.
Well I live in a country where we've contained the virus and far less than 0.25% of the population has contracted it, so you're just wrong. Maybe America can't contain, but they are the outlier in this pandemic due to their poor leadership and negligence.
Okay, but now your country can't let anyone into it without 2+ weeks quarantine. Similarly you need to be ready to "lockdown" (or whatever policy your country used) at any given moment if there's a flare-up.
Practicing containment is like leaving a forest full of extremely dry brush. It works great until the fire starts.
No, it's a matter of assessing risk. Why would you risk infecting your entire population with a novel virus that kills on the order of 1% of all infected, when you can do shutdowns and perform slow reopenings to limit spread below 5% of the population until vaccination?
We should be assuming that immunity doens't last long and basing all policies on that assumption until proven otherwise.
I know it certainly appears like a suboptimal strategy, but it assumes that the measures did indeed do what they were expected, that's contentious (we can discuss why, but I think it's obvious).
In a risk-benefit analysis, it leaves future (speculative) advances in treatment VS acquiring herd immunity as quickly as possible and with minimal actual damage, for this it makes sense to maximize exposure for the less at risk.
Also, the summer is a better season to get infected, at least because of generally better immune system function (because of better vitamin d status).
Not just Vitamin D, but to a lesser extent nitric oxide as well.
Anyway to state your excellent point in a different way: “contain until vaccine” is a strategy based around a temporally unbounded future event. When has it ever made sense to bet the farm on a highly uncertain future event?
This world would be so much better off if we never knew that SARS-2 existed and therefore did not engage in any artificial suppression of natural transmission.
Hospitals/ICUs being overrun in the United States is not realistic. I'm not equipped to discuss the medical capacity of other countries, but Sweden did fine.
Exactly. Absent a vaccine, herd immunity is the failure condition that occurs when a virus has infected as many people as it can within a population. It is the default baseline against which all interventions should be compared.
If immunity to the disease is not long-lasting (> 3 months), herd immunity is likely impossible. There are plenty of viruses that can reinfect people who have recovered from them (Coronaviruses being a common example of these) for which we have no herd immunity.
Is there any evidence you can re-contract Covid-19? If not, I'd fall back to the following argument: Some health care workers have been exposed regularly for six months by now. It'd be very news worthy if someone was confirmed to be re-infected. Given I haven't seen that news, I think I can conclude that immunity lasts at least six months in working age people.
Also, if I understand correctly, it has recently been shown that people who were infected with SARS 17 years ago still have memory T cells for SARS. (And, I think SARS is one of the viruses most closely related to Covid-19, and therefore there's reason to expect a long immunity period for it too).
"Memory T cells induced by previous pathogens can shape the susceptibility to, and clinical severity of, subsequent infections. <snip> We then showed that SARS-recovered patients (n=23) still possess long-lasting memory T cells reactive to SARS-NP 17 years after the 2003 outbreak." - from https://www.nature.com/articles/s41586-020-2550-z
There is no credible evidence of re-infection. The isolated cases can be explained away in a bayesian sense by PCR false positives or false negatives. It’s the usual base rate neglect fallacy.
The idea of reinfection contradicts decades of well established immunological principles. It also ignores the fact that we have a close relative of SARS-2 to study. That relative is SARS-1 and we have detected strong t cell activation after 17+ years. Therefore immunity is enduring and long lasting.
SARS-2 is substantially structurally similar to SARS-1.
Alternatively, take a statistical argument. There have been millions of cases around the world. SARS-2 is highly infectious for those who are susceptible. Therefore we would have thousands if not more well-documented, inarguable cases of reinfection. We don’t have those. All we have is a bunch of articles from heavily biased sources like Vox that have a vested interest in pushing the “doomer” narrative.
Why haven’t we seen widespread reinfection if it is truly possible?
If this research holds up, we'll have your well documented cases in probably 3-6 months. Frontline doctors, outside the one cited in the Vox article, are already insisting its true.
Antibodies do wane, and they are supposed to. They generally don't last longer than a few months with SARS-[1,2].
Even though they wane, memory b cells persist, meaning subsequent infection is milder and theoretically less transmissible.
Additionally that reinfection potential only exists if you ignore t-cells. When you factor in t-cells, it simply does not happen.
We're in July 2020. SARS-2 existed since some point in 2019, probably midway through. Granted we couldn't detect reinfection until the whole globe had been freaking out about it, so let's start our clock from January 2020.
It's been 6 months and we don't have dozens of well-documented, credible reinfections?
No, such one-off supposed reinfections are much more explainable from a bayesian perspective of either false positives or false negatives of PCR.
Find me someone who is not immunocompromised, who is PCR-positive for SARS-2 and from whom viable SARS-2 is successfully cultured, then show them fighting off the infection and being PCR-negative and symptom-free for weeks, then show me them being PCR-positive again with viable SARS-2 cultured from their body. That's the standard.
20 examples of that and reinfection definitely happens. Until then, our priors are that we should assume it does not.
Such fears are just used to argue against herd immunity, which has been made into a "dirty word" (phrase). Herd immunity is a natural phenomenom, arguing "against" it is like arguing against natural selection in my book. (The analogy is not perfect but I hope you see the point. I'm tired of being called callous for saying "hey let's not fuck with the normal population immunity dynamics that we've used for every other highly infectious virus in existence")
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BTW, I can't find the study but they have tested reinfection in primates and showed them unable to get reinfected
This is addressed in the Nature article I linked. They compare SARS/MERS immunity to COVID-19 and find different results:
>Sustained IgG levels were maintained for more than 2 years after SARS-CoV infection. Antibody responses in individuals with laboratory-confirmed MERS-CoV infection lasted for at least 34 months after the outbreak. Recently, several studies characterizing adaptive immune responses to SARS-CoV-2 infection have reported that most COVID-19 convalescent individuals have detectable neutralizing antibodies, which correlate with the numbers of virus-specific T cells. In this study, we observed that IgG levels and neutralizing antibodies in a high proportion of individuals who recovered from SARS-CoV-2 infection start to decrease within 2–3 months after infection. In another analysis of the dynamics of neutralizing antibody titers in eight convalescent patients with COVID-19, four patients showed decreased neutralizing antibodies approximately 6–7 weeks after illness onset. One mathematical model also suggests a short duration of immunity after SARS-CoV-2 infection. Together, these data might indicate the risks of using COVID-19 ‘immunity passports’ and support the prolongation of public health interventions, including social distancing, hygiene, isolation of high-risk groups and widespread testing.
So the rate of decrease is already greater than SARS and MERS under this initial investigation. I agree that we don't know the rate or duration of immunity, but nothing so far seems to point in the direction you keep emphasizing or justifies your confidence. I actually do hope immunity ends up being longer lasting, but what I "hope" is irrelevant.
I don't know that herd immunity is a dirty word, but might, for COVID, be being deployed dangerously and pseudo-scientifically. The "natural phenomenon" you refer to does not occur in all cases for all diseases. It's not callousness unless you're explicitly denying that reality and justifying excess death and illness on a dynamic which may not even be in play.
> The "natural phenomenon" you refer to does not occur in all cases for all diseases.
What's an example of an infectious disease that the body can fight off that does not result in herd immunity? (so, herpes and aids don't count because the body doesn't fight them off whereas we KNOW that the body fights off SARS-like diseases)
As far as reinfection is concerned, T-cells are more relevant. I am aware that antibody response fades sooner for SARS-CoV-2.
* Here, we first studied T cell responses to structural (nucleocapsid protein, NP) and non-structural (NSP-7 and NSP13 of ORF1) regions of SARS-CoV-2 in COVID-19 convalescents (n=36). In all of them we demonstrated the presence of CD4 and CD8 T cells recognizing multiple regions of the NP protein. We then showed that SARS-recovered patients (n=23) still possess long-lasting memory T cells reactive to SARS-NP 17 years after the 2003 outbreak, which displayed robust cross-reactivity to SARS-CoV-2 NP.
* Surprisingly, we also frequently detected SARS-CoV-2 specific T cells in individuals with no history of SARS, COVID-19 or contact with SARS/COVID-19 patients (n=37)
> It's not callousness unless you're explicitly denying that reality and justifying excess death and illness on a dynamic which may not even be in play.
Again, the excess death is the deaths caused by lockdown, not the deaths caused by a highly infectious respiratory virus. All highly infectious respiratory viruses are dealt with the same way: acquiring population immunity. Vaccines are just a way to achieve that more cheaply, but because we do not currently have a vaccine it does not make sense to try to "stop, drop and roll" until we have one. Especially because, speaking for the US, we are on track to hit population immunity before we ever get one.
>Again, the excess death is the deaths caused by lockdown, not the deaths caused by a highly infectious respiratory virus.
At the point that you're making blatantly counterfactual statements like this, it's hard to take anything else you say seriously. Some estimates put excess deaths from things besides COVID during lockdowns at about 35% to the total, but they in no way exceed the excess COVID deaths themselves, especially given the likelihood of COVID death undercounts.
You also obviously don't understand how the thresholds for herd immunity work are dependent on duration of immunity and social dynamics of populations. All of humanity doesn't just get together and say "let's get together, right now, and see which of us dies," as much as you would seemingly like to argue that they should. We don't have herd immunity to any number of diseases (e.g. cholera) because we quash their spread through other means, like sanitation, quarantines, using masks. I don’t know why you cite SARS over and over again without acknowledging that we don’t have herd immunity or a vaccine for it.
(1) You misunderstand my use of the term excess death. I was using it in the same sense of the comment I was replying to.
I wasn’t talking about “excess deaths” ie the extra deaths not explainable by known covid deaths. Sorry for the confusion. (Although I think more of those deaths are non-covid, likely cardiac disease etc due to fear of hospital)
(2) I talk about sars-1 because covid is caused by sars-2. You understand that right?
We don’t have herd immunity to sars-1 because it burned itself out. Sars-2 will not do that because it is not nearly as lethal and exhibits presymptomatic spread. It is here to stay.
Also by pointing out we don’t have a vaccine for sars-1 that only strengthens my argument that banking on a vaccine for sars-2 is foolish
Meta: your comments on this thread imply a degree of certainty that isn't justified by the evidence as I understand it. I am just a lay person here, but that's my impression as someone who has done a lot of reading.
As far as coronaviruses go, there are four mild human coronaviruses that are responsible for about 15% of common colds and for which humans do not develop any long lasting immunity.
There are also the three severe human coronaviruses: MERS, SARS-CoV, and SARS-CoV-2. AFAIU, long-lasting immunity to these is not well understood.
I do not understand how you can make such an authoritative statement about re-infection risk based on the limited data we have about SARS-CoV-2. Here's what immunologists have to say:
> In summary, progress since January 2020 has been impressive, but there is still so much more to learn. Are T cells protective and if so which are the key antigens and and cytokine effector programs to focus on? Are all T cell responses beneficial, or are some contributory to immunopathology and to be avoided? If it is indeed the case that antibodies are transient and T cell memory is more durable (though, how durable?), what can we learn about anomalies of T follicular helper-B cell interactions in germinal centers? In the short to medium term, we need to ensure that all of this T cell toolkit and knowledge is brought to bear on robust, comparative evaluation of the different vaccine platforms, their immunogenicity, efficacy and safety. Entering the next part of the battle, there are many thousands of people suffering the chronic aftermath of infection posed by chronic, so-called ‘long-COVID’ cases, characterized by diverse symptoms including fatigue, joint pain and dyspnea (19). A more detailed understanding of the T cell immunology will be valuable in deciphering this pathogenesis.
Of course there's uncertainty, but the idea of re-infection contradicts decades of established immunological principles.
At a minimum, we can agree that in the event of re-infection, the subsequent infection will hit a lower peak viral load and therefore theoretically a much milder outcome with reduced transmissibility, right? This is called immunological memory and arises due to memory b cells and memory t cells which persist across decades.
It establishes that those exposed to SARS-1, which structurally and functionally is incredibly similar to SARS-2 and thus is our best model of how to think about SARS-2, have long-lasting immunity. Their t-cells not only react to SARS-1 after 17 years, they also have immunity to SARS-2, which is a testament to how similar they are structurally speaking.
Additionally exposure to those common cold human coronaviruses you mentioned almost certainly confers immunity to SARS-2 based off that same paper. We're still hashing out the details, of course.
Immunology is incredibly complex and there is still plenty to learn about as far as the exact specifics of what unfolds
here, yes. But we should assume reinfection isn't possible, because:
- It doesn't happen in SARS-1 which is by far the best model we have
- If it did happen, given the MILLIONS of cases of COVID-19 worldwide, we would have seen THOUSANDS of rigorously documented examples of the phenomenom happening
- Those arguing for reinfection tend to not make any mention of immunological memory
- Those arguing for reinfection do so to in an attempt to scare us into staying locked down until "the vaccine", which I am opposed to because I am opposed to any public health policy that banks on a future technological innovation that does not yet exist, particularly when I fear that the environment of irrational fear and anxiety and outright hysteria is going to be used to mandate vaccines, which is highly unethical under my moral framework
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As far as me sounding over-certain, frankly it's cognitive draining to be arguing against a horde of people whose priors have been completely screwed up by programming from a media that takes delight in knowingly lying to citizens, and even our trusted public health officials like Fauci don't have the courage or perhaps the desire to break out of the collective mass delusion we are all trapped in.
So yes, if I had infinite time and energy I agree, I could do a way better job of capturing uncertainty. I've written an 8000+ word writeup on COVID that does a much better job capturing the uncertainty, but it's very difficult to do without...writing 8000 words.
Also this doesn't justify it but I do feel the need to point out that those arguing for the "doom" scenario are even more egregiously overstating certainty, and tend to not be called out on their ridiculous statements. So that's why I tend to come into these threads guns blazing, with the predictable result of getting hammered by downvotes. C'est la vie.
Immunity isn't a binary, neither is herd immunity. While there are reports of reinfection, those cases are quite rare.
Even a modest degree of immunity can significantly lower spread. In France, Spain, Germany, you still have hundreds of cases every day, but they don't grow to thousands of cases anymore.
> While there are reports of reinfection, those cases are quite rare.
The disease hasn’t been around long enough to make this claim.
> Even a modest degree of immunity can significantly lower spread. In France, Spain, Germany, you still have hundreds of cases every day, but they don't grow to thousands of cases anymore.
This is true, but depends on the duration of immunity and a more uniform global response (or very tight border and quarantine adherence). Ongoing, sporadic COVID crises would still be pretty disruptive unless we have highly effective therapeutics.
Sweden has roughly 80k confirmed coronavirus cases in 10M people. Assuming equal probability of first and second infection (which I believe undercounts second infections, since some people have more opportunity for exposure than others due to their jobs and lifestyles), and assuming equal probability of first and second detection (which again I believe undercounts), we should have something around 10M*(80k/10M)^2 = 640 confirmed reinfections.
So where are they? Are you claiming that these hundreds of confirmed reinfections simply haven't been reported? Note that the number of actual reinfections would be orders of magnitude higher; the calculation above already assumes underascertainment by a factor of ~100x. You can redo this math in any moderately hard-hit region, though I chose Sweden here because their rate of infections vs. time has been more constant (eliminating the possibility that all the infections happened in a brief early peak, after which everyone acted more carefully so there's no longer any opportunity for reinfection). I'm not saying that reinfection is impossible, just that so far, if it exists, it's very rare.
And please don't cite the Vox article. In normal times, it would be criticized as "science by press release" or worse, a single anecdotal case written up as definitive for the popular press, with no case history and no publication to review. Maybe the author's patient really did get reinfected and it's common (but that seems vanishingly unlikely to me per above), or maybe the patient was reinfected but it's rare like getting chickenpox twice, or maybe the patient just had one long infection and tested false-negative (which is very common generally) in the middle. But since the author has disclosed nothing but the shocking headline result, we can't know.
So I believe you are sowing public panic without evidence. While it is impossible to directly demonstrate that immunity for a disease discovered X months ago lasts longer than X months, it is reasonable to expect that in this case. Maybe you think that at worst, if you're wrong, then you're telling a noble lie--but the public health authorities who said masks don't work (remember that?) did too, and look how that ended up. I can easily imagine Trump on television a year from now explaining that because people got reinfected, the vaccine is obviously a scam.
Abandoning the truth in favor of a perceived noble goal has unpredictable but generally bad effects, and I wish people would stop. Or if you actually believe what you're writing, I'm not sure what to say--please read the scientific literature (and not the popular media, which has been horrible in all directions), dust off your high school biology, and make your best assessment based on that. I think you'll find that while the coronavirus is a very serious problem, it's not the near-apocalyptic one that your comments seem to imply.
I linked to the Vox article because it covers a lot of bases in disputing the spurious narratives that have circulated in places like the US, where the disease is out of control, pandemic response is poor, and various forms of denialism are used to excuse all of this. I don't think its an apocalyptic scenario for humanity writ large, but certainly a dangerous one for many countries, especially if an ongoing, effective public health response is required.
>While it is impossible to directly demonstrate that immunity for a disease discovered X months ago lasts longer than X months, it is reasonable to expect that in this case.
Instead of attributing motives to other people, perhaps interrogate your own need to insist on statements like this, absent any evidence, as well as the tone of your broader rebuttal. I have no intention of sowing panic or engaging in "noble lies," but nor will I embrace evidence-free narratives to soothe myself or others.
If the US intervened early or effectively with measures like those in Taiwan or South Korea, we would likely have the situation under control. It's still possible that we could do this and I hope that we do.
I appreciate the reply, and I agree that the concentration of antibodies in the blood has been observed to drop with time. That's relatively common in many diseases though, and doesn't mean that the patients no longer have any useful immunity. The test thresholds were set for best (but still imperfect) discrimination between known positives (mostly severe cases) and known negatives, and there's no specific reason to believe they predict when a recovered patient becomes susceptible again. They're also testing for IgG, when we know that T cell and IgA immunity are important. One of your papers mentioned IgM, which is expected to drop quickly to undetectable levels while the patients retain immunity (not to say you suggested otherwise, of course).
I also agree that whatever immunity patients get after a mild or asymptomatic case is likely to be weaker than after a severe case. That's one case where my calculation above could be wrong--if there are many reinfections but the first or second case is always very mild, we might be much more likely to miss those. That would still be good news for the patients, though bad news for the overall population if they're still comparably infectious.
Finally, even if a patient's immunity degrades to the point they no longer exhibit sterilizing immunity (i.e., the virus still replicates a little at first), in most diseases they won't get as sick as the first time. So even if the coronavirus becomes endemic (which seems relatively likely, since many countries will lack the resources to eradicate it even with a vaccine), I expect the cost in mortality from whatever reinfections do occur to be far lower than what we're seeing now. The opposite of that (antibody-dependent enhancement) does occur, and was a specific concern here because vaccine studies for the original SARS showed evidence of that. So far vaccine studies for SARS-CoV-2 do not, though.
I actually thought the SF Chronicle article wasn't terrible, more pessimistic in its conclusions and tone than I would be given the same evidence but with many of the points above. Their headline seems irresponsible to me though; even if durable sterilizing immunity were impossible, a vaccine that cut the IFR by a factor of ten would be tremendously valuable to the elderly. All that nuance is lost when people just say "reinfection is possible". I was probably too strong to say "sowing public panic", but I do believe your comments paint a falsely pessimistic picture of the current science, and that this false pessimism can be harmful later (e.g., by causing people not to seek a vaccine because of something they half-understood about immunity). Specifically, I also believe the absence of confirmed reinfections out of places like Sweden is strong evidence that immunity usually lasts >3 months. If you were claiming that reinfection might be common after a year, then I'd be much less sure (though I'd still guess probably not based on the original SARS).
In any case, I certainly agree that younger people shouldn't get themselves deliberately infected in search of whatever immunity that affords (though the death rate among young people is low enough that I doubt reinfection would change the calculus for anyone considering that either way). I also agree that the USA response has been terrible, and resulted in a lot of avoidable death--I'm not sure, but it seems possible to me that just with universal mask use and good hygiene (like in Japan), we could live otherwise normal life with negligible spread.
ETA: And here's a paper showing neutralizing antibodies for at least three months (the limit of the study, which they're continuing) in New York. It seems beyond any reasonable doubt to me that immunity lasts three months, and I believe you're simply wrong to question that. Longer gets more speculative, but I think it's quite likely.
I agree that the evidence suggests an at least 3 month immunity for symptomatic cases, but anything beyond that is up in the air and complicated by how asymptomatic cases relate to immunity. I'd personally get the vaccine if it had proven immunity or reduction in severity for just this amount of time, if only to benefit others at risk and prevent asymptomatic transmission. And certainly would never dissuade others from doing so.
Cases are low and falling in New York, Sweden, London, Italy, Spain, despite varying and loosening social distancing measures. How do you explain that? Those places already have herd immunity. Serotesting for antibodies misses t-cell immunity and other forms of resistance, and variation in spreading patterns makes the herd immunity threshold lower than we thought. This is the only plausible explanation and nobody wants to admit it.
Look, what you are saying makes sense until you say "This is the only plausible explanation" at which point I get lost. Just because you can't imagine other explanations doesn't mean that there aren't any. And this also presupposes that there are no hazards to anyone in that case. The fact is this disease remains very dangerous for a lot of people. So while it's plausible that we will have herd immunity sooner rather than later, it also misses the point which is that it's very dangerous to get infected with this virus.
No, they don't, or they wouldn't have new cases, even without even somewhat looser mandatory controls than other places. What they have is some degree of immunity in the population (not herd immunity) plus (in some subset of those places) some degree of contact tracing backed by targeted mandatory, or at least voluntary, quarantines/isolation of the exposed, and (in large part because of the intense impacts each has had) voluntary general distancing.
> No, they don't, or they wouldn't have new cases, even without even somewhat looser mandatory controls than other places.
That's not what herd immunity means.
The Herd immunity threshold is attained when the R factor drops below 1, assuming otherwise uninhibited spread. The threshold for herd immunity for COVID-19 has been estimated at 50-80%, but that is assuming an R0 that is likely overestimated.
Given that spread is still mitigated by certain interventions, and since we don't know the impact of those interventions on R, nor do we know R0, we don't know if we have herd immunity. However, we do have R below one in many European countries.
Herd immunity isn't a binary threshold after which zero cases occur. Even in a first-order homogeneous and well-mixed SIR model, you may asymptotically approach 1 - 1/R0 of the population infected without ever getting there. If you do cross that threshold ("overshoot"), then the case count starts to drop, but new people still get infected and die on the downslope. The only case where a disease will naturally burn itself out abruptly is if there was massive overshoot, which would be bad, because it means yet more people died than necessary for natural herd immunity.
And for real some people have many more contacts than others (nurses, police, etc.). They get infected first, with disproportionate harm, but then become immune first with disproportionate benefit. That heterogeneity means 1 - 1/R0 is potentially a significant overestimate of the share of the population that needs to get infected for herd immunity, but there have been very limited efforts to quantify that so far.
It seems like some people believe natural herd immunity (from recovered patients) could work like vaccination does, to effectively eradicate the disease? That's probably false--the most likely natural endgame would be that the coronavirus becomes endemic, always present with some low incidence, with continuing mortality that's very low (because the incidence is low, and because older people probably benefit from immunity from when they were younger and the IFR for young people is <1/100 of older people's) but nonzero.
Finally, herd immunity and interventions (social distancing, masks, etc.) work together. It's possible (and likely I believe) that in hard-hit areas that now show R ~ 1, this is due to the product of both factors, and that either relaxing to their previous lifestyle or applying the same interventions in a naive (100% susceptible) population would show R > 1.
Cases are lower still or zero in many other places with far too few cases to have achieved herd immunity. The only plausible explanation is that containment measures have some effect.
Every increase in the percentage of people with immunity reduces R0. At some point, even absent any other measures, the R0 would be below 1 just due to the number of people that are immune; herd immunity.
But in any case, the immunity level of the population reduces the need for other measures in order to stay below an R0 of 1.
There’s a massive spectrum of efficacy in the dozens of different suppression or containment policies that can be applied, combined with demographics and geography of the location being studied.
But in any case, the immunity level of the population is a downward force on R0 that, for example, will naturally keep daily cases lower in New York vs. Florida regardless of policy.
The problem with this plan is that it's very hard to do safely. Let's say I don't care about deaths from COVID-19 that were untreatable; I still care about excess deaths tyat were treatable, but don't get treated because hospitals are overwelmed by patients or overwelmed because medical staff is sick.
To avoid that, you basically have to limit the number of beds COVID patients are using and modulate the infection rate to keep the beds in use close to the limit without going over. Of course, modulating the rate is difficult, because people's behavior is hard to modulate. Also the demand for new beds shows up about 2 weeks after infection, so you have to modulate today based on what your bed capacity looks like then.
Hospital are frequently overwhelmed in the past, nothing new, at least at current situation is no more overwhelmed than what has frequently happen in the past.
And worth noting that there is not a whole lot hospitals can do anyway. The overwhelming majority have COVID-19 that is so mild that they never would go to a hospital. Of those that have more serious symptoms, some will be benefit from being given oxygen. There are very few people who warrant invasive ventilation, and those that do have very bad odds anyway.
The meme around hospital overrun is just that, a meme. Especially given everywhere having at least a small percentage of positive serology tests. I doubt anywhere in the US would get truly overrun with uninhibited spread at this point.
Vaccines can either reduce the severity of disease or grant immunity for a period roughly comparable to the window of reinfection. Depending on the duration of immunity, a successful vaccine may require multiple doses per year.
Vaccination is likely an option for long term COVID-19 herd immunity. The mutation rate is shockingly low, so a nationwide focus on containment was the best option early on. It’s still possible without wrecking the economy.
The US seems to be using the worst off all possible options. However, several countries have succeeded and demonstrate it’s possible to succeed.
Assuming we capture about 10% of COVID instances as actual cases, then the US is getting 770,000 new instances a day.
Stockholm burnt itself out with 20% of the population getting immunity (determined via antibody testing).
So (328,000,000 - 37,000,000) / 770,000 = 378 days until herd immunity, considering the existing cases.
What is more likely is that the case numbers will ramp up significantly though, to over 100,000 per day at some point. In that case the USA will have herd immunity within the year.
This is nothing new. Influenza hits about 20% of the population (60 million people) as well and then burns out for the season. We struggle yearly with keeping influenza out of nursing homes and with the surge of hospitalization that it creates.
The good news is that right now there are no excess deaths in the USA and that hospitals all over the country are handling the virus and not running out of space (more beds can be always be converted to ICU, ICU capacity is not infexible, same as is done for influenza).
There are already hospitals in Texas and I think Florida that are rejecting patients because they are full, that's when fatality rate and excess mortality kicks in. What kills you isn't suboptimal care, it's the impossibility of getting any treatment.
Capturing 10% of cases would put the US CFR of ~0.4% which is completely unsupported. Increasing that to even 30% so a 1.2% CFR and your talking 3.1 years which is well past estimates for an effective vaccine.
PS: Influenza vaccines are common with 68% of people over 65 getting vaccinated in the US. Further at least half of all cases are asymptotic which ends up contributing significantly to herd immunity.
20% of 328 million is 65.6 million. Divided by 770k is ~85 days.
It’s probably better to think of immunity as regional and also not binary (herd vs not herd).
States like MA and NY have a significant benefit from their population immunity levels, versus FL and TX less so. That is to say they have to do less (if not nothing) to keep their R0 below 1 and whatever cases do show up are less likely to spread widely.
Immunity benefits are cumulative to any policy measures put in place. You can try to slow down the rate (flatten the curve) which might not change the ultimate case count in the end, but can lower deaths through greater availability of care. At some point immunity and mitigation measures combined will get you below R0 of 1.
If you’re an island nation with enough testing for effective contact tracing and constant vigilance and willing to lockdown repeatedly, then the other option is trying to actually prevent any spread even without any immunity, but you have to be able to continue this process indefinitely until a vaccine is widely available.
I would make of it that these are outliers cherrypicked for the scare value in the headlines. The vast majority of hospitals everywhere are doing fine.
In New York, the hospitals are so far under capacity that they're running TV ads begging people to start coming back in for elective procedures.
Cases are surging in Florida and Texas, not New York. New York's wave is past. When New York's wave was at its peak, hospitals and doctors there were absolutely maxed out. There were first hand reports from doctors and nurses on the front line who said as much. If they had not undergone a complete lock down things would have been much worse.
Now we see new waves popping up elsewhere and surprise, their hospitals are filling. Hospitals are having a great time in places where they took the virus seriously. New York did not take it seriously at first and they suffered. Now Texas and Florida are not taking it seriously and they are suffering as well. And you're suggesting that we can just let the virus run rampant and we won't see our healthcare system buckle?
> In New York, the hospitals are so far under capacity
Do you think 20% exposure (at a cost of 17.5k lives) buys you herd immunity?
Even in hotspots like New York City that have been hit hardest by the pandemic, initial studies suggest that perhaps 15-21%6,7 of people have been exposed so far. In getting to that level of exposure, more than 17,500 of the 8.4 million people in New York City (about 1 in every 500 New Yorkers) have died [...]
To reach herd immunity for COVID-19, likely 70% or more of the population would need to be immune.
https://coronavirus.jhu.edu/from-our-experts/early-herd-immu...
That 70% is an early estimate of heard immunity while doing nothing differently than pre-covid.
The hope is that its more like 20% gets you herd immunity while practicing moderate social distancing. It's not too unreasonable. Japan has been able to avoid lockdowns and mass testing by mostly just using masks and avoiding very close conversations.
> The vast majority of hospitals everywhere are doing fine.
That's great if you need something done at a hospital that is not super time sensitive; it's not great if you're in the area where hospitals are overful and you have an urgent need.
Epidemic response needs to be done at a regional level in response to what's going on in that region, taking note of what's happening nearby as it might spill over, and learning from other areas within the country and worldwide to try to figure out what works best. It's totally reasonable, if the numbers support it, for some regions to be increasing restrictions and others to be decreasing restrictions. Clear communication from all levels of response would certainly help.
> Vaccination is likely an option for long term COVID-19 herd immunity.
To achieve herd immunity for measles at least 90-95% of the population need to be vaccinated. A disease like polio is less contagious, and 80-85% of the population would need to be vaccinated for herd immunity to work.
https://www.ovg.ox.ac.uk/news/herd-immunity-how-does-it-work
It suggests our immunity to SARS-CoV-2 does not last very long at all — as little as two months for some people. If this is the case, it means a potential vaccine might require regular boosters, and herd immunity might not be viable at all.
https://www.medrxiv.org/content/10.1101/2020.07.09.20148429v...
Can't get 80% people to wear a mask, much less seasonal vaccinations.
I'd be guessing that very early in the quest towards herd immunity the medical institutions would be overrun and the end result of that would be a whole lot more dead people than the lockdown scenario.
From what it appears we know about the virus so far, a vaccine is the only sane way to possibly hope to reach herd immunity.
Protect the vulnerable (no sending Covid positive patients into their living spaces!) while allowing low risk population to develop and overcome the virus.
This seems like the most logical way to combat issue, as opposed to hiding and hoping it goes away. Of course proposing it publicly means to be smeared by the media and politicians and twitter blue checks, who always have our best interests in mind.
Does this solution cause no pain and death? Of course not! It’s about causing the least amount of pain long term, including the externalities of our actions.
The problem is that this is incredibly hard to do. It’s much easier to protect the vulnerable if the routes for community transmission are reduced or eliminated; if society is acting as normal it’s really hard to stop those specific transmission vectors. Given that we can’t convince people to wear masks, I’m dubious about any plan that requires more planning and communication.
We also have no idea if herd immunity will work, or for how long. Lots of coronaviruses confer either no immunity or a short term one; remember that a lot of common cold cases are coronaviruses too, and you can catch those repeatedly. Also, pursuing herd immunity involves infecting basically 20-50% of the population, a strategy that might kill 500k to 1.5mil Americans (assuming CFR stays at 1%, an optimistic assumption in this scenario)
We also have no idea what the health impacts for non-fatal cases are. Lots of patients are surviving with heart & lung damage; long term impacts TBD. Crippling an entire generation from the get go would both be tragic, and would put lie to the idea that not opening schools is “letting them fall behind”.
There isn't enough evidence of long term immunity to make herd immunity a sensible strategy. It's smeared by the media b/c it's way less preferable than the alternative of containing it like nearly every developed country in the world.
“This strategy would kill over half a million Americans” isn’t even really a smear, it’s an accurate description of why the herd immunity strategy is bad.
They said the same about tens of thousands dying; we’re now at 141k dead Americans. If you want to dismiss it as “fear mongering” that’s your prerogative, just don’t be surprised that most people find this unconvincing.
The problem with this approach is it also assumes that overcoming the virus means a return to 100% health with no long term impact. We're already seeing that it can lead to other long term conditions. I have a friend who is being treated for heart damage after having COVID.
I'm in a low risk population but just because I'm not likely to die from it doesn't mean it's completely harmless to me.
Protecting the vulnerable has never actually worked. In theory it's possible, but it would require constantly testing nursing home workers that don't have the money to do this and an administration that hasn't shown the ability to support it. Every area that's had a significant level of spread has had issues where nursing home care workers brought in the virus from the community. The exception is Hong Kong where nursing home residents were quarantined in hospitals for significant periods. This presupposes the leadership to setup a system like this and the willingness of nursing home residents to be isolated for long periods of time. If we had either of those things we'd be able to contain the virus in the broader population.
That's not how it works. If you had 100% immunity in the young, the old would still be at relatively similar risk because of homophily in social networks. That is, old people spend most of their time with old people. Herd immunity for the general population requires a homogenous mixture of social interactions across those infected.
Keeping the vulnerable protected sounds good and all, but in the case of, say, children, the vulnerable is the teaching staff.
The alternative - hiding people in homes until vaccine is widely available - means death.
From alcohol & substance abuse, from increased suicides, from domestic violence, and so on. Extended period of being prevented from running your business (or out of employment) without steady income, and bottled up at home is a major stresor and silent killer. The hospitals already reported significantly elevated suicides.
There is no magical strategy to stave off all the problems; balancing the risks and managing precautions as our knowledge expands is the correct, if hard to politically sell, way to go.
Opening up without restrictions would kill somewhere between 500,000 and 1,300,000 Americans, assuming that the CFR doesn’t rise above 1% (an optimistic assumption). If you think lockdowns will kill that many Americans, then provide your sources.
The new estimates of HIT factoring in widespread t-cell cross-reactivity in humans that have NEVER been exposed to a SARS-like virus nor anyone who was themselves infected with one, implies that the true HIT is somewhere around 25%.
Do the math on the US with an IFR of .3% and an HIT of 25%. That’s what a likely scenario looks like. It means a few hundred thousand dead.
As an upper bound do the same math with .9% IFR and 25% HIT.
BTW you should also consider the risk that lockdown puts the body into a state where it is more susceptible to bad COVID-19 outcomes, due to vitamin d deficiency, lack of nitric oxide, lack of exercise, reduced sleep, social isolation, unemployment, and an unprecedented environment of widespread fear&hysteria. Also consider the lives we have already lost when calculating the delta between containment versus not practicing containment.
IMO containment is a foolish and infantile strategy which makes us perpetually at risk of an outbreak. Population immunity is the stable and logical solution. Banking on a vaccine is an awful idea, doubly so in a country where we can’t mandate a vaccine without plunging ourselves into civil war. Vaccine-attributable herd immunity only works if a bunch of people get vaccinated. Granted the t-cell reactivity findings alter the calculus there, but we would need to vaccinate people who do not demonstrate cross reactivity in order for that fact to change the number of required vaccines.
> Do the math on the US with an IFR of .3% and an HIT of 25%. That’s what a likely scenario looks like. It means a few hundred thousand dead.
Let’s be precise. That’s a quarter of a million dead Americans. I’d consider that number to be deep in the “catastrophic failure” territory.
I also find the idea that the IFR would stay at 0.3% to be absurdly optimistic. We know that fatality rates scale with hospital load, any minor change to IFR could result in tens or hundreds of thousands of unnecessary deaths.
> BTW you should also consider the risk that lockdown puts the body into a state where it is more susceptible to bad COVID-19 outcomes, due to vitamin d deficiency, lack of nitric oxide, lack of exercise, reduced sleep, social isolation, unemployment, and an unprecedented environment of widespread fear&hysteria. Also consider the lives we have already lost when calculating the delta between containment versus not practicing containment.
Prove it.
> IMO containment is a foolish and infantile strategy which makes us perpetually at risk of an outbreak.
It’s worked elsewhere.
> Banking on a vaccine is an awful idea, doubly so in a country where we can’t mandate a vaccine without plunging ourselves into civil war.
This level of nihilism is genuinely baffling to me. What course of action are you recommending? Just ignore it?
> I also find the idea that the IFR would stay at 0.3% to be absurdly optimistic. We know that fatality rates scale with hospital load, any minor change to IFR could result in tens or hundreds of thousands of unnecessary deaths.
Hospitals being overwhelmed is not a serious concern at this point in time. Even at NY at the peak, one hospital would be past capacity while a nearby one would be nearly empty. Shuffling is not ideal but it works.
> This level of nihilism is genuinely baffling to me. What course of action are you recommending? Just ignore it?
It's not nihilism. I don't believe that practicing containment actually avoids mortality, except in the most optimistic scenario where lockdown-associated deaths are unreasonably low and a safe/effective vaccine is developed and deployed unreasonably fast.
My recommendation is not to employ any measures to slow the spread of SARS-2 in the general population, but instead to let the virus naturally pass through the general population. We can practice containment for elderly care facilities, although those individuals should be permitted to leave the facility and stay at home if they abject to the prison-like conditions required to avoid pre-symptomatic spread.
> Let’s be precise. That’s a quarter of a million dead Americans. I’d consider that number to be deep in the “catastrophic failure” territory.
Well, we already have 130,000 deaths, so that's about double where we're at now. So, we're talking about a delta of +120,000 if you want to be hyper-precise (I was not to account for uncertainty).
That's not a catastrophic failure at all; early (unrealistic, but that didn't stop our policy leaders from using them) estimates were forecasting 2.2 million dead, that's Ferguson's paper with a .9% IFR and 82% of pop. getting infected.
Please don't twist these words to portray me as callous, as you seem apt to do, but are you aware that ~500k americans die from cardiac disease every year? Smoking?
> Prove it.
You know that there will never be a RCT, so you must rely on good mental models and experimental results, such as ones showing the incredible role of vitamin D in the pathology of respiratory illness, the fact that nitric oxide lowers blood pressure and is currently being studied as a possible COVID-19 treatment, the obvious result that closing gyms = less exercise, the fact that unemployment is disruptive to one's life and tends to lead to a disregulation of sleep schedules, emotional states, etc.
> It’s worked elsewhere.
Where, exactly? Be specific.
New Zealand is the classic example held up here, and now New Zealand, which is a tourist economy, cannot allow any foreign entrants into their country without a 2+ week quarantine. I think that's a bad and unstable solution. BTW this is less of a concern but it makes them vulnerable to bioterrorism (intentionally spreading SARS-2).
OTOH Sweden followed a herd immunity strategy and has gotten there. Findings of t-cell cross-reactivity in the absence of having ever been exposed to a SARS-type virus indicates that a large swath of the population is not susceptible to COVID-19, period. Of those that are, the vast majority will either be asymptomatic, paucisymptomatic, or experience symptoms consistent with a mild cold. A small fraction will develop severe COVID-19 (which is dramatically worsened by vitamin d deficiency), culminating in the need for invasive ventilation and possible death.
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In general, the risks of COVID-19 itself have been overblown, and somehow we never have enough information despite very well-defined risk categories and good bounds on what bad COVID-19 looks like (it looks like SARS-1, the original SARS). Whereas what we do not have bounds on are the results of an unprecedented global economic destabilization and lockdown, nor the socioemotional costs we're inflicting upon our children as well as ourselves.
> That's not a catastrophic failure at all; early (unrealistic, but that didn't stop our policy leaders from using them) estimates were forecasting 2.2 million dead, that's Ferguson's paper with a .9% IFR and 82% of pop. getting infected.
Honestly we might as well stop the conversation here. A quarter of a million extra dead isn't a failure? Wow. You and I just don't have anywhere close to the same values.
The difference is you think that mortality is avoidable. I don't. We're talking about the US, right? You still think containment is possible in the US? I am absolutely baffled.
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You have used the classic rhetorical technique of those on the "doom" faction: take a well-reasoned rebuttal, and reply with a single sentence implying I am callous for openly discussing mortality.
No, the callous ones are those that are imposing a dangerous and unprecedented regime of lockdown, and using fear and hysteria to do so.
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Also your math is just wrong. An extra quarter million? We already hit 130k dead, that leaves 120k left "to go" with your number.
Or...what could have been done from the beginning. 3-week lockdown to get a grip, then mandatory mask laws (indoor and outdoor) and a reduction in indoor events and large social gatherings. Life and the economy goes on mostly as normal.
Even in the SF Bay Area, fewer than half the people I see outside actually wear masks. It's crazy how little people seem to care.
stop worrying about, and projecting unfounded motivations upon, maskless people outside. it's better for your health via stress reduction, at the very least.
Other people's masks protect us, our masks protect other people.
Someone on Reddit gave the analogy of people peeing themselves with or without clothes on. If you're clothed and someone else pees in your direction, you're gonna get at least a little wet. If they're clothed, you don't get wet at all.
If someone developed a comfortable mask that gave the wearer near-100% protection and was widely available, I wouldn't worry about what others do.
the atmosphere is incomprehensably vast compared to viruses, making the chances of getting covid outside essentially zero. worry more sensibly about prolonged face-to-face conversation if you need to worry, but not maskless strangers outside.
Even if these strangers blithely brush past you, making no attempt to maintain social distancing? Sometimes they'll even come up from behind you, giving you no chance to avoid them.
yes, even then. the likelihood of transmission is still negligibly miniscule. from the virus's perspective, it has to pass a number of gauntlets and a bunch of labyrinths to even reach a position of possible infection. just don't stop and have a conversation without a little distance.
I know you're joking, but I was surprised to learn [1] that there are cases pointing to the likelihood that recovery from infection will not necessarily lead to immunity from subsequent infection.
The Health Ministry of Switzerland has said children cannot transmit covid at all. Along with the fact that children being affected by the virus is extremely rare, it would seem like the only concern is for adult staff to maintain precautions with each other, which seems much safer than e.g. working in a close quarters kitchen line, which we've been allowing all along.
FB political ads don't seem to be the root cause of their radicalizing influence. My understanding is that it's more related to how their algorithms push more and more extreme pages and groups.
A relatively non-partisan person who likes a news article about gun rights gets pushed news and pages that promote more conservative viewpoints, and those pages lead to fringe ideas, conspiracy theories, and the groups that promote those ideas.
Trump/Biden ads seem less problematic than memes about vigilante justice against minorities that float around FB.
It's plateaued and has been hovering around 100k per day for 2 weeks (outside California clearing its backlog on 4/4).
The White House promised 27M by 3/31 and we were at 1M.
It doesn't look like it's ramping up.
The inventory chart at the top of the article is a bit misleading. It'd be better to use a months supply of inventory chart.
A 100% increase in inventory is equivalent to a -50% decrease in inventory, but they show up out of proportion. It's much easier to increase inventory by 100% if the months of supply is very very low. (e.g. going from 1 month of inventory to 2 months of inventory is a lot less substantial than 2 months to 4 months)
Most of the research on FODMAPs have come out of Monash University in Australia.
Here’s a video from one of the lead researchers making a presentation on it. https://youtu.be/ByszVbFBPtY
I’ve been on this for two weeks. The diet is incredibly restrictive and unenjoyable. My symptoms have been a little better judging from my food/symptom log.
> I’ve been on this for two weeks. The diet is incredibly restrictive and unenjoyable. My symptoms have been a little better judging from my food/symptom log.
I don't know if this is the place for "It Gets Better", but my wife was also on the diet, and also found it restrictive and unenjoyable, but found a noticeable difference in her symptoms. One important point is that it is not meant to be a lifelong diet; it is meant to provide a 'reset' on which a future satisfactory baseline, with lower FODMAPs (especially in areas of discovered sensitivity) but not none, can be built. She has found much more success managing her symptoms since then. (One example discovery: a previous lactose-intolerance test had totally failed to catch her severe lactose intolerance.)
