Even the opening photo caption in that opinion piece is wrong.
There are plenty of 20 and 30-somethings that end up in the hospital from not being able to breathe.
Our fight is worse because there is no testing in the USA when every other country has mass testing. If we knew who had it, we could isolate just those people and the country wouldn't be headed towards recession (hopefully not depression).
This article is almost completely rhetoric, bereft of quantitative analysis and at odds with what the broader medical community has been saying. The New York Times really does let any credentialed dingus post shit on their website.
The root cause of this article seems to be that it's inconvenient having my adult kids in the house and how long must this go on.
The idea seems to be to somehow isolate at risk populations (the elderly, mostly) and resume business as usual. As pointed out by others, it's too late in the absence of a vaccine to do anything but try and reduce the infection rate, unless society decides to just let the cards fall where they may and sacrifice the old and sick.
How long it goes on would depend on the effectiveness of this strategy, and you can tell be monitoring the infection rate. China claims that it has essentially stopped new infections after ~3 months, so this doesn't seem like it will be an indefinite lockdown.
No. It might have been easier if countries reacted in January when it was obviously going to infect everyone. Now it's too late for anything but a lockdown.
Yup. The surgical strike option is long past viability in the US and many other countries. There's already way too many cases, and we don't remotely have enough resources in the form of tests and case workers to track down active infections and everyone that person has been in contact with.
Exactly. With mass testing options, we would be one solid plan away from getting back to some semblance of normal life. A combo of taking temp and testing those with fever, and the quarantining the sick, we could be confident in being in public again. I know this is critical but how long will we need to isolate if we don’t get medical intervention? Can our economy survive this kind of shut down for more than a few weeks?
Edit to say I’m all for flattening the curve, and I’m not a denier. But there are trade offs going on here. We aren’t rich enough to ride this out for several months without permanent systemic damage. I think tough questions are warranted
Well I’m hearing most people are going to get it anyway. With tests we can slow it down. We’re going to have to accept some risk though aren’t we? We can’t really afford to shut the whole economy down for several months. And if you look at Italy it doesn’t appear to working that well anyway.
At least with testing we can catch a large chunk of the asymptomatic spreaders and get control of this thing. But in a few weeks when this fist wave passes, we’re gonna all have to learn to mitigate risk with good hygiene and accept we may get it. Testing is our only hope to returning to normal life before we totally crush our economy.
China should have reacted while it was there, before it spread to everywhere. But what's done is done.
By the way his point is that what happened in Italy is normal, old and frail people will die. No need to ruin everything to--maybe--extend their life for a few more years.
Pay old and sick people to quarantine?
-edit to add--
were saving x lives from Coronavirus at an enormous cost. How many others are dying because they can't get their current health issues dealt with in a normal manner due to the mobilization to fight this virus?
My guess is that a lot of people that normally would have lived, will now die from cancer, diabetes, heart issues etc etc.
No, Italy's real issue is they're have the oldest population in Europe and the highest per/capita smokers in Europe. Since Covid-19 hits that demographic hardest (elderly with respiratory issues), they have the highest mortality rate. The average age of those dying from this in Italy is 80.
Don't forget the under 55 group are still consuming precious ICU resources. No, they don't typically die, but yes they're tying up needed resources and as such are contributing to the overall number of deaths.
I am afraid that we will sacrifice (a LOT) and the same people will die anyway. Let's face it, maybe we'll extend their life by 7 weeks or so. Many are alive that to millions of dollars in medical support for their last years.
But then no country will just say, "let's let our people die." However, unless a vaccine is discovered soon enough or the virus miraculously is manageable, people will be very uneasy.
The simple fact of the matter is you can't have a significantly long lock down, that's not possible. If the economy truly fails we all go down. You think fighting over: toilet paper, hand sanitizer, respirators and testing kits is crazy? Wait till people are fighting over food, water and shelter.
The clustering of complications and death from Covid-19 among the elderly and chronically ill, but not children (there have been only very rare deaths in children), suggests that we could achieve the crucial goals of social distancing — saving lives and not overwhelming our medical system — by preferentially protecting the medically frail and those over age 60, and in particular those over 70 and 80, from exposure.
Finally, some sanity.
The over 70 and chronically ill should be quarantined and provided with hydroxychloroquine + azithromycin, and the rest should "social distance" those at risk, but otherwise go about their business. That way the virus spreads quickly among the less at risk, they suffer no or minor symptoms, and develop herd immunity.
Except that children can spread it faster among caretakers that have contact with the elderly. Many of those caretakers, like people my age, either have young children (like me), or are in contact with people who have young children.
It also turns out that certain classes of drugs can drop the otherwise statistically less at risk squarely into the grave risk category without their knowing it. (High BP meds, NSAIDS, others we perhaps don't yet know about). Going for the "maybe it isn't that big of a deal" approach seems like a bad idea to me.
One point that stood out to me as odd is that he says family units are clustering together and that's worse for the elderly/most at risk. He mentions students coming home from college but aren't they the only major group coming home that don't live there normally? If people live with their parents and grandparents then it seems to make sense that working to keep them from getting infected (ie - keeping K-12 students home, parents avoiding the work place) is a better course of action than sending them into school and work. If they've already moved away then they shouldn't be taking this time as a free vacation to see those people anyway. I'm not sure how you would protect those at risk people while keeping everyone else in their normal lives. Fill the hospital beds with them and don't let in the coronavirus infected?
Edit to add: US Population 65 years and over: 16.03% (male 22,678,235/female 28,376,817) (wikipedia)
Total Staffed Beds in All U.S. Hospitals: 924,107 (aha.org)
Hmmm, I dont like the article however there is some logic here.
If you are a low risk adult, and if you have the option to infect yourself at home, you would only have to isolate for 2-3 weeks until you have developed immunity and are good to go back to work and help others etc...
By not letting young people get infected we're isolating them for way way longer than they should be and this is extremely inefficient.
However, leaving ethics aside entirely, for that solution to work we would need self-infection kits for low risk people to use at home which is quite messed up.
The article asks some legitimate questions that beg for answers:
If we succeed in slowing the spread of coronavirus from torrent to trickle, then when does the society-wide disruption end? When will it be safe for healthy children and younger teachers to return to school, much less older teachers and teachers with chronic illnesses? When will it be safe for the work force to repopulate the workplace, given that some are in the at-risk group for severe infection?
When would it be safe to visit loved ones in nursing homes or hospitals? When once again might grandparents pick up their grandchildren?
There are many possible answers, but the most likely one is: We just don’t know. We could wait until there’s an effective treatment, a vaccine or transmission rates fall to undetectable levels. But what if those are a year or more away? Then we suffer the full extent of societal disruption the virus might cause for all those months. The costs, not just in money, are staggering to contemplate.
The mass isolation approach fails for me on multiple levels. First, why would you change the way 100% of the things work when all you have to do is change the way 5% to 10% of the things work? Why not employ levels of isolation that are proportionally aggressive to vulnerability to serious symptoms or death? Second, I thought we decided that trying to manhandle nature because we think we know better doesn't work? Wouldn't we be better off if we let nature take it's course so that 90% of the population suffers mild flu systems, but gains some level of enhanced immunity to further protect the vulnerable groups going forward while at the same time not collapsing the economy?
There are a number of reasons why the fight is worth it.
- 88% of the people who contract COVID-19 develop a fever.
- 20% of the people who contract COVID-19 are hospitalized-they require oxygen. If they recover, they are left with 20-30% decreased lung function.
- 6% are critical require ICU.
This virus has different properties from the flu. It actively destroys lung cells. It's not clear that there is long-term immunity. Concentrated exposure is very lethal; we have several members of a NJ family die after contracting the illness during a dinner party. We have only a fraction of the hospital capacity for all the coronavirus patients and this also hurts ICU patients with other diseases.
I don't think that we want this disease to embed itself in the same way as the flu currently does. We can't have this disease mutate each year like the flu and cull an additional 2% of the population annually over the current annual death rate of 0.95%. Overnight, this virus would become the leading killer--more than all other causes combined. The number of people that will die from this disease compares with major wars.
This is just the first of this type of pandemic. There were other viruses like bird flu and Zika that didn't have an impact.
This also causes society to reorganize itself to lessen the impact of future pandemics. Even without the government actions taken, the fear was already affecting travel and other industries.
35 comments
[ 3.1 ms ] story [ 86.0 ms ] threadThere are plenty of 20 and 30-somethings that end up in the hospital from not being able to breathe.
Our fight is worse because there is no testing in the USA when every other country has mass testing. If we knew who had it, we could isolate just those people and the country wouldn't be headed towards recession (hopefully not depression).
The idea seems to be to somehow isolate at risk populations (the elderly, mostly) and resume business as usual. As pointed out by others, it's too late in the absence of a vaccine to do anything but try and reduce the infection rate, unless society decides to just let the cards fall where they may and sacrifice the old and sick.
How long it goes on would depend on the effectiveness of this strategy, and you can tell be monitoring the infection rate. China claims that it has essentially stopped new infections after ~3 months, so this doesn't seem like it will be an indefinite lockdown.
Thought-provoking piece.
And if we had much more available testing, what it proposes could be a smart way to go.
Until we have much more available testing, it's a pipe dream.
Edit to say I’m all for flattening the curve, and I’m not a denier. But there are trade offs going on here. We aren’t rich enough to ride this out for several months without permanent systemic damage. I think tough questions are warranted
You can have, and spread, covid-19 for several days before you develop a temperature.
At least with testing we can catch a large chunk of the asymptomatic spreaders and get control of this thing. But in a few weeks when this fist wave passes, we’re gonna all have to learn to mitigate risk with good hygiene and accept we may get it. Testing is our only hope to returning to normal life before we totally crush our economy.
Many things that can create positive outcomes are in motion: vaccines, drugs to lessen symptoms, testing spin up, etc.
However, all of these things need time to come to fruition.
For example, once we actually have enough tests, targeted quarantines now work. At that point, we can start backing off the full lockdowns.
However, we're currently in an unchecked exponential growth phase. The only thing you can do right NOW, is shut down.
Given time, more options may open up. But what we need most right now is time.
Right now they are having massive casualties per day, to almost (if not more) than ww2, and there is no sign of slowing down yet.
"Italy reports 5,986 new cases of coronavirus and 627 new deaths, raising total to 47,021 cases and 4,032 dead"
By the way his point is that what happened in Italy is normal, old and frail people will die. No need to ruin everything to--maybe--extend their life for a few more years.
Pay old and sick people to quarantine?
-edit to add-- were saving x lives from Coronavirus at an enormous cost. How many others are dying because they can't get their current health issues dealt with in a normal manner due to the mobilization to fight this virus?
My guess is that a lot of people that normally would have lived, will now die from cancer, diabetes, heart issues etc etc.
Current approach is a disaster.
I would have asked most at risk population to self quarantine.
Cut on red tape for usage of antivirals. (Hydroxychloroquine a proven safe one said to work has been held back for weeks due to paperwork)
I would have even gone as far as requisitioning private companies to par for the lack of medical supplies and drugs.
The eroding of civil liberties some EU countries is experiencing is plain unacceptable.
But then no country will just say, "let's let our people die." However, unless a vaccine is discovered soon enough or the virus miraculously is manageable, people will be very uneasy.
Finally, some sanity.
The over 70 and chronically ill should be quarantined and provided with hydroxychloroquine + azithromycin, and the rest should "social distance" those at risk, but otherwise go about their business. That way the virus spreads quickly among the less at risk, they suffer no or minor symptoms, and develop herd immunity.
It sounds wonderful if it works but unfortunately hard to enforce. And not to mention virus could mutate causing second outbreak.
It also turns out that certain classes of drugs can drop the otherwise statistically less at risk squarely into the grave risk category without their knowing it. (High BP meds, NSAIDS, others we perhaps don't yet know about). Going for the "maybe it isn't that big of a deal" approach seems like a bad idea to me.
Edit to add: US Population 65 years and over: 16.03% (male 22,678,235/female 28,376,817) (wikipedia)
Total Staffed Beds in All U.S. Hospitals: 924,107 (aha.org)
If you are a low risk adult, and if you have the option to infect yourself at home, you would only have to isolate for 2-3 weeks until you have developed immunity and are good to go back to work and help others etc...
By not letting young people get infected we're isolating them for way way longer than they should be and this is extremely inefficient.
However, leaving ethics aside entirely, for that solution to work we would need self-infection kits for low risk people to use at home which is quite messed up.
If we succeed in slowing the spread of coronavirus from torrent to trickle, then when does the society-wide disruption end? When will it be safe for healthy children and younger teachers to return to school, much less older teachers and teachers with chronic illnesses? When will it be safe for the work force to repopulate the workplace, given that some are in the at-risk group for severe infection?
When would it be safe to visit loved ones in nursing homes or hospitals? When once again might grandparents pick up their grandchildren?
There are many possible answers, but the most likely one is: We just don’t know. We could wait until there’s an effective treatment, a vaccine or transmission rates fall to undetectable levels. But what if those are a year or more away? Then we suffer the full extent of societal disruption the virus might cause for all those months. The costs, not just in money, are staggering to contemplate.
This virus has different properties from the flu. It actively destroys lung cells. It's not clear that there is long-term immunity. Concentrated exposure is very lethal; we have several members of a NJ family die after contracting the illness during a dinner party. We have only a fraction of the hospital capacity for all the coronavirus patients and this also hurts ICU patients with other diseases.
I don't think that we want this disease to embed itself in the same way as the flu currently does. We can't have this disease mutate each year like the flu and cull an additional 2% of the population annually over the current annual death rate of 0.95%. Overnight, this virus would become the leading killer--more than all other causes combined. The number of people that will die from this disease compares with major wars.
This is just the first of this type of pandemic. There were other viruses like bird flu and Zika that didn't have an impact.
This also causes society to reorganize itself to lessen the impact of future pandemics. Even without the government actions taken, the fear was already affecting travel and other industries.
We're killing the 10th man: https://www.strive.com/post/the-10th-man-rule
I spoke to a physician at Yale where Dr. Katz is based: he asked me to copy n paste the text because it's behind a paywall. facepalm