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Originally Posted by 'Hamas' Jenkins
We've had plateaus for HIV/AIDS because treatment reduces infectiousness, condoms prevent transmission, and the R0 was based upon the virus itself unmitigated. When people are on antiretroviral therapy, use PrEP, or use condoms, the R0 drops.
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Absolutely - but not below 1. It's dropped without dying off. It doesn't HAVE to get below 1 to drop. That's all I'm saying - you seem to be suggesting that declines or peaks/valleys are evidence of an inexorable march towards an R0 below 1 - I'm saying we've seen it in a myriad of instances for a myriad of reasons and the end result is virtually never an R0 below 1. Doesn't mean there aren't gains and that they shouldn't be pursued - but an organic die-off isn't the likely scenario at all. Especially not when you consider the global scale and long-term requirements associated w/ a wide enough R0 below 1 to matter in the end (even presuming spread could be reduced that far on smaller levels over shorter timelines).
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If you increase compliance you can reach a threshold where R0 can be reduced to the point where the epidemic cannot sustain itself. It's no different than other assumptions in medicine--a guy that watches his diet and takes his metformin as scheduled will have a lower A1C than someone that is only 50% compliant with their diet and medication.
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And I again say that this works fine on a spreadsheet and will not work in real life. Because it simply never
has for a disease that has gotten this far afield.
I'm not even saying the first 90% of the climb will be impossible (though I expect it'll be damn hard; far beyond what humanity writ large will be willing to endure for the period of time they'll be asked to endure it). I'm saying that last 10% will be. The only way it's truly viable in the real world (as you have been fond of pointing out the difference between in vivo and in vitro results) is if it turns out that the 'moderated' social distancing measures being kicked around by the CDC yield a reduction to that level. I don't actually think they will, but they're at least semi-enforceable over a long enough timeline to actually matter.